0001630050-17-000002.txt : 20170331 0001630050-17-000002.hdr.sgml : 20170331 20170331162126 ACCESSION NUMBER: 0001630050-17-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170331 DATE AS OF CHANGE: 20170331 EFFECTIVENESS DATE: 20170331 FILER: COMPANY DATA: COMPANY CONFORMED NAME: 410 Medical, Inc. CENTRAL INDEX KEY: 0001630050 IRS NUMBER: 463389037 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-283833 FILM NUMBER: 17730664 BUSINESS ADDRESS: STREET 1: 201 W. MAIN STREET, SUITE 207 CITY: DURHAM STATE: NC ZIP: 27701 BUSINESS PHONE: 9192417900 MAIL ADDRESS: STREET 1: 201 W. MAIN STREET, SUITE 207 CITY: DURHAM STATE: NC ZIP: 27701 FORMER COMPANY: FORMER CONFORMED NAME: 410 Medical Innovation, LLC DATE OF NAME CHANGE: 20150107 D 1 primary_doc.xml X0707 D LIVE 0001630050 410 Medical, Inc. 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 9192417900 DELAWARE 410 Medical Innovation, LLC Corporation true 2013 KYLE CHENET 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Executive Officer Director MARK DONALD PIEHL 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Executive Officer Director GALEN ROBERTSON 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Executive Officer LUKAS MILLER ROUSH 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director MIKE LIDDELL 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director LARRY MILLER 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director Other Health Care Decline to Disclose 06b false 2017-03-17 false true false 0 5000000 3274993 1725007 false 5 0 0 0 None other than payments of salary and/or bonuses in the ordinary course of business to certain of the parties named in response to Item 3. false 410 Medical, Inc. /s/ Mikal B. Shaikh Mikal B. Shaikh Attorney-in-Fact 2017-03-31