0001630050-21-000001.txt : 20211229 0001630050-21-000001.hdr.sgml : 20211229 20211229093954 ACCESSION NUMBER: 0001630050-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211229 DATE AS OF CHANGE: 20211229 EFFECTIVENESS DATE: 20211229 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: 021-427026 FILM NUMBER: 211526490 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 X0708 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 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 LUKAS MILLER ROUSH 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director JEFF TERRELL 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director DANIEL S. DUFFY 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director STANLEY D. LYNALL 201 W. MAIN STREET, SUITE 207 DURHAM NC NORTH CAROLINA 27701 Director Other Health Care Decline to Disclose 06b false 2021-12-20 false true false 0 5000000 3087500 1912500 false 25 0 0 0 None other than payments of salary in the ordinary course of business to certain of the parties named in response to Item 3. false 410 Medical, Inc. /s/Kyle Chenet Kyle Chenet Chief Executive Officer 2021-12-29