0001437749-21-000958.txt : 20210121 0001437749-21-000958.hdr.sgml : 20210121 20210121073041 ACCESSION NUMBER: 0001437749-21-000958 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210121 DATE AS OF CHANGE: 20210121 EFFECTIVENESS DATE: 20210121 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provisio Medical, Inc. CENTRAL INDEX KEY: 0001685703 IRS NUMBER: 200305318 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-386913 FILM NUMBER: 21540366 BUSINESS ADDRESS: STREET 1: 10449 HUNTERS RIDGE PLACE CITY: SAN DIEGO STATE: CA ZIP: 92127 BUSINESS PHONE: 5087409940 MAIL ADDRESS: STREET 1: 10449 HUNTERS RIDGE PLACE CITY: SAN DIEGO STATE: CA ZIP: 92127 D 1 primary_doc.xml X0708 D LIVE 0001685703 Provisio Medical, Inc. 10815 Rancho Bernardo Road Suite 110 San Diego CA CALIFORNIA 92127 (858) 524-3901 DELAWARE None None Corporation true Stephen Eric Ryan c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Executive Officer Director Promoter Aurelio Fernandez c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Timothy Lindenfelser c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Frank J. Del Rio c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director George Quinoy c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Other Technology Decline to Disclose 06b false 2021-01-15 false true true Preferred Stock false 50000 4000002 1998024 2001978 false 16 0 0 500000 true false Provisio Medical, Inc. /s/ Stephen Eric Ryan Stephen Eric Ryan President 2021-01-19