0001372781-16-000004.txt : 20160805 0001372781-16-000004.hdr.sgml : 20160805 20160805134929 ACCESSION NUMBER: 0001372781-16-000004 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160805 DATE AS OF CHANGE: 20160805 EFFECTIVENESS DATE: 20160805 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Mirabilis Medica, Inc. CENTRAL INDEX KEY: 0001372781 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-268424 FILM NUMBER: 161810327 BUSINESS ADDRESS: STREET 1: 18706 NORTH CREEK PARKWAY SUITE 104 CITY: BOTHELL STATE: WA ZIP: 98011 BUSINESS PHONE: 425-486-8230 MAIL ADDRESS: STREET 1: 18706 NORTH CREEK PARKWAY SUITE 104 CITY: BOTHELL STATE: WA ZIP: 98011 FORMER COMPANY: FORMER CONFORMED NAME: Mirabilis Medica Inc DATE OF NAME CHANGE: 20060815 D 1 primary_doc.xml X0707 D LIVE 0001372781 Mirabilis Medica, Inc. 18706 NORTH CREEK PARKWAY SUITE 104 BOTHELL WA WASHINGTON 98011 425-486-8230 DELAWARE Mirabilis Medica Inc Corporation true Roger Stern c/o Mirabilis Medica, Inc. 18706 North Creek Parkway Suite 104 Bothell WA WASHINGTON 98011 Director Fred Schwarzer c/o Mirabilis Medica, Inc. 18706 North Creek Parkway Suite 104 Bothell WA WASHINGTON 98011 Director Nelson Teng c/o Mirabilis Medica, Inc. 18706 North Creek Parkway Suite 104 Bothell WA WASHINGTON 98011 Director Kevin Fong c/o Mirabilis Medica, Inc. 18706 North Creek Parkway Suite 104 Bothell WA WASHINGTON 98011 Director Jens Quistgaard c/o Mirabilis Medica, Inc. 18706 North Creek Parkway Suite 104 Bothell WA WASHINGTON 98011 Executive Officer Director Other Health Care Decline to Disclose 06b false 2016-08-03 false true true false 0 5000000 5000000 0 Total Offering Amount does not include (i) principal and accrued interest on previously issued convertible notes that converted into equity; (ii) up to 5,057,884 warrants issued upon financing. false 3 0 0 0 true false Mirabilis Medica, Inc. /s/ Jens Quistgaard Jens Quistgaard Chief Executive Officer 2016-08-04