0001538864-21-000003.txt : 20210113 0001538864-21-000003.hdr.sgml : 20210113 20210112210532 ACCESSION NUMBER: 0001538864-21-000003 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210113 DATE AS OF CHANGE: 20210112 EFFECTIVENESS DATE: 20210113 FILER: COMPANY DATA: COMPANY CONFORMED NAME: QT IMAGING, INC. CENTRAL INDEX KEY: 0001538864 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-385620 FILM NUMBER: 21524794 BUSINESS ADDRESS: STREET 1: 3 HAMILTON LANDING STREET 2: SUITE 160 CITY: NOVATO STATE: CA ZIP: 94949 BUSINESS PHONE: 4158427242 MAIL ADDRESS: STREET 1: 3 HAMILTON LANDING STREET 2: SUITE 160 CITY: NOVATO STATE: CA ZIP: 94949 FORMER COMPANY: FORMER CONFORMED NAME: QT ULTRASOUND LLC DATE OF NAME CHANGE: 20151030 FORMER COMPANY: FORMER CONFORMED NAME: CVUS Clinical Trials, LLC DATE OF NAME CHANGE: 20120106 D/A 1 primary_doc.xml X0708 D/A LIVE 0001538864 QT IMAGING, INC. 3 HAMILTON LANDING SUITE 160 NOVATO CA CALIFORNIA 94949 4158427242 DELAWARE QT ULTRASOUND LLC CVUS Clinical Trials, LLC Corporation true John C. Klock 3 Hamilton Landing Suite 160 Novato CA CALIFORNIA 94949 Executive Officer Director Chief Executive Officer and Director Randall A. Mackey 3 Hamilton Landing Suite 160 Novato CA CALIFORNIA 94949 Director Richard J. Stanley 3 Hamilton Landing Suite 160 Novato CA CALIFORNIA 94949 Director Other Health Care $1 - $1,000,000 06b true 0001538864-21-000002 2020-12-29 false true true true We converted QT Ultrasound LLC, a DE LLC, into QT Imaging, Inc., a DE corporation. The Certificate was filed with DE on 12/29/20, effective 12/31/20. This Form D is filed for the issuance of common stock and options to the LLC members upon the conversion. 0 1 0 1 Shares of common stock are issued upon the statutory conversion of units of membership interest. Options are issued upon the statutory conversion of profits interest units. No payments are being made. false 636 0 0 0 false QT IMAGING, INC. John Klock John C. Klock Chief Executive Officer and Director 2021-01-12