0001209191-17-012103.txt : 20170217 0001209191-17-012103.hdr.sgml : 20170217 20170217162350 ACCESSION NUMBER: 0001209191-17-012103 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170217 DATE AS OF CHANGE: 20170217 EFFECTIVENESS DATE: 20170217 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Watermark Medical Holdings, Inc. CENTRAL INDEX KEY: 0001573917 IRS NUMBER: 371719099 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-280973 FILM NUMBER: 17621694 BUSINESS ADDRESS: STREET 1: 1641 WORTHINGTON ROAD STREET 2: SUITE 320 CITY: WEST PALM BEACH STATE: FL ZIP: 33409 BUSINESS PHONE: (877) 710-6999 MAIL ADDRESS: STREET 1: 1641 WORTHINGTON ROAD STREET 2: SUITE 320 CITY: WEST PALM BEACH STATE: FL ZIP: 33409 D 1 primary_doc.xml X0707 D LIVE 0001573917 Watermark Medical Holdings, Inc. 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 877-710-6999 DELAWARE None None Corporation true 2013 Sean Heyniger 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Executive Officer Director Jack Fiedor 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Executive Officer Jacob Lamm 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Director Drew Graham 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Director John Sculley 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Director Dr. Richard Bogan 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Executive Officer Director Don Burton 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Director Dan Ryan 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Director Greg Poulos 1641 Worthington Road Suite 320 West Palm Beach FL FLORIDA 33409 Executive Officer Other Health Care Decline to Disclose 06b false 2017-02-14 false true true false 5000 5000000 2500000 2500000 Of the Total Offering Amount, up to $3,392,285 represents cash investments; the remaining amount relates to the conversion of outstanding principal and accrued interest under certain convertible debt. false 15 0 0 0 false Watermark Medical Holdings, Inc. /s/ Jack Fiedor Jack Fiedor Chief Financial Officer 2017-02-17