0000892712-14-000481.txt : 20140616 0000892712-14-000481.hdr.sgml : 20140616 20140616121031 ACCESSION NUMBER: 0000892712-14-000481 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20140616 DATE AS OF CHANGE: 20140616 EFFECTIVENESS DATE: 20140616 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ELLI HEALTH, INC. CENTRAL INDEX KEY: 0001604448 IRS NUMBER: 462598681 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-219243 FILM NUMBER: 14922190 BUSINESS ADDRESS: STREET 1: N1 W31444 HICKORY HOLLOW CITY: DELAFIELD STATE: WI ZIP: 53018 BUSINESS PHONE: 262-378-0565 MAIL ADDRESS: STREET 1: N1 W31444 HICKORY HOLLOW CITY: DELAFIELD STATE: WI ZIP: 53018 D 1 primary_doc.xml X0707 D LIVE 0001604448 ELLI HEALTH, INC. N1 W31444 HICKORY HOLLOW COURT DELAFIELD WI WISCONSIN 53018 262-378-0565 WISCONSIN None None Corporation true 2013 Jay C. Mason N1 W31444 Hickory Hollow Court Delafield WI WISCONSIN 53018 Executive Officer Director Promoter Chief Executive Officer and President Liem N. Nguyen N1 W31444 Hickory Hollow Court Delafield WI WISCONSIN 53018 Executive Officer Director Promoter Chief Operating Officer, Vice President, Secretary and Treasurer Other Technology Decline to Disclose 06b false 2014-06-10 false true false 0 N/A None None None N/A N/A N/A XX Unknown 00000 All States false 425600 200000 225600 false 2 0 0 10000 $10,000 in proceeds will be used to reimburse Jay C. Mason and Liem N. Nguyen for certain expenses that Messrs. Mason and Nguyen previously advanced to Elli Health, Inc. false ELLI HEALTH, INC. /s/ Jay Mason Jay Mason Chief Executive Officer and President 2014-06-16