0001624755-14-000001.txt : 20141121 0001624755-14-000001.hdr.sgml : 20141121 20141120200605 ACCESSION NUMBER: 0001624755-14-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20141121 DATE AS OF CHANGE: 20141120 EFFECTIVENESS DATE: 20141121 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Mozaic Medical Inc CENTRAL INDEX KEY: 0001624755 IRS NUMBER: 471594800 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-228802 FILM NUMBER: 141240503 BUSINESS ADDRESS: STREET 1: 47 WHISPERING PINE CIRCLE CITY: WORCESTER STATE: MA ZIP: 01606 BUSINESS PHONE: 781-863-6276 MAIL ADDRESS: STREET 1: 47 WHISPERING PINE CIRCLE CITY: WORCESTER STATE: MA ZIP: 01606 D 1 primary_doc.xml X0707 D LIVE 0001624755 Mozaic Medical Inc 47 WHISPERING PINE CIRCLE WORCESTER MA MASSACHUSETTS 01606 781-863-6276 DELAWARE None None Corporation true 2014 Joshua Shaw 47 Whispering Pine Circle Worcester MA MASSACHUSETTS 01606 Executive Officer Director Christopher Macomber 44 Winneconnett Road Worcester MA MASSACHUSETTS 01606 Executive Officer Director Other Health Care Decline to Disclose 06b false 2014-10-24 false true true true true Promissory Note convertible into common stock or next round security on specified conditions false 10000 500000 225000 275000 false 4 0 0 0 false Mozaic Medical Inc Christopher Macomber Christopher Macomber President 2014-11-20