0001168404-16-000041.txt : 20160929 0001168404-16-000041.hdr.sgml : 20160929 20160929170216 ACCESSION NUMBER: 0001168404-16-000041 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160929 DATE AS OF CHANGE: 20160929 EFFECTIVENESS DATE: 20160929 FILER: COMPANY DATA: COMPANY CONFORMED NAME: PotaVida, Inc. CENTRAL INDEX KEY: 0001635104 IRS NUMBER: 452488446 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-271584 FILM NUMBER: 161910533 BUSINESS ADDRESS: STREET 1: 999 3RD AVENUE, SUITE 700 CITY: SEATTLE STATE: WA ZIP: 98104 BUSINESS PHONE: (206) 406-3558 MAIL ADDRESS: STREET 1: 999 3RD AVENUE, SUITE 700 CITY: SEATTLE STATE: WA ZIP: 98104 D 1 primary_doc.xml X0707 D LIVE 0001635104 PotaVida, Inc. 999 3RD AVENUE, SUITE 700 SEATTLE WA WASHINGTON 98104 (206) 406-3558 DELAWARE None None Corporation true Charles Matlack c/o PotaVida, Inc. 999 Third Ave., Suite 700 Seattle WA WASHINGTON 98104 Executive Officer Director Tyler Davis c/o PotaVida, Inc. 999 Third Ave., Suite 700 Seattle WA WASHINGTON 98104 Executive Officer Director Jacqueline Linnes c/o PotaVida, Inc. 999 Third Ave., Suite 700 Seattle WA WASHINGTON 98104 Executive Officer Director Other Technology Decline to Disclose 06b false 2016-09-15 false true false 0 750000 275000 475000 false 7 0 0 0 false PotaVida, Inc. /s/ CHARLES MATLACK Charles Matlack Chief Executive Officer 2016-09-29