0001652565-15-000001.txt : 20150911 0001652565-15-000001.hdr.sgml : 20150911 20150911150035 ACCESSION NUMBER: 0001652565-15-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20150911 DATE AS OF CHANGE: 20150911 EFFECTIVENESS DATE: 20150911 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Persivia Holdings Inc. CENTRAL INDEX KEY: 0001652565 IRS NUMBER: 473914583 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-247462 FILM NUMBER: 151103256 BUSINESS ADDRESS: STREET 1: 900 CHELMSFORD STREET STREET 2: TOWER 3, 7TH FLOOR CITY: LOWELL STATE: MA ZIP: 01851 BUSINESS PHONE: 978-856-4501 MAIL ADDRESS: STREET 1: 900 CHELMSFORD STREET STREET 2: TOWER 3, 7TH FLOOR CITY: LOWELL STATE: MA ZIP: 01851 D 1 primary_doc.xml X0707 D LIVE 0001652565 Persivia Holdings Inc. 900 CHELMSFORD STREET TOWER 3, 7TH FLOOR LOWELL MA MASSACHUSETTS 01851 978-856-4501 DELAWARE None None Corporation true 2015 Mansoor A. Khan c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Executive Officer Director Fauzia Khan c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Executive Officer Director Other Decline to Disclose 06b false 2015-08-28 false true true Issuance of Series A Preferred Stock and Series B Preferred Stock in connection with a merger transaction. 0 3300000 3300000 0 false 1 0 0 0 false Persivia Holdings Inc. /s/Mansoor A. Khan Mansoor A. Khan President 2015-09-11