0001699927-21-000001.txt : 20210914 0001699927-21-000001.hdr.sgml : 20210914 20210914171313 ACCESSION NUMBER: 0001699927-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210914 DATE AS OF CHANGE: 20210914 EFFECTIVENESS DATE: 20210914 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CARBON HEALTH TECHNOLOGIES, INC. CENTRAL INDEX KEY: 0001699927 IRS NUMBER: 474422182 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-413350 FILM NUMBER: 211253164 BUSINESS ADDRESS: STREET 1: 93 LAKEWOOD CIRCLE CITY: SAN MATEO STATE: CA ZIP: 94402 BUSINESS PHONE: (650) 740-4524 MAIL ADDRESS: STREET 1: 93 LAKEWOOD CIRCLE CITY: SAN MATEO STATE: CA ZIP: 94402 FORMER COMPANY: FORMER CONFORMED NAME: MD Collab Inc. DATE OF NAME CHANGE: 20170304 D 1 primary_doc.xml X0708 D LIVE 0001699927 CARBON HEALTH TECHNOLOGIES, INC. 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 (415) 275-6191 DELAWARE MD Collab Inc. Corporation true Eren Bali 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Executive Officer Director Caesar Djavaherian 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Paul Lee 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Alireaz Tahmasebzadeh 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director James C. Alling 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Julie Smith 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Judy Smith 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Christine Gorjanc 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Director Jay Kim 300 California Street, 7th Floor San Francisco CA CALIFORNIA 94104 Executive Officer Other Health Care Decline to Disclose 06b false 2021-09-01 false true true 0 10676314 10676314 0 false 13 0 0 0 false CARBON HEALTH TECHNOLOGIES, INC. /s/ Ali Hartley Ali Hartley General Counsel 2021-09-14