0001567619-21-013629.txt : 20210719 0001567619-21-013629.hdr.sgml : 20210719 20210719155721 ACCESSION NUMBER: 0001567619-21-013629 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210719 DATE AS OF CHANGE: 20210719 EFFECTIVENESS DATE: 20210719 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ACTIV Surgical, Inc. CENTRAL INDEX KEY: 0001710426 IRS NUMBER: 472924761 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-406785 FILM NUMBER: 211097883 BUSINESS ADDRESS: STREET 1: 840 SUMMER STREET, SUITE 108 CITY: BOSTON STATE: MA ZIP: 02127 BUSINESS PHONE: (646) 312-9611 MAIL ADDRESS: STREET 1: 840 SUMMER STREET, SUITE 108 CITY: BOSTON STATE: MA ZIP: 02127 FORMER COMPANY: FORMER CONFORMED NAME: Omniboros Inc. DATE OF NAME CHANGE: 20170627 D 1 primary_doc.xml X0708 D LIVE 0001710426 ACTIV Surgical, Inc. 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 617-333-8162 DELAWARE OMNIBOROS INC. Omniboros Inc. Corporation true TODD USEN 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Executive Officer Director PETER KIM 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Executive Officer Director TOM CALEF 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Executive Officer PAUL MEISTER 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director EMILY CASEY 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director ASHOK KRISHNAMURTHI 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director AMEENA EL-BIBANY 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director WILL COWEN 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director BABAK YAZDANI 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Director HEATHER MANNILA 840 SUMMER STREET - STE. 108 BOSTON MA MASSACHUSETTS 02127 Executive Officer Other Health Care Decline to Disclose 06b false 2021-07-02 false true false 0 42629995 40629929 2000066 false 16 0 0 0 false ACTIV Surgical, Inc. /S/ TODD USEN TODD USEN CHIEF EXECUTIVE OFFICER 2021-07-19