0001725402-17-000001.txt : 20171222 0001725402-17-000001.hdr.sgml : 20171222 20171222102338 ACCESSION NUMBER: 0001725402-17-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20171222 DATE AS OF CHANGE: 20171222 EFFECTIVENESS DATE: 20171222 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Supira Medical, Inc. CENTRAL INDEX KEY: 0001725402 IRS NUMBER: 455466626 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-301508 FILM NUMBER: 171271525 BUSINESS ADDRESS: STREET 1: 590 DIVISION STREET CITY: CAMPBELL STATE: CA ZIP: 95008 BUSINESS PHONE: (510) 705-2569 MAIL ADDRESS: STREET 1: 590 DIVISION STREET CITY: CAMPBELL STATE: CA ZIP: 95008 D 1 primary_doc.xml X0708 D LIVE 0001725402 Supira Medical, Inc. 590 DIVISION STREET CAMPBELL CA CALIFORNIA 95008 (510) 705-2569 DELAWARE Lumenblation Medical, Inc. None Corporation true Jean Orth 590 Division Street Campbell CA CALIFORNIA 95008 Executive Officer Mariam Maghribi 590 Division Street Campbell CA CALIFORNIA 95008 Executive Officer Director Amr Salahieh 590 Division Street Campbell CA CALIFORNIA 95008 Director Other Decline to Disclose 06b false 2017-12-07 false true false 0 2000000 1614998 385002 false 15 0 0 0 false Supira Medical, Inc. /s/ Jean Orth Jean Orth President and CEO 2017-12-21