0001730054-18-000001.txt : 20180206 0001730054-18-000001.hdr.sgml : 20180206 20180206151830 ACCESSION NUMBER: 0001730054-18-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180206 DATE AS OF CHANGE: 20180206 EFFECTIVENESS DATE: 20180206 FILER: COMPANY DATA: COMPANY CONFORMED NAME: BlackSwan Vascular, Inc. CENTRAL INDEX KEY: 0001730054 IRS NUMBER: 823391719 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-304936 FILM NUMBER: 18577388 BUSINESS ADDRESS: STREET 1: 709 SANDOVAL WAY CITY: HAYWARD STATE: CA ZIP: 94544 BUSINESS PHONE: 650-222-3622 MAIL ADDRESS: STREET 1: 709 SANDOVAL WAY CITY: HAYWARD STATE: CA ZIP: 94544 D 1 primary_doc.xml X0708 D LIVE 0001730054 BlackSwan Vascular, Inc. 709 SANDOVAL WAY HAYWARD CA CALIFORNIA 94544 650-222-3622 DELAWARE None None Corporation true 2017 Celso Bagaoisan 709 Sandoval Way Hayward CA CALIFORNIA 94544 Executive Officer Director Suresh Pai 709 Sandoval Way Hayward CA CALIFORNIA 94544 Executive Officer Director Adrian M. Rich 305 Lytton Avenue Palo Alto CA CALIFORNIA 94301 Executive Officer Other Decline to Disclose 06b false 2018-01-26 false true false 0 4000000 1830000 2170000 false 22 0 0 0 false BlackSwan Vascular, Inc. /s/ Adrian M. Rich Adrian M. Rich Secretary 2018-02-06