0001730054-19-000001.txt : 20190426 0001730054-19-000001.hdr.sgml : 20190426 20190425192458 ACCESSION NUMBER: 0001730054-19-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190426 DATE AS OF CHANGE: 20190425 EFFECTIVENESS DATE: 20190426 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: 021-338188 FILM NUMBER: 19768887 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 Suresh Pai 709 Sandoval Way Hayward CA CALIFORNIA 94544 Executive Officer Director Sanjay Shrivastava 709 Sandoval Way Hayward CA CALIFORNIA 94544 Director Mike Bates 709 Sandoval Way Hayward CA CALIFORNIA 94544 Director Adrian M. Rich 3150 Porter Drive Palo Alto CA CALIFORNIA 94304 Executive Officer Other Decline to Disclose 06b false 2019-04-09 false true false 0 1500000 995000 505000 false 10 0 0 0 false BlackSwan Vascular, Inc. /s/ Suresh Pai Suresh Pai CEO 2019-04-25