0001734426-19-000002.txt : 20191105 0001734426-19-000002.hdr.sgml : 20191105 20191105164605 ACCESSION NUMBER: 0001734426-19-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b ITEM INFORMATION: Investment Company Act Section 3(c) ITEM INFORMATION: Section 3(c)(7) FILED AS OF DATE: 20191105 DATE AS OF CHANGE: 20191105 EFFECTIVENESS DATE: 20191105 FILER: COMPANY DATA: COMPANY CONFORMED NAME: 565 SPV I, L.P. CENTRAL INDEX KEY: 0001734426 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-352669 FILM NUMBER: 191193971 BUSINESS ADDRESS: STREET 1: 628 MIDDLEFIELD ROAD CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (323) 860-4900 MAIL ADDRESS: STREET 1: 628 MIDDLEFIELD ROAD CITY: PALO ALTO STATE: CA ZIP: 94301 FORMER COMPANY: FORMER CONFORMED NAME: Samsara BioCapital SPV I, L.P. DATE OF NAME CHANGE: 20180313 D 1 primary_doc.xml X0708 D LIVE 0001734426 565 SPV I, L.P. 628 MIDDLEFIELD ROAD PALO ALTO CA CALIFORNIA 94301 (650) 285-4270 DELAWARE Samsara BioCapital SPV I, L.P. Limited Partnership true 2019 N/A 565 SPV GP I, LLC 628 Middlefield Road Palo Alto CA CALIFORNIA 94301 Director General Partner of the Issuer (the "General Partner") Srinivas Akkaraju c/o 565 SPV GP I, LLC 628 Middlefield Road Palo Alto CA CALIFORNIA 94301 Director Managing Member of the General Partner of the Issuer Michael Dybbs c/o 565 SPV GP I, LLC 628 Middlefield Road Palo Alto CA CALIFORNIA 94301 Director Managing Member of the General Partner of the Issuer Pooled Investment Fund Venture Capital Fund false Decline to Disclose 06b 3C 3C.7 false 2019-10-17 false true true false 0 8333333 8333333 0 false 8 0 0 0 The General Partner (or an affiliate thereof) is entitled to a management fee. false 565 SPV I, L.P. /s/ Srinivas Akkaraju Srinivas Akkaraju Managing Member of the General Partner of the Issuer 2019-11-05