0001740380-20-000002.txt : 20201230 0001740380-20-000002.hdr.sgml : 20201230 20201230113316 ACCESSION NUMBER: 0001740380-20-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20201230 DATE AS OF CHANGE: 20201230 EFFECTIVENESS DATE: 20201230 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CiVi Biopharma Holdings, Inc. CENTRAL INDEX KEY: 0001740380 IRS NUMBER: 824833651 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-384757 FILM NUMBER: 201424674 BUSINESS ADDRESS: STREET 1: ONE TOWN PLACE, SUITE 200 CITY: BRYN MAWR STATE: PA ZIP: 19010 BUSINESS PHONE: 484-222-6251 MAIL ADDRESS: STREET 1: ONE TOWN PLACE, SUITE 200 CITY: BRYN MAWR STATE: PA ZIP: 19010 D 1 primary_doc.xml X0708 D LIVE 0001740380 CiVi Biopharma Holdings, Inc. 5425 Wisconsin Ave. Chevy Chase MD MARYLAND 20815 301.968.2392 DELAWARE None None Corporation true 2017 Henrik Oerum c/o CiVi Biopharma Holdings, Inc. 5425 Wisconsin Ave. Chevy Chase MD MARYLAND 20815 Director Shalom Jacobovitz c/o CiVi Biopharma Holdings, Inc. 5425 Wisconsin Ave. Chevy Chase MD MARYLAND 20815 Executive Officer Director Aaron Davis c/o CiVi Biopharma Holdings, Inc. 5425 Wisconsin Ave. Chevy Chase MD MARYLAND 20815 Director Christopher Fuglesang c/o CiVi Biopharma Holdings, Inc. Chevy Chase MD MARYLAND 20815 Director Carole Nuechterlein c/o CiVi Biopharma Holdings, Inc. Chevy Chase MD MARYLAND 20815 Director Matthew Pietras c/o CiVi Biopharma Holdings, Inc. 5425 Wisconsin Ave. Chevy Chase MD MARYLAND 20815 Executive Officer Biotechnology Decline to Disclose 06b false 2020-11-18 false true true Preferred Stock can convert to underlying shares of Common Stock. false 0 27456172 27456172 0 A portion of the proceeds were satisfied by cancellation of indebtedness. false 9 0 0 0 false CiVi Biopharma Holdings, Inc. /s/ Shalom Jacobovitz Shalom Jacobovitz Chief Executive Officer 2020-12-15