0001752666-20-000004.txt : 20201112 0001752666-20-000004.hdr.sgml : 20201112 20201112154211 ACCESSION NUMBER: 0001752666-20-000004 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20201112 DATE AS OF CHANGE: 20201112 EFFECTIVENESS DATE: 20201112 FILER: COMPANY DATA: COMPANY CONFORMED NAME: FusiForm, Inc. CENTRAL INDEX KEY: 0001752666 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-380402 FILM NUMBER: 201306363 BUSINESS ADDRESS: STREET 1: 916 NORTH CHARLES STREET CITY: BALTIMORE STATE: MD ZIP: 21201 BUSINESS PHONE: 8334440833 MAIL ADDRESS: STREET 1: 916 NORTH CHARLES STREET CITY: BALTIMORE STATE: MD ZIP: 21201 D 1 primary_doc.xml X0708 D LIVE 0001752666 FusiForm, Inc. 916 NORTH CHARLES STREET BALTIMORE MD MARYLAND 21201 8334440833 DELAWARE None None Corporation true 2017 Alex Mathews 916 North Charles Street Baltimore MD MARYLAND 21201 Executive Officer Director Eric Carlborg 916 North Charles Street Baltimore MD MARYLAND 21202 Director David Lee 916 North Charles Street Baltimore MD MARYLAND 21202 Director Hugh Evans 916 North Charles Street Baltimore MD MARYLAND 21202 Director Other Technology Decline to Disclose 06b false 2020-10-28 false true false 0 2943084 2943084 0 false 5 0 0 0 false FusiForm, Inc. /s/Alex Mathews Alex Mathews Chief Executive Officer 2020-11-12