0001786919-19-000003.txt : 20191226 0001786919-19-000003.hdr.sgml : 20191226 20191226163036 ACCESSION NUMBER: 0001786919-19-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20191226 DATE AS OF CHANGE: 20191226 EFFECTIVENESS DATE: 20191226 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Mind Medicine, Inc. CENTRAL INDEX KEY: 0001786919 IRS NUMBER: 841947694 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-356466 FILM NUMBER: 191310850 BUSINESS ADDRESS: STREET 1: 1325 AIRMOTIVE WAY, SUITE 175A CITY: RENO STATE: NV ZIP: 89502 BUSINESS PHONE: (650) 208-2454 MAIL ADDRESS: STREET 1: 1325 AIRMOTIVE WAY, SUITE 175A CITY: RENO STATE: NV ZIP: 89502 D 1 primary_doc.xml X0708 D LIVE 0001786919 Mind Medicine, Inc. 1325 AIRMOTIVE WAY, SUITE 175A RENO NV NEVADA 89502 (650) 208-2454 DELAWARE None None Corporation true 2019 Tessaraolo Rob 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Director Promoter Peter Volk 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Nico R Forte 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Scott R Freeman 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Don Gehlert 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer JR Rahn 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Director Jeanne Bonelle 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Ferdi Belga 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Carol Nast 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Bruce Linton 1325 Airmotive Way, Suite 175A Reno NV NEVADA 89502 Executive Officer Other Decline to Disclose 06b false 2019-12-19 false true false 0 2311636 2311636 0 false 22 0 0 0 false Mind Medicine, Inc. /s/ Rob Tessaraolo Rob Tessaraolo Chief Executive Officer 2019-12-26