0001808761-21-000001.txt : 20210929 0001808761-21-000001.hdr.sgml : 20210929 20210929131500 ACCESSION NUMBER: 0001808761-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210929 DATE AS OF CHANGE: 20210929 EFFECTIVENESS DATE: 20210929 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Black Swan Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001808761 IRS NUMBER: 832505872 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-415024 FILM NUMBER: 211290706 BUSINESS ADDRESS: STREET 1: 9008 LAURA LAKE DRIVE CITY: WAKE FOREST STATE: NC ZIP: 27587 BUSINESS PHONE: 919-612-4363 MAIL ADDRESS: STREET 1: 9008 LAURA LAKE DRIVE CITY: WAKE FOREST STATE: NC ZIP: 27587 D 1 primary_doc.xml X0708 D LIVE 0001808761 Black Swan Pharmaceuticals, Inc. 9008 LAURA LAKE DRIVE WAKE FOREST NC NORTH CAROLINA 27587 919-612-4363 DELAWARE None None Corporation true 2018 Craig Metz c/o Black Swan Pharmaceuticals, Inc. 9008 Laura Lake Drive Wake Forest NC NORTH CAROLINA 27587 Executive Officer Director Om Dhingra c/o Black Swan Pharmaceuticals, Inc. 9008 Laura Lake Drive Wake Forest NC NORTH CAROLINA 27587 Director Anthony Akkari c/o Black Swan Pharmaceuticals, Inc. 9008 Laura Lake Drive Wake Forest NC NORTH CAROLINA 27587 Director Steve Arnott c/o Black Swan Pharmaceuticals, Inc. 9008 Laura Lake Drive Wake Forest NC NORTH CAROLINA 27587 Director Julian Arbuckle /o Black Swan Pharmaceuticals, Inc. 9008 Laura Lake Drive Wake Forest NC NORTH CAROLINA 27587 Director Pharmaceuticals Decline to Disclose 06b false 2021-09-14 false true Simple Agreement for Future Equity false 0 3000000 1916618 1083382 false 5 0 0 0 Other than the payment of salaries and other compensation and benefits and reimbursement of expenses, no officer, director, partner, manager or promoter will receive any payments from the proceeds of this offering. false Black Swan Pharmaceuticals, Inc. /s/ Craig Metz Craig Metz Chief Executive Officer 2021-09-29