0001840080-21-000002.txt : 20210504 0001840080-21-000002.hdr.sgml : 20210504 20210504102305 ACCESSION NUMBER: 0001840080-21-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210504 DATE AS OF CHANGE: 20210504 EFFECTIVENESS DATE: 20210504 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Revelation Biosciences, Inc CENTRAL INDEX KEY: 0001812479 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-398081 FILM NUMBER: 21886549 BUSINESS ADDRESS: STREET 1: 4660 LAJOLLA VILLAGE DRIVE STREET 2: SUITE 100 CITY: SAN DIEGO STATE: CA ZIP: 92122 BUSINESS PHONE: 650-800-3717 MAIL ADDRESS: STREET 1: 4660 LAJOLLA VILLAGE DRIVE STREET 2: SUITE 100 CITY: SAN DIEGO STATE: CA ZIP: 92122 FORMER COMPANY: FORMER CONFORMED NAME: Revelation Therapeutics, LLC DATE OF NAME CHANGE: 20200518 D 1 primary_doc.xml X0708 D LIVE 0001812479 Revelation Biosciences, Inc 4660 LAJOLLA VILLAGE DRIVE SUITE 100 SAN DIEGO CA CALIFORNIA 92122 650-800-3717 DELAWARE Revelation Therapeutics, LLC Corporation true 2020 Chester S. Zygmont III 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 92122 Executive Officer James M. Rolke 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 94025 Executive Officer Director George F. Tidmarsh 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 94025 Director Jennifer Carver 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 94025 Director Jess Roper 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 94025 Director Curt LaBelle 4660 La Jolla Village Dr. Suite 100 San Diego CA CALIFORNIA 94025 Director Biotechnology Decline to Disclose 06b false 2021-01-04 false true false 5032 5144458 5144458 0 false 44 0 0 0 false Revelation Biosciences, Inc /s/ Chester S. Zygmont, III Chester S. Zygmont, III CFO 2021-05-04