0001875901-21-000001.txt : 20211228 0001875901-21-000001.hdr.sgml : 20211228 20211227203413 ACCESSION NUMBER: 0001875901-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211228 DATE AS OF CHANGE: 20211227 EFFECTIVENESS DATE: 20211228 FILER: COMPANY DATA: COMPANY CONFORMED NAME: MycoMedica Life Sciences, PBC CENTRAL INDEX KEY: 0001875901 IRS NUMBER: 862365282 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-426886 FILM NUMBER: 211521912 BUSINESS ADDRESS: STREET 1: 50 SE NELSON ROAD CITY: SHELTON STATE: WA ZIP: 98584 BUSINESS PHONE: (360) 951-1500 MAIL ADDRESS: STREET 1: 50 SE NELSON ROAD CITY: SHELTON STATE: WA ZIP: 98584 D 1 primary_doc.xml X0708 D LIVE 0001875901 MycoMedica Life Sciences, PBC 50 SE NELSON ROAD SHELTON WA WASHINGTON 98584 (360) 951-1500 DELAWARE None None Corporation true 2021 Paul Stamets 50 SE Nelson Road Shelton WA WASHINGTON 98584 Executive Officer Director Promoter Tad Buchanan 50 SE Nelson Road Shelton WA WASHINGTON 98584 Executive Officer Director Pamela Kryskow 50 SE Nelson Road Shelton WA WASHINGTON 98584 Director James Joaquin 50 SE Nelson Road Shelton WA WASHINGTON 98584 Director John Parrish 50 SE Nelson Road Shelton WA WASHINGTON 98584 Executive Officer Biotechnology Decline to Disclose 06b false 2021-05-25 false true false 0 7389366 7389366 0 Does not include $574,917.07 sold to 23 investors who reside outside the United States false 81 0 0 0 false MycoMedica Life Sciences, PBC /s/ Paul Stamets Paul Stamets President 2021-12-27