0001944690-22-000001.txt : 20220928 0001944690-22-000001.hdr.sgml : 20220928 20220928125615 ACCESSION NUMBER: 0001944690-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220928 DATE AS OF CHANGE: 20220928 EFFECTIVENESS DATE: 20220928 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Form Bio Inc. CENTRAL INDEX KEY: 0001944690 IRS NUMBER: 882442346 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-460104 FILM NUMBER: 221274356 BUSINESS ADDRESS: STREET 1: 1401 LAVACA STREET CITY: AUSTIN STATE: TX ZIP: 78701 BUSINESS PHONE: 917-554-0580 MAIL ADDRESS: STREET 1: 1401 LAVACA STREET CITY: AUSTIN STATE: TX ZIP: 78701 D 1 primary_doc.xml X0708 D LIVE 0001944690 Form Bio Inc. 1401 LAVACA STREET AUSTIN TX TEXAS 78701 917-554-0580 DELAWARE None None Corporation true 2022 Kent Wakeford c/o Form Bio Inc. 1401 Lavaca Street Austin TX TEXAS 78701 Executive Officer Director Promoter Andrew Busey c/o Form Bio Inc. 1401 Lavaca Street Austin TX TEXAS 78701 Executive Officer Director Promoter Benjamin Lamm c/o Form Bio Inc. 1401 Lavaca Street Austin TX TEXAS 78701 Director Promoter John Spinale c/o Form Bio Inc. 1401 Lavaca Street Austin TX TEXAS 78701 Director Biotechnology Decline to Disclose 06b false 2022-09-12 false true false 0 26320000 16000000 10320000 false 4 0 0 0 false Form Bio Inc. /s/ Kent Wakeford Kent Wakeford Chief Executive Officer 2022-09-28