0001973419-23-000001.txt : 20230720 0001973419-23-000001.hdr.sgml : 20230720 20230720153059 ACCESSION NUMBER: 0001973419-23-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20230720 DATE AS OF CHANGE: 20230720 EFFECTIVENESS DATE: 20230720 FILER: COMPANY DATA: COMPANY CONFORMED NAME: 1104Health, Inc. CENTRAL INDEX KEY: 0001973419 IRS NUMBER: 861432645 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-487494 FILM NUMBER: 231099597 BUSINESS ADDRESS: STREET 1: 5110 MANNING DRIVE CITY: BETHESDA STATE: MD ZIP: 20814 BUSINESS PHONE: 800-881-6113 MAIL ADDRESS: STREET 1: 5110 MANNING DRIVE CITY: BETHESDA STATE: MD ZIP: 20814 D 1 primary_doc.xml X0708 D LIVE 0001973419 1104Health, Inc. 5110 MANNING DRIVE BETHESDA MD MARYLAND 20814 800-881-6113 DELAWARE 1104Health, LLC None Corporation true 2022 Qun Rose Wang 5110 Manning Drive Bethesda MD MARYLAND 20814 Executive Officer Director Other Technology Decline to Disclose 06b false 2022-12-12 false true true Simple Agreement for Future Equity false 0 1000000 350000 650000 false 5 0 0 0 false 1104Health, Inc. /s/ Qun Rose Wang Qun Rose Wang Chief Executive Officer 2023-07-20