0001998097-23-000001.txt : 20231023 0001998097-23-000001.hdr.sgml : 20231023 20231023114902 ACCESSION NUMBER: 0001998097-23-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20231023 DATE AS OF CHANGE: 20231023 EFFECTIVENESS DATE: 20231023 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Injectsure, Inc. CENTRAL INDEX KEY: 0001998097 IRS NUMBER: 873581315 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-495391 FILM NUMBER: 231339202 BUSINESS ADDRESS: STREET 1: 721 US HIGHWAY 1 STREET 2: 101 CITY: NORTH PALM BEACH STATE: FL ZIP: 33408 BUSINESS PHONE: 4243240496 MAIL ADDRESS: STREET 1: 721 US HIGHWAY 1 STREET 2: 101 CITY: NORTH PALM BEACH STATE: FL ZIP: 33408 D 1 primary_doc.xml X0708 D LIVE 0001998097 Injectsure, Inc. 721 US HIGHWAY 1 101 NORTH PALM BEACH FL FLORIDA 33408 4243240496 DELAWARE None None Corporation true Daniel L Kapp 322 Murcia Drive Jupiter FL FLORIDA 33458 Director Patrick J Tighe 2070 Dickens Terrace Palm Beach Gardens FL FLORIDA 33418 Director Mike Jafar 43 Sea Terrace Newport Beach CA CALIFORNIA 92657 Director Lee Evans 1836 Port Westbourne PL Newport Beach CA CALIFORNIA 92660 Executive Officer Director Tim Derhan 70 Huron Road Bellerose NY NEW YORK 11001 Director Kim DeOrsey 1542 Limetree Bay Ave. Jupiter FL FLORIDA 33458 Executive Officer Other $1 - $1,000,000 06b false 2023-10-12 false true Simple Agreement for Future Equity (SAFE) false 25000 2500000 250000 2250000 false 1 0 0 0 false Injectsure, Inc. Harry Mirabile, Esq. Harry Mirabile, Esq. Attorney 2023-10-23