SECURITIES AND EXCHANGE COMMISSION
SECURITIES AND EXCHANGE COMMISSION
FORM D
Official notice of an offering of securities that is made without registration under the Securities Act in reliance on an exemption provided by Regulation D and Section 4(6) under the Act.
Filing Date: 2010-06-28
SEC Accession No. 0001326280-10-000004 (HTML Version on )
FILER
Pervacio Inc
CIK:1326280| IRS No.: 201908198 | State of Incorp.:DE | Fiscal Year End: 1231 Type: D | Act: 33 | File No.: 021-144102 | Film No.: 10919510
Mailing Address 211 NORTH UNION STREET ALEXANDRIA VA 22314
Business Address 211 NORTH UNION STREET ALEXANDRIA VA 22314 888-221-4762
Copyright ? 2012 . All Rights Reserved. Please Consider the Environment Before Printing This Document
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM D
Notice of Exempt Offering of Securities
OMB APPROVAL
OMB Number:
3235-0076
Expires:
June 30, 2012
Estimated average burden
hours per response:
4.00
1. Issuer's Identity
CIK (Filer ID Number)
Previous Name(s)
0001326280
Name of Issuer
Pervacio Inc
Jurisdiction of Incorporation/Organization
DELAWARE
Year of Incorporation/Organization
Over Five Years Ago
Within Last Five Years (Specify Year)
Yet to Be Formed
None
Entity Type
Corporation Limited Partnership Limited Liability Company General Partnership Business Trust Other
2. Principal Place of Business and Contact Information
Name of Issuer
Pervacio Inc
Street Address 1
211 NORTH UNION STREET
City
State/Province/Country
ALEXANDRIA
VIRGINIA
Street Address 2
ZIP/Postal Code 22314
3. Related Persons Last Name Kanodia Street Address 1 211 North Union Street City
Alexandria
First Name Sanjay Street Address 2
State/Province/Country VIRGINIA
Relationship: Executive Officer Director Promoter
Clarification of Response (if Necessary)
Phone No. of Issuer 888-221-4762
Middle Name
ZIP/Postal Code 22314
Last Name Dersookian Street Address 1 211 North Union Street City
Alexandria
First Name Michael Street Address 2
State/Province/Country VIRGINIA
Relationship: Executive Officer Director Promoter
Clarification of Response (if Necessary)
Middle Name
ZIP/Postal Code 22310
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Last Name Asher Street Address 1 211 North Union Street City
Alexandria
First Name Craig Street Address 2
State/Province/Country VIRGINIA
Relationship: Executive Officer Director Promoter
Clarification of Response (if Necessary)
Last Name Peake Street Address 1 211 North Union Street City
Alexandria
First Name Tripp Street Address 2
State/Province/Country VIRGINIA
Relationship: Executive Officer Director Promoter
Clarification of Response (if Necessary)
Middle Name
ZIP/Postal Code 22314
Middle Name
ZIP/Postal Code 22134
4. Industry Group
Agriculture Banking & Financial Services Commercial Banking Insurance Investing Investment Banking Pooled Investment Fund
Other Banking & Financial
Services
Business Services Energy Coal Mining Electric Utilities Energy Conservation Environmental Services Oil & Gas Other Energy
5. Issuer Size
Revenue Range
No Revenues
$1 - $1,000,000
$1,000,001 - $5,000,000 $5,000,001 - $25,000,000 $25,000,001 - $100,000,000
Health Care
Biotechnology Health Insurance Hospitals & Physicians Pharmaceuticals Other Health Care Manufacturing Real Estate
Commercial Construction REITS & Finance Residential Other Real Estate
Retailing Restaurants
Technology
Computers Telecommunications Other Technology Travel
Airlines & Airports Lodging & Conventions Tourism & Travel Services Other Travel Other
Aggregate Net Asset Value Range No Aggregate Net Asset Value $1 - $5,000,000 $5,000,001 - $25,000,000 $25,000,001 - $50,000,000 $50,000,001 - $100,000,000
Copyright ? 2012 . All Rights Reserved. Please Consider the Environment Before Printing This Document
Over $100,000,000 Decline to Disclose Not Applicable
Over $100,000,000 Decline to Disclose Not Applicable
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
Rule 504(b)(1) (not (i), (ii) or (iii)) Rule 505
Rule 504 (b)(1)(i) Rule 504 (b)(1)(ii) Rule 504 (b)(1)(iii)
Rule 506 Securities Act Section 4(6) Investment Company Act Section 3(c)
Section 3(c)(1) Section 3(c)(9)
Section 3(c)(2) Section 3(c)(10)
Section 3(c)(3) Section 3(c)(11)
Section 3(c)(4) Section 3(c)(12)
Section 3(c)(5) Section 3(c)(13)
Section 3(c)(6) Section 3(c)(14)
Section 3(c)(7)
7. Type of Filing
New Notice Date of First Sale 2010-06-15 First Sale Yet to Occur Amendment
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? Yes No
9. Type(s) of Securities Offered (select all that apply)
Pooled Investment Fund Interests
Equity
Tenant-in-Common Securities
Debt
Mineral Property Securities
Security Warrant
to or
be Acquired Upon Exercise of Option, Other Right to Acquire Security
Option, Warrant or Other Right to Acquire Another Security Other (describe)
Conversion of convertible promissory notes, including interest, and other outstanding loans into Junior Preferred Stock.
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer?
Yes
No
Clarification of Response (if Necessary)
11. Minimum Investment Minimum investment accepted from any outside investor $ 0 USD
12. Sales Compensation Recipient
(Associated) Broker or Dealer None
Street Address 1
Recipient CRD Number None (Associated) Broker or Dealer CRD Number None
Street Address 2
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City
State/Province/Country
State(s) of Check "All
Solicitation (select all that apply) States" or check individual States
All
States
Foreign/non-US
ZIP/Postal Code
13. Offering and Sales Amounts
Total Offering Amount
$ 5,306,524 USD or Indefinite
Total Amount Sold
$ 3,686,169 USD
Total Remaining to be Sold $ 1,620,355 USD or Indefinite
Clarification of Response (if Necessary) Sale of Series A-1 and Series A-2 Preferred Stock for an aggregate price of up to $4,000,000; conversion of promissory notes, including interest, and other outstanding loans, into Junior Preferred Stock for an aggregate price of $1,306,528.
14. Investors
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as
4
accredited investors, enter the total number of investors who already have invested in the offering:
15. Sales Commissions & Finders' Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions $ 0 USD Estimate
Finders' Fees
$ 0 USD Estimate
Clarification of Response (if Necessary)
16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
$ 0 USD Estimate
Clarification of Response (if Necessary)
Signature and Submission
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission
In submitting this notice, each Issuer named above is:
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