0001720648-17-000002.txt : 20171030 0001720648-17-000002.hdr.sgml : 20171030 20171030172215 ACCESSION NUMBER: 0001720648-17-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 504(b)(1) (not (i), (ii) or (iii)) FILED AS OF DATE: 20171030 DATE AS OF CHANGE: 20171030 EFFECTIVENESS DATE: 20171030 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Polycomp Administrative Services, Inc. CENTRAL INDEX KEY: 0001720648 IRS NUMBER: 952889854 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-297726 FILM NUMBER: 171163346 BUSINESS ADDRESS: STREET 1: 3000 LAVA RIDGE COURT, NO. 130 CITY: ROSEVILLE STATE: CA ZIP: 95661 BUSINESS PHONE: 9167733480 MAIL ADDRESS: STREET 1: 3000 LAVA RIDGE COURT, NO. 130 CITY: ROSEVILLE STATE: CA ZIP: 95661 D 1 primary_doc.xml X0708 D LIVE 0001720648 Polycomp Administrative Services, Inc. 3000 LAVA RIDGE COURT, NO. 130 ROSEVILLE CA CALIFORNIA 95661 9167733480 CALIFORNIA None None Corporation true Donna Harmon 3000 Lava Ridge Court, No. 130 Roseville CA CALIFORNIA 95661 Executive Officer Director Other Banking and Financial Services $5,000,001 - $25,000,000 04 false 2016-12-31 false true false 0 1799 1799 0 false 0 0 0 0 false Polycomp Administrative Services, Inc. Donna Harmon Donna Harmon President 2017-10-30