The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete. The reader should not assume that the information is accurate and complete. |
| UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM D
Notice of Exempt Offering of Securities
| OMB APPROVAL | OMB Number: | 3235-0076 | Estimated average burden | hours per response: | 4.00 |
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1. Issuer's Identity
CIK (Filer ID Number) | Previous Names | | Entity Type |
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0001603191 | | X | Corporation | | Limited Partnership | | Limited Liability Company | | General Partnership | | Business Trust | | Other (Specify) |
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Name of Issuer |
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Kairos AR, Inc. |
Jurisdiction of Incorporation/Organization |
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DELAWARE |
Year of Incorporation/Organization |
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| Over Five Years Ago | X | Within Last Five Years (Specify Year) | 2012 | | Yet to Be Formed |
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2. Principal Place of Business and Contact Information
Name of Issuer |
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Kairos AR, Inc. |
Street Address 1 | Street Address 2 |
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2200 NW 2nd Ave, Suite 211 |
City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer |
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MIAMI | FLORIDA | 33127 | (786) 472-1242 |
3. Related Persons
Last Name | First Name | Middle Name |
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Brackeen | Brian |
Street Address 1 | Street Address 2 |
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2200 NW 2nd Ave, Suite 211 |
City | State/Province/Country | ZIP/PostalCode |
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Miami | FLORIDA | 33127 |
Relationship: | X | Executive Officer | X | Director | | Promoter |
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Clarification of Response (if Necessary):
Last Name | First Name | Middle Name |
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Levinson | Marc |
Street Address 1 | Street Address 2 |
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2200 NW 2nd Ave, Suite 211 |
City | State/Province/Country | ZIP/PostalCode |
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Miami | FLORIDA | 33127 |
Relationship: | X | Executive Officer | | Director | | Promoter |
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Clarification of Response (if Necessary):
Last Name | First Name | Middle Name |
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Baldwin | Carol |
Street Address 1 | Street Address 2 |
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2200 NW 2nd Ave, Suite 211 |
City | State/Province/Country | ZIP/PostalCode |
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Miami | FLORIDA | 33127 |
Relationship: | X | Executive Officer | | Director | | Promoter |
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Clarification of Response (if Necessary):
4. Industry Group
| Agriculture | | Banking & Financial Services | | | Commercial Banking | | Insurance | | Investing | | Investment Banking | | Pooled Investment Fund | | | | Is the issuer registered as an investment company under the Investment Company Act of 1940? | | | | Other Banking & Financial Services |
| | Business Services | | Energy | | | | | | | | | | | | |
| | Health Care | | | | | | | | | | | | Manufacturing | | Real Estate | | | | | | | | | | |
| | Retailing | | Restaurants | | Technology | | | | | | | | Travel | | | | | | | Tourism & Travel Services |
| | | | Other |
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5. Issuer Size
Revenue Range | OR | Aggregate Net Asset Value Range |
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| No Revenues | | No Aggregate Net Asset Value |
| $1 - $1,000,000 | | $1 - $5,000,000 |
| $1,000,001 - $5,000,000 | | $5,000,001 - $25,000,000 |
| $5,000,001 - $25,000,000 | | $25,000,001 - $50,000,000 |
| $25,000,001 - $100,000,000 | | $50,000,001 - $100,000,000 |
| Over $100,000,000 | | Over $100,000,000 |
X | Decline to Disclose | | Decline to Disclose |
| Not Applicable | | Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
| | Rule 504(b)(1) (not (i), (ii) or (iii)) |
|
| | Rule 504 (b)(1)(i) |
| | Rule 504 (b)(1)(ii) |
| | Rule 504 (b)(1)(iii) |
| | Rule 505 |
| X | Rule 506(b) |
| | Rule 506(c) |
| | Securities Act Section 4(a)(5) |
| 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) |
| |
| 7. Type of Filing
X | New Notice | | Date of First Sale | 2015-05-21 | | | First Sale Yet to Occur |
| Amendment |
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? | | |
9. Type(s) of Securities Offered (select all that apply)
| Equity | | Pooled Investment Fund Interests |
X | Debt | | Tenant-in-Common Securities |
X | Option, Warrant or Other Right to Acquire Another Security | | Mineral Property Securities |
| Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security | | Other (describe) |
| |
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? | | |
Clarification of Response (if Necessary):
Stock acquisition11. Minimum Investment
Minimum investment accepted from any outside investor | $0 | USD |
12. Sales Compensation
Recipient | Recipient CRD Number | X | None |
|
500 Startups, L.P. | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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444 Castro Street #1200 |
City | State/Province/Country | ZIP/Postal Code |
Mountain View | CALIFORNIA | 94041 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
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Recipient | Recipient CRD Number | X | None |
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Anna Jane Handley | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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Suite 4E, 195 Hollywood Road |
City | State/Province/Country | ZIP/Postal Code |
Central, Hong Kong | CHINA | 000000 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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Geoffrey John Handley | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
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None | None |
Street Address 1 | Street Address 2 |
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Suite 4E, 195 Hollywood Road |
City | State/Province/Country | ZIP/Postal Code |
Central, Hong Kong | CHINA | 000000 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
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Recipient | Recipient CRD Number | X | None |
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Andrew K. Boszhardt, Jr. | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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660 Madison Avenue, Suite 1405 |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10065 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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Eniac Ventures c/o Nihal Mehta | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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240 W 23rd Street 4C |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10007 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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Simon Gelfand | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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Hahar 8 |
City | State/Province/Country | ZIP/Postal Code |
Kochav Yair | ISRAEL | 44864 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
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Recipient | Recipient CRD Number | X | None |
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Great Oaks Venture Fund LP | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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660 Madison Avenue, Suite 1405 |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10065 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
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Recipient | Recipient CRD Number | X | None |
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Harman Family Revocable Trust | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
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None | None |
Street Address 1 | Street Address 2 |
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281 South Balsamina Way |
City | State/Province/Country | ZIP/Postal Code |
Portola Valley | CALIFORNIA | 94028 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
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Recipient | Recipient CRD Number | X | None |
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Don Hutchinson Trust | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
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None | None |
Street Address 1 | Street Address 2 |
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657 Sunset Way |
City | State/Province/Country | ZIP/Postal Code |
Emerald Hills | CALIFORNIA | 94062 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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Intervis Partners | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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86 Chambers Street | Suite 704 |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10007 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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John W. Green | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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563 Belvedere Drive SE |
City | State/Province/Country | ZIP/Postal Code |
Grand Rapids | MICHIGAN | 49506 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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Benjamin Che-Ming Jun and Elaine Wong Revocable Trust | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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1425 Benito Avenue |
City | State/Province/Country | ZIP/Postal Code |
Burlingame | CALIFORNIA | 94010 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
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KD Capital N.A. Ltd. Unit 702, 7/F | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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Tower B Manulife Fincl. Centre 223-231 | Wai Yip Street Kwum Tong, Kowloon |
City | State/Province/Country | ZIP/Postal Code |
Hong Kong | CHINA | 000000 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Christina Lyn Keller Trust | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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8560 Vergennes St. SE |
City | State/Province/Country | ZIP/Postal Code |
Ada | MICHIGAN | 49301 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Peter C. Krupp | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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6012 Sedgley Ct. |
City | State/Province/Country | ZIP/Postal Code |
Burr Ridge | ILLINOIS | 60527 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Ernest H. Pomerantz | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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60 East 42nd Street | Suite 3014 |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10165 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Quotidian Ventures, LLC | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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311 W. Broadway, TH2 |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10013 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Edward T. Schiff | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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540 Madison Avenue | 26th Floor |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10022 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Robert Semmens | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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539 2nd Street |
City | State/Province/Country | ZIP/Postal Code |
Brooklyn | NEW YORK | 11215 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
SG Fund, LLC | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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201 Monroe Ave. NW, Suite 400 |
City | State/Province/Country | ZIP/Postal Code |
Grand Rapids | MICHIGAN | 49503 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Alan Supp | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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7117 Davies Dr. NE |
City | State/Province/Country | ZIP/Postal Code |
Rockford | MICHIGAN | 49341 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
TechStars NYC 2011 LLC | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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1050 Walnut Street | Suite 202 |
City | State/Province/Country | ZIP/Postal Code |
Boulder | COLORADO | 80302 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Webika Ltd. | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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Ha'Yezira 3 |
City | State/Province/Country | ZIP/Postal Code |
Ramat Gan | ISRAEL | 52521 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Jay Weintraub | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
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49 East 21st Street | Apartment 9D |
City | State/Province/Country | ZIP/Postal Code |
New York | NEW YORK | 10010 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
The Windquest Group, Inc. | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
---|
201 Monroe Ave. NW, Suite 500 |
City | State/Province/Country | ZIP/Postal Code |
Grand Rapids | MICHIGAN | 49503 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Sam Yagan | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
---|
1232 N. Damen |
City | State/Province/Country | ZIP/Postal Code |
Chicago | ILLINOIS | 60622 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Jason Sosa | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
---|
6754 Bernal Ave. 740-110 |
City | State/Province/Country | ZIP/Postal Code |
Pleasanton | CALIFORNIA | 94566 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Chris Piekarski | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
---|
533 Ridgeview Drive |
City | State/Province/Country | ZIP/Postal Code |
Louisville | COLORADO | 80027 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
Recipient | Recipient CRD Number | X | None |
|
Alessio Signorini | None |
(Associated) Broker or Dealer | X | None |
| (Associated) Broker or Dealer CRD Number | X | None |
|
None | None |
Street Address 1 | Street Address 2 |
---|
716 N. Voluntario Street |
City | State/Province/Country | ZIP/Postal Code |
Santa Barbara | CALIFORNIA | 93103 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States | | All States |
| |
|
13. Offering and Sales Amounts
Total Offering Amount | $1,800,000 | USD | |
Total Amount Sold | $1,800,000 | USD |
Total Remaining to be Sold | $0 | USD | |
Clarification of Response (if Necessary):
14. Investors
| Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the 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 accredited investors, enter the total number of investors who already have invested in the offering: | |
15. Sales Commissions & Finder's 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 | |
Finders' Fees | $0 | USD | |
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.
Clarification of Response (if Necessary):
Issuance of convertible notes in connection with the purchase price.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: |
- Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, in the accordance with applicable law, the information furnished to offerees.*
- Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against the issuer in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
- Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Regulation D for one of the reasons stated in Rule 505(b)(2)(iii) or Rule 506(d).
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Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
Issuer | Signature | Name of Signer | Title | Date |
---|
Kairos AR, Inc. | /s/ Brian Brackeen | Brian Brackeen | CEO | 2015-05-27 |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.