0001243233-21-000002.txt : 20210713
0001243233-21-000002.hdr.sgml : 20210713
20210713131700
ACCESSION NUMBER: 0001243233-21-000002
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20210713
DATE AS OF CHANGE: 20210713
EFFECTIVENESS DATE: 20210713
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: Olive AI, Inc.
CENTRAL INDEX KEY: 0001639542
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-406017
FILM NUMBER: 211087373
BUSINESS ADDRESS:
STREET 1: 99 EAST MAIN STREET
CITY: COLUMBUS
STATE: OH
ZIP: 43215
BUSINESS PHONE: (800) 501-3161
MAIL ADDRESS:
STREET 1: 99 EAST MAIN STREET
CITY: COLUMBUS
STATE: OH
ZIP: 43215
FORMER COMPANY:
FORMER CONFORMED NAME: CrossChx, Inc.
DATE OF NAME CHANGE: 20150414
D
1
primary_doc.xml
X0708
D
LIVE
0001639542
Olive AI, Inc.
99 EAST MAIN STREET
COLUMBUS
OH
OHIO
43215
(800) 501-3161
DELAWARE
CrossChx, Inc.
Corporation
true
Sean
Lane
99 East Main Street
Columbus
OH
OHIO
43215
Executive Officer
Director
Kumi
Walker
99 East Main Street
Columbus
OH
OHIO
43215
Director
John
Kuelper
99 East Main Street
Columbus
OH
OHIO
43215
Director
Christopher
Olsen
99 East Main Street
Columbus
OH
OHIO
43215
Director
Brock
Wanless
99 East Main Street
Columbus
OH
OHIO
43215
Executive Officer
David
Agus
99 East Main Street
C
OH
OHIO
43215
Director
George
S.
Barrett
99 East Main Street
Columbus
OH
OHIO
43215
Director
Ronald
A.
Paulus
99 East Main Street
Columbus
OH
OHIO
43215
Director
Ali
Byrd
99 East Main Street
Columbus
OH
OHIO
43215
Executive Officer
Monti
Saroya
99 East Main Street
Columbus
OH
OHIO
43215
Director
Other Technology
Decline to Disclose
- 06b
false
2021-06-28
false
true
true
Series H Preferred Stock and Common Stock issuable upon conversion
false
0
471141226
450320360
20820866
false
8
0
0
0
false
Olive AI, Inc.
/s/ Brock Wanless
Brock Wanless
Secretary and General Counsel
2021-07-12