0001725335-17-000001.txt : 20171214
0001725335-17-000001.hdr.sgml : 20171214
20171214113320
ACCESSION NUMBER: 0001725335-17-000001
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20171214
DATE AS OF CHANGE: 20171214
EFFECTIVENESS DATE: 20171214
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: PATIENTPAY, INC.
CENTRAL INDEX KEY: 0001725335
IRS NUMBER: 263353802
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-300721
FILM NUMBER: 171255520
BUSINESS ADDRESS:
STREET 1: 1005 SLATER ROAD, SUITE 214
CITY: DURHAM
STATE: NC
ZIP: 27703
BUSINESS PHONE: (888) 730-9374
MAIL ADDRESS:
STREET 1: 1005 SLATER ROAD, SUITE 214
CITY: DURHAM
STATE: NC
ZIP: 27703
D
1
primary_doc.xml
X0708
D
LIVE
0001725335
PATIENTPAY, INC.
1005 SLATER ROAD, SUITE 214
DURHAM
NC
NORTH CAROLINA
27703
(888) 730-9374
DELAWARE
None
None
Corporation
true
RICHMOND
BERNHARDT, III
1005 SLATER ROAD, SUITE 214
DURHAM
NC
NORTH CAROLINA
27703
Executive Officer
Director
Other Health Care
Decline to Disclose
- 06b
false
2017-11-28
false
true
false
25000
6025000
6025000
0
false
11
262500
0
262500
false
PATIENTPAY, INC.
/THOMAS FURR/
THOMAS FURR
CHIEF EXECUTIVE OFFICER
2017-12-14