0001725335-17-000002.txt : 20171214 0001725335-17-000002.hdr.sgml : 20171214 20171214150303 ACCESSION NUMBER: 0001725335-17-000002 CONFORMED SUBMISSION TYPE: D/A 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/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-300721 FILM NUMBER: 171255958 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/A 1 primary_doc.xml X0708 D/A 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 THEODORE CALDWELL 1005 SLATER ROAD, SUITE 214 DURHAM NC NORTH CAROLINA 27703 Director THOMAS FURR 1005 SLATER ROAD, SUITE 214 DURHAM NC NORTH CAROLINA 27703 Executive Officer Director E. MILES KILBURN 1005 SLATER ROAD, SUITE 214 DURHAM NC NORTH CAROLINA 27703 Director PETER HUNT 1005 SLATER ROAD, SUITE 214 DURHAM NC NORTH CAROLINA 27703 Director Other Health Care Decline to Disclose 06b true 0001725335-17-000001 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