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