0001725335-21-000001.txt : 20211012 0001725335-21-000001.hdr.sgml : 20211012 20211012112210 ACCESSION NUMBER: 0001725335-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211012 DATE AS OF CHANGE: 20211012 EFFECTIVENESS DATE: 20211012 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: 021-416511 FILM NUMBER: 211317745 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 100 DURHAM NC NORTH CAROLINA 27703 919-794-8080 DELAWARE None None Corporation true Thomas Furr 1005 Slater Road, Suite 100 Durham NC NORTH CAROLINA 27703 Executive Officer Director Gerald L. Wallace Jr. 1005 Slater Road, Suite 100 Durham NC NORTH CAROLINA 27703 Director Lou Silverman 1005 Slater Road, Suite 100 Durham NC NORTH CAROLINA 27703 Director E. Miles Kilburn 1005 Slater Road, Suite 100 Durham NC NORTH CAROLINA 27703 Director Mark Tomaino 1005 Slater Road, Suite 100 Durham NC NORTH CAROLINA 27703 Director Other Not Applicable 06b false 2021-08-20 false true false 21060 12172604 12172604 0 false 34 0 0 0 false PATIENTPAY, INC. /Thomas Furr/ Thomas Furr Chief Executive Officer 2021-10-12