0001691252-16-000001.txt : 20161207 0001691252-16-000001.hdr.sgml : 20161207 20161207123749 ACCESSION NUMBER: 0001691252-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161207 DATE AS OF CHANGE: 20161207 EFFECTIVENESS DATE: 20161207 FILER: COMPANY DATA: COMPANY CONFORMED NAME: I-Pass Patient Safety Institute, Inc. CENTRAL INDEX KEY: 0001691252 IRS NUMBER: 812378891 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-275785 FILM NUMBER: 162038268 BUSINESS ADDRESS: STREET 1: 275 GROVE STREET, SUITE 2-400 CITY: NEWTON STATE: MA ZIP: 02466 BUSINESS PHONE: 508-740-5689 MAIL ADDRESS: STREET 1: 275 GROVE STREET, SUITE 2-400 CITY: NEWTON STATE: MA ZIP: 02466 D 1 primary_doc.xml X0707 D LIVE 0001691252 I-Pass Patient Safety Institute, Inc. 275 GROVE STREET, SUITE 2-400 NEWTON MA MASSACHUSETTS 02466 508-740-5689 DELAWARE None None Corporation true 2016 William Floyd 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Executive Officer Director Tim O'Shea 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Executive Officer Director Ronald Scott Pitt 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Executive Officer Christopher Landrigan 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Director Nancy D. Spector 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Director Amy J. Starmer 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Director Ted Sectish 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Director Zachary M. Zeitlin 275 Grove Street, Suite 2-400 Newton MA MASSACHUSETTS 02466 Director Other Technology Decline to Disclose 06b false 2016-11-23 false true false 10000 1500000 1300000 200000 false 9 0 0 0 false I-Pass Patient Safety Institute, Inc. Ronald Scott Pitt Ronald Scott Pitt CFO 2016-12-07