0001795015-21-000001.txt : 20211105 0001795015-21-000001.hdr.sgml : 20211105 20211105170350 ACCESSION NUMBER: 0001795015-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211105 DATE AS OF CHANGE: 20211105 EFFECTIVENESS DATE: 20211105 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Samasource Impact Sourcing, Inc. CENTRAL INDEX KEY: 0001795015 IRS NUMBER: 831229156 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-420133 FILM NUMBER: 211385436 BUSINESS ADDRESS: STREET 1: 2017 MISSION STREET, SUITE 301 CITY: SAN FRANCISCO STATE: CA ZIP: 94110 BUSINESS PHONE: 206-769-8709 MAIL ADDRESS: STREET 1: 2017 MISSION STREET, SUITE 301 CITY: SAN FRANCISCO STATE: CA ZIP: 94110 D 1 primary_doc.xml X0708 D LIVE 0001795015 Samasource Impact Sourcing, Inc. 2017 MISSION STREET, SUITE 301 SAN FRANCISCO CA CALIFORNIA 94110 206-769-8709 DELAWARE None None Corporation true 2018 Wendy Gonzalez c/o Samasource Impact Sourcing, Inc. 2017 Mission Street, Suite 301 San Francisco CA CALIFORNIA 94110 Executive Officer Director Colby Moosman c/o Samasource Impact Sourcing, Inc. 2017 Mission Street, Suite 301 San Francisco CA CALIFORNIA 94110 Executive Officer Johann Schleier-Smith c/o Samasource Impact Sourcing, Inc. 2017 Mission Street, Suite 301 San Francisco CA CALIFORNIA 94110 Director Brendan Baker c/o Samasource Impact Sourcing, Inc. 2017 Mission Street, Suite 301 San Francisco CA CALIFORNIA 94110 Director Jean Wisch (Wils) Theagene c/o Samasource Impact Sourcing, Inc. 2017 Mission Street, Suite 301 San Francisco CA CALIFORNIA 94110 Director Other Technology Decline to Disclose 06b false 2021-10-26 false true false 0 70438130 63938144 6499986 false 9 0 0 0 false Samasource Impact Sourcing, Inc. /s/ Wendy Gonzalez Wendy Gonzalez Chief Executive Officer of the Issuer 2021-11-05