0001926185-22-000001.txt : 20220502 0001926185-22-000001.hdr.sgml : 20220502 20220502141859 ACCESSION NUMBER: 0001926185-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220502 DATE AS OF CHANGE: 20220502 EFFECTIVENESS DATE: 20220502 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Periscope Health Analytics, Inc. CENTRAL INDEX KEY: 0001926185 IRS NUMBER: 873035574 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-444070 FILM NUMBER: 22881158 BUSINESS ADDRESS: STREET 1: 213 WHITEROCK DRIVE CITY: MOUNT HOLLY STATE: NC ZIP: 28120 BUSINESS PHONE: 919-649-3088 MAIL ADDRESS: STREET 1: 213 WHITEROCK DRIVE CITY: MOUNT HOLLY STATE: NC ZIP: 28120 D 1 primary_doc.xml X0708 D LIVE 0001926185 Periscope Health Analytics, Inc. 125 W Tremont Ave Apt. 808 Charlotte NC NORTH CAROLINA 28203 919-649-3088 DELAWARE Integrated Health Research, Inc. None Corporation true 2021 Wallace C. Hollowell, III 125 W Tremont Ave Apt. 808 Charlotte NC NORTH CAROLINA 28203 Executive Officer Director Vice President, Corporate Secretary, and Director of Issuer Charles G. Sutten, III 125 W Tremont Ave Apt. 808 Charlotte NC NORTH CAROLINA 28203 Executive Officer Director President/CEO of Issuer Amy Kazmierczak 125 W Tremont Ave Apt. 808 Charlotte NC NORTH CAROLINA 28203 Executive Officer Other Health Care Decline to Disclose 06b false 2022-04-22 false true false 25000 4000000 575000 3425000 false 9 0 0 50000 The Issuer intends to use $50,000.00 in proceeds to repay a prior promissory note held by an executive officer, which amount is being rolled over into a Simple Agreement for Future Equity being issued to such executive officer in the offering. false Periscope Health Analytics, Inc. /s/ Wallace C. Hollowell, III Wallace C. Hollowell, III Vice President, Corporate Secretary, and Director of Issuer 2022-05-02