0001243233-21-000003.txt : 20211001 0001243233-21-000003.hdr.sgml : 20211001 20211001144506 ACCESSION NUMBER: 0001243233-21-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211001 DATE AS OF CHANGE: 20211001 EFFECTIVENESS DATE: 20211001 FILER: COMPANY DATA: COMPANY CONFORMED NAME: System Initiative, Inc. CENTRAL INDEX KEY: 0001783955 IRS NUMBER: 841997091 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-415414 FILM NUMBER: 211298434 BUSINESS ADDRESS: STREET 1: 548 MARKET STREET STREET 2: SUITE 66061 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 310-773-7664 MAIL ADDRESS: STREET 1: 548 MARKET STREET STREET 2: SUITE 66061 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 D 1 primary_doc.xml X0708 D LIVE 0001783955 System Initiative, Inc. 548 Market Street Suite 66061 San Francisco CA CALIFORNIA 94104 310-773-7664 DELAWARE None None Corporation true 2019 Adam Brent Jacob c/o System Initiative, Inc. 548 Market Street, Suite 66061 San Francisco CA CALIFORNIA 94104 Executive Officer Director Alexandre Ethier c/o System Initiative, Inc. 548 Market Street, Suite 66061 San Francisco CA CALIFORNIA 94104 Executive Officer Director Mahir Lupinacci c/o System Initiative, Inc. 548 Market Street, Suite 66061 San Francisco CA CALIFORNIA 94104 Executive Officer Sunil Dhaliwal c/o Amplify Partners 800 Menlo Avenue, Suite 220 Menlo Park CA CALIFORNIA 94025 Director Other Technology Decline to Disclose 06b false 2019-07-22 false true true Series Seed Preferred Stock and Common Stock issuable upon conversion false 0 2999999 2999999 0 false 4 0 0 0 false System Initiative, Inc. /s/ Adam Brent Jacob Adam Brent Jacob Chief Executive Officer 2021-09-30