| Name: | Formativ Health Management, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Withdrawn |
| Date of Organization in Rhode Island: | 21 Dec 2017 (7 years ago) |
| Date of Dissolution: | 21 May 2021 (4 years ago) |
| Date of Status Change: | 21 May 2021 (4 years ago) |
| Identification Number: | 001679830 |
| Place of Formation: | DELAWARE |
| Principal Address: | 4875 BELFORT RD, JACKSONVILLE, FL, 32256, USA |
| Mailing Address: | 4875 BELFORT ROAD, JACKSONVILLE, FL, 32256, USA |
| Purpose: | PATIENT ACCESS REVENUE CYCLE MANAGEMENT PRACTICE OPERATIONS SERVICES |
NAICS
541219 Other Accounting ServicesThis U.S. industry comprises establishments (except offices of CPAs) engaged in providing accounting services (except tax return preparation services only or payroll services only). These establishments may also provide tax return preparation or payroll services. Accountant (except CPA) offices, bookkeeper offices, and billing offices are included in this industry. Learn more at the U.S. Census Bureau
| Name | Role | Address |
|---|---|---|
| HOLLY KOEHLER | PRESIDENT | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Name | Role | Address |
|---|---|---|
| LAURENCE KRAEMER | SECRETARY | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Name | Role | Address |
|---|---|---|
| HOLLY KOEHLER | CEO | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Name | Role | Address |
|---|---|---|
| MICHELE CUSACK | CFO | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Name | Role | Address |
|---|---|---|
| EUGENE TANGNEY | CHIEF ADMINISTRATIVE OFFICER | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Name | Role | Address |
|---|---|---|
| EUGENE TANGNEY | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| MARK SOLAZZO | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| LAURENCE KRAEMER | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| HOLLY KOEHLER | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| JOSEPH MOSCOLA | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| MICHELE CUSACK | DIRECTOR | 4875 BELFORT RD JACKSONVILLE, FL 32256 USA |
| Number | Name | File Date |
|---|---|---|
| 202107308980 | Agent Resigned | 2021-12-15 |
| 202197116010 | Application for Certificate of Withdrawal | 2021-05-21 |
| 202188063910 | Annual Report | 2021-01-28 |
| 202035556970 | Annual Report | 2020-02-28 |
| 201991202480 | Annual Report | 2019-04-26 |
| 201857955860 | Annual Report | 2018-02-09 |
| 201755270290 | Application for Certificate of Authority | 2017-12-21 |
Date of last update: 27 Oct 2024
Sources: Rhode Island Department of State
