| 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| Status: | Withdrawn |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 Services |
| 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
