0001061818-16-000003.txt : 20160715 0001061818-16-000003.hdr.sgml : 20160715 20160714174120 ACCESSION NUMBER: 0001061818-16-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160715 DATE AS OF CHANGE: 20160714 EFFECTIVENESS DATE: 20160715 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CORA HEALTH SERVICES INC CENTRAL INDEX KEY: 0001061818 IRS NUMBER: 341853567 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038 FILM NUMBER: 161768107 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: FIRST PHYSICAL THERAPY LLC CENTRAL INDEX KEY: 0001679152 IRS NUMBER: 571123400 STATE OF INCORPORATION: SC FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-04 FILM NUMBER: 161768111 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: MED/AID, LLC CENTRAL INDEX KEY: 0001679153 IRS NUMBER: 251546990 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-05 FILM NUMBER: 161768112 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: MEGA I, LLC CENTRAL INDEX KEY: 0001679155 IRS NUMBER: 251604318 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-06 FILM NUMBER: 161768113 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: TRIFLEX CARE, LLC CENTRAL INDEX KEY: 0001679156 IRS NUMBER: 472312756 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-03 FILM NUMBER: 161768110 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CORA GEORGIA LLC CENTRAL INDEX KEY: 0001679157 IRS NUMBER: 812815181 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-02 FILM NUMBER: 161768109 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CORA SOUTH CAROLINA LLC CENTRAL INDEX KEY: 0001679151 IRS NUMBER: 462814974 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-07 FILM NUMBER: 161768114 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CORA HEALTH HOLDINGS CORP. CENTRAL INDEX KEY: 0001679519 IRS NUMBER: 812613246 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-08 FILM NUMBER: 161768115 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CORA NORTH CAROLINA, LLC CENTRAL INDEX KEY: 0001679158 IRS NUMBER: 812222302 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-267038-01 FILM NUMBER: 161768108 BUSINESS ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 BUSINESS PHONE: (419) 221-3004 MAIL ADDRESS: STREET 1: 1110 SHAWNEE ROAD, BOX 150 CITY: LIMA STATE: OH ZIP: 45802 D 1 primary_doc.xml X0707 D LIVE 0001061818 CORA HEALTH SERVICES INC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE None None Corporation true 0001679519 CORA HEALTH HOLDINGS CORP. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE None None Corporation true 2016 0001679151 CORA SOUTH CAROLINA LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE None None Limited Liability Company true 2012 0001679155 MEGA I, LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE MEGA I CORP. None Limited Liability Company true 0001679153 MED/AID, LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE MED/AID, INC. None Limited Liability Company true 0001679152 FIRST PHYSICAL THERAPY LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 SOUTH CAROLINA None None Limited Liability Company true 0001679156 TRIFLEX CARE, LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE TRIFLEX CARE, INC. None Limited Liability Company true 2014 0001679157 CORA GEORGIA LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE None None Limited Liability Company true 2013 0001679158 CORA NORTH CAROLINA, LLC 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 (419) 221-3004 DELAWARE None None Limited Liability Company true 2016 DENNIS R. SMITH C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer Director STEPHEN KRZYMINSKI C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer JUSTIN A. BORRA C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer BRAD C. ROUSH C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer NICHOLAS A. ORUM C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer Director LUKE SCHROEDER C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Executive Officer Director WILLIARD E. LYNN C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Director MITCH TANNENBAUM C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Director ERIC WARNER C/O CORA HEALTH SERVICES, INC. 1110 SHAWNEE ROAD, BOX 150 LIMA OH OHIO 45802 Director Other Health Care Decline to Disclose 06b false 2016-06-30 true true true 0 21750000 10000000 11750000 false 6 0 0 0 false CORA HEALTH SERVICES INC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 CORA HEALTH HOLDINGS CORP. /S/ LUKE SCHROEDER LUKE SCHROEDER VP AND SECRETARY 2016-07-14 CORA SOUTH CAROLINA LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 MEGA I, LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 MED/AID, LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 FIRST PHYSICAL THERAPY LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 TRIFLEX CARE, LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 CORA GEORGIA LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11 CORA NORTH CAROLINA, LLC /S/ BRAD C. ROUSH BRAD C. ROUSH EVP, SECRETARY AND GC 2016-07-11