0001313842-14-000001.txt : 20140110 0001313842-14-000001.hdr.sgml : 20140110 20140110145757 ACCESSION NUMBER: 0001313842-14-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20140110 DATE AS OF CHANGE: 20140110 EFFECTIVENESS DATE: 20140110 FILER: COMPANY DATA: COMPANY CONFORMED NAME: FIDELIS SENIORCARE INC CENTRAL INDEX KEY: 0001313842 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-199484 FILM NUMBER: 14521587 BUSINESS ADDRESS: STREET 1: 20 NORTH MARTINGALE ROAD STREET 2: SUITE 180 CITY: SCHAUMBERG STATE: IL ZIP: 60173 BUSINESS PHONE: 8476050501 MAIL ADDRESS: STREET 1: 20 NORTH MARTINGALE ROAD STREET 2: SUITE 180 CITY: SCHAUMBERG STATE: IL ZIP: 60173 FORMER COMPANY: FORMER CONFORMED NAME: Fidelis SeniorCare, Inc. DATE OF NAME CHANGE: 20121001 FORMER COMPANY: FORMER CONFORMED NAME: FIDELIS SENIORCARE INC DATE OF NAME CHANGE: 20050107 D/A 1 primary_doc.xml X0707 D/A LIVE 0001313842 FIDELIS SENIORCARE INC 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 8476050501 DELAWARE Fidelis SeniorCare, Inc. FIDELIS SENIORCARE INC Corporation true Samuel R. Willcoxon 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Executive Officer Director Ramsay Battin 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Bruce Fried 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Barbara Lubash 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Corey Mulloy 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Greg Weinhoff 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Edward Wristen 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Timothy Petersen 20 NORTH MARTINGALE ROAD SUITE 180 SCHAUMBERG IL ILLINOIS 60173 Director Other Health Care Decline to Disclose 06b true 0001313842-13-000003 2013-06-28 false true true true false 0 9700000 7165360 2534640 Principal and interest on the notes may be, and in certain cases, shall be, converted into issuer's equity securities in a subsequent financing. Warrants exercisable for preferred stock for which consideration will only be upon exercise of the warrants. false 18 0 0 0 false FIDELIS SENIORCARE INC /s/ Kim R. Tulsky Kim R. Tulsky Secretary 2014-01-10