0001362118-15-000003.txt : 20150122 0001362118-15-000003.hdr.sgml : 20150122 20150122100157 ACCESSION NUMBER: 0001362118-15-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20150122 DATE AS OF CHANGE: 20150122 EFFECTIVENESS DATE: 20150122 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Forward Health Group, Inc. CENTRAL INDEX KEY: 0001474300 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-232676 FILM NUMBER: 15540386 BUSINESS ADDRESS: STREET 1: 44 EAST MIFFLIN STREET STREET 2: SUITE 601 CITY: MADISON STATE: WI ZIP: 53703 BUSINESS PHONE: 800-805-8590 MAIL ADDRESS: STREET 1: 44 EAST MIFFLIN STREET STREET 2: SUITE 601 CITY: MADISON STATE: WI ZIP: 53703 D 1 primary_doc.xml X0707 D LIVE 0001474300 Forward Health Group, Inc. 44 EAST MIFFLIN STREET SUITE 601 MADISON WI WISCONSIN 53703 608-729-7530 DELAWARE None None Corporation true 2014 MICHAEL BARBOUCHE 44 EAST MIFFLIN STREET #601 MADISON WI WISCONSIN 53703 Executive Officer Director BRYAN BECKER 44 EAST MIFFLIN STREET #601 MADISON WI WISCONSIN 53703 Director MICHAEL C. BINGHAM 44 EAST MIFFLIN STREET #601 MADISON WI WISCONSIN 53703 Director CONOR GREEN 44 EAST MIFFLIN STREET #601 MADISON WI WISCONSIN 53703 Director NANCY SIELAFF 44 EAST MIFFLIN STREET #601 MADISON WI WISCONSIN 53703 Executive Officer Other Health Care Decline to Disclose 06b false 2014-09-18 false true false 0 5000000 5000000 0 false 1 0 0 0 false Forward Health Group, Inc. /s/ Michael Barbouche Michael Barbouche CEO 2015-01-20