0001140361-18-009317.txt : 20180221 0001140361-18-009317.hdr.sgml : 20180221 20180221151019 ACCESSION NUMBER: 0001140361-18-009317 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180221 DATE AS OF CHANGE: 20180221 EFFECTIVENESS DATE: 20180221 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Form Energy, Inc. CENTRAL INDEX KEY: 0001717130 IRS NUMBER: 822266384 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-306143 FILM NUMBER: 18628120 BUSINESS ADDRESS: STREET 1: 44 PRINCE ST. CITY: CAMBRIDGE STATE: MA ZIP: 02139 BUSINESS PHONE: 617-401-7980 MAIL ADDRESS: STREET 1: 44 PRINCE ST. CITY: CAMBRIDGE STATE: MA ZIP: 02139 FORMER COMPANY: FORMER CONFORMED NAME: Baseload Renewables, Inc. DATE OF NAME CHANGE: 20170915 D 1 primary_doc.xml X0708 D LIVE 0001717130 Form Energy, Inc. 44 PRINCE ST. CAMBRIDGE MA MASSACHUSETTS 02139 617-401-7980 DELAWARE None Baseload Renewables, Inc. Corporation true 2017 Yet-Ming Chiang 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Executive Officer Director Theodore A. Wiley 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Executive Officer Director Mateo Jaramillo 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Director Katie Rae 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Director Gabriel Kra 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Director David Thomas Danielson 44 PRINCE ST. Cambridge MA MASSACHUSETTS 02139 Director Other Decline to Disclose 06b false 2018-02-06 false true false 0 7405001 7405001 0 false 7 0 0 0 false Form Energy, Inc. Theodore A. Wiley Theodore A. Wiley Chief Executive Officer 2018-02-21