0001567619-19-017457.txt : 20190822 0001567619-19-017457.hdr.sgml : 20190822 20190822142458 ACCESSION NUMBER: 0001567619-19-017457 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190822 DATE AS OF CHANGE: 20190822 EFFECTIVENESS DATE: 20190822 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: 021-347202 FILM NUMBER: 191045660 BUSINESS ADDRESS: STREET 1: 444 SOMERVILLE AVE CITY: SOMERVILLE STATE: MA ZIP: 02143 BUSINESS PHONE: 844-367-6462 MAIL ADDRESS: STREET 1: 444 SOMERVILLE AVE CITY: SOMERVILLE STATE: MA ZIP: 02143 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. 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 844-367-6462 DELAWARE None Baseload Renewables, Inc. Corporation true 2017 Mateo Jaramillo 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Executive Officer Director Theodore A. Wiley 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Executive Officer Director Katie Rae 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Director Gabriel Kra 444 SOMERVILLE AVE som MA MASSACHUSETTS 02143 Director David Thomas Danielson 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Director Massimiliano Pieri 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Director Michael Skelly 444 SOMERVILLE AVE SOMERVILLE MA MASSACHUSETTS 02143 Director Other Decline to Disclose 06b false 2019-08-07 false true false 0 39999996 39999996 0 false 9 0 0 0 false Form Energy, Inc. Mateo Jaramillo Mateo Jaramillo Chief Executive Officer 2019-08-22