0001567619-21-007202.txt : 20210331 0001567619-21-007202.hdr.sgml : 20210331 20210330173246 ACCESSION NUMBER: 0001567619-21-007202 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210331 DATE AS OF CHANGE: 20210330 EFFECTIVENESS DATE: 20210331 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/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-375494 FILM NUMBER: 21788451 BUSINESS ADDRESS: STREET 1: 30 DANE STREET CITY: SOMERVILLE STATE: MA ZIP: 02143 BUSINESS PHONE: 844-367-6462 MAIL ADDRESS: STREET 1: 30 DANE STREET CITY: SOMERVILLE STATE: MA ZIP: 02143 FORMER COMPANY: FORMER CONFORMED NAME: Baseload Renewables, Inc. DATE OF NAME CHANGE: 20170915 D/A 1 primary_doc.xml X0708 D/A LIVE 0001717130 Form Energy, Inc. 30 Dane Street SOMERVILLE MA MASSACHUSETTS 02143 844-367-6462 DELAWARE None Baseload Renewables, Inc. Corporation true 2017 Michael Skelly 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director Theodore A. Wiley 30 Dane Street Somerville MA MASSACHUSETTS 02143 Executive Officer Mateo Jaramillo 30 Dane Street Somerville MA MASSACHUSETTS 02143 Executive Officer Director Katie Rae 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director Gabriel Kra 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director David Thomas Danielson 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director Massimiliano Pieri 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director William Henry Woodford IV 30 Dane Street Somerville MA MASSACHUSETTS 02143 Executive Officer Philip J. Deutch 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director Yet-Ming Chiang 30 Dane Street Somerville MA MASSACHUSETTS 02143 Director Other Decline to Disclose 06b true 0001567619-20-016703 2020-08-28 false true false 0 75999942 75999942 0 false 19 0 0 0 false Form Energy, Inc. /s/ Mateo Jaramillo Mateo Jaramillo Chief Executive Officer 2021-03-30