0001362118-22-000052.txt : 20220725 0001362118-22-000052.hdr.sgml : 20220725 20220725100718 ACCESSION NUMBER: 0001362118-22-000052 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220725 DATE AS OF CHANGE: 20220725 EFFECTIVENESS DATE: 20220725 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ReviveHealth, Inc. CENTRAL INDEX KEY: 0001920843 IRS NUMBER: 861279290 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-453503 FILM NUMBER: 221101924 BUSINESS ADDRESS: STREET 1: 5000 SAWGRASS VILLAGE CIRCLE STREET 2: SUITE 4 CITY: PONTE VEDRA BEACH STATE: FL ZIP: 32082 BUSINESS PHONE: 713-865-1772 MAIL ADDRESS: STREET 1: 5000 SAWGRASS VILLAGE CIRCLE STREET 2: SUITE 4 CITY: PONTE VEDRA BEACH STATE: FL ZIP: 32082 D 1 primary_doc.xml X0708 D LIVE 0001920843 ReviveHealth, Inc. 5000 SAWGRASS VILLAGE CIRCLE SUITE 4 PONTE VEDRA BEACH FL FLORIDA 32082 713-865-1772 DELAWARE None None Corporation true 2020 HOWARD BUFF 5000 SAWGRASS VILLAGE CIRCLE SUITE 4 PONTE VERDA BEACH FL FLORIDA 32082 Director JEFF BERNHARD 5000 SAWGRASS VILLAGE CIRCLE SUITE 4 PONTE VERDA BEACH FL FLORIDA 32082 Executive Officer Director MARK DUMOFF 5000 SAWGRASS VILLAGE CIRCLE SUITE 4 PONTE VERDA BEACH FL FLORIDA 32082 Director JOHN WALKER 5000 SAWGRASS VILLAGE CIRCLE PONTE VERDA BEACH FL FLORIDA 32082 Director STEVE LERCH 5000 SAWGRASS VILLAGE CIRCLE SUITE 4 PONTE VERDA BEACH FL FLORIDA 32082 Executive Officer Other Health Care Decline to Disclose 06b false 2022-01-05 false true false 0 1115874 1115874 0 false 5 0 0 0 false ReviveHealth, Inc. /s/ Jeff Bernhard Jeff Bernhard CEO 2022-07-23