Form Health, Inc. — Form D
Form Health, Inc. of Boston, MA, a company, filed a Form D exempt-offering notice with the SEC on 2019-06-10. The offering totals $3.6M, of which $3.4M was reported sold. Industry: Other Health Care.
Offering
- Filed: 2019-06-10
- Form: D
- Accession: 0001779388-19-000001
- Industry: Other Health Care
- Exemptions: 06b
- Total offering: $3.6M
- Amount sold: $3.4M
- Remaining: $165K
- Investors: 9
- Date of first sale: 2019-05-24
- Security types: equity
- Revenue range: Decline to Disclose
- SEC file number: 021-341522
Issuer
- Name: Form Health, Inc.
- CIK: 0001779388
- Entity type: Corporation
- Jurisdiction: DELAWARE
- Incorporated: 2019
- Address: 109 State Street, Boston, MA, 02109
- Phone: (617) 505-1520
Officers, directors & promoters (5)
| Name | Role | Location |
|---|
| Latif Peracha | Director | New York, NY |
| Evan Richardson | Director | Boston, MA |
| Evan Richardson | Executive Officer | Boston, MA |
| Evan Richardson | Promoter | Boston, MA |
| Juliette Bolea | Director | Brooklyn, NY |
Other filings by this issuer (6)
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