Morningstar Document Research: Filings

Form D

FORM D

Notice of Exempt Offering of Securities

UNITED STATES SECURITIES
AND EXCHANGE COMMISSION
Washington, D.C.

OMB APPROVAL

OMB Number: 3235-0076

Expires: June 30, 2012

Estimated Average burden hours per response: 4.0

1. Issuer's Identity

CIK (Filer ID Number)

Previous Name(s)

None

Entity Type

0001420030

Corporation

Limited Partnership

Limited Liability Company

General Partnership

Business Trust

Other

Name of Issuer

Targeted Medical Pharma, Inc.

Jurisdiction of Incorporation/Organization

DELAWARE

Year of Incorporation/Organization

Over Five Years Ago

Within Last Five Years (Specify Year)

2007

Yet to Be Formed

2. Principal Place of Business and Contact Information

Name of Issuer

Targeted Medical Pharma, Inc.

Street Address 1

Street Address 2

2980 BEVERLY GLEN CIRCLE

SUITE 301

City

State/Province/Country

ZIP/Postal Code

Phone No. of Issuer

LOS ANGELES

CALIFORNIA

90077

310-474-9809

3. Related Persons

Last Name

First Name

Middle Name

Shell, MD

William

E.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Charuvastra

Elizabeth

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Giffoni

Kim

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Warnecke

Steve

B.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Blachman

Amir

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

DeWald

Maurice

J.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Webster

Donald

J.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Nemiroff

Arthur

R.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer

Director

Promoter

Clarification of Response (if Necessary)

Last Name

First Name

Middle Name

Bluher

John

H.

Street Address 1

Street Address 2

2980 Beverly Glen Circle

Suite 301

City

State/Province/Country

ZIP/Postal Code

Los Angeles

CALIFORNIA

90077

Relationship:

Executive Officer