0001437749-16-036643.txt : 20160808 0001437749-16-036643.hdr.sgml : 20160808 20160808081029 ACCESSION NUMBER: 0001437749-16-036643 CONFORMED SUBMISSION TYPE: 15-12B PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20160808 DATE AS OF CHANGE: 20160808 EFFECTIVENESS DATE: 20160808 FILER: COMPANY DATA: COMPANY CONFORMED NAME: ExamWorks Group, Inc. CENTRAL INDEX KEY: 0001498021 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000] IRS NUMBER: 272909425 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 15-12B SEC ACT: 1934 Act SEC FILE NUMBER: 001-34930 FILM NUMBER: 161812789 BUSINESS ADDRESS: STREET 1: 3280 PEACHTREE ROAD STREET 2: SUITE 2625 CITY: ATLANTA STATE: GA ZIP: 30305 BUSINESS PHONE: 404-952-2400 MAIL ADDRESS: STREET 1: 3280 PEACHTREE ROAD STREET 2: SUITE 2625 CITY: ATLANTA STATE: GA ZIP: 30305 15-12B 1 exam20160805_1512b.htm FORM 15-12B exam20160805_1512b.htm

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

FORM 15

 

 

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934

OR SUSPENSION OF DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

 

Commission File Number 001-34930

 

 

ExamWorks Group, Inc.

(Exact name of registrant as specified in its charter)

 

 

3280 Peachtree Road, N.E.

Suite 2625

Atlanta, GA 30305

(404) 952-2400

(Address, including zip code, and telephone number, including area code, of registrant’s principal executive offices)

 

Common Stock, $0.0001 par value per share

(Title of each class of securities covered by this Form)

 

None

(Titles of all other classes of securities for which a duty to file reports under section 13(a) or 15(d) remains)

 

 

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

 

 

 

Rule 12g-4(a)(1)

☒

 

 

 

Rule 12g-4(a)(2)

☐

 

    Rule 12h-3(b)(1)(i) ☒  
    Rule 12h-3(b)(1)(ii) ☐  
    Rule 15d-6 ☐  
    Rule 15d-22(b)       ☐  

 

Approximate number of holders of record as of the certification or notice date: One

 

 
 
 

 

 

 

Pursuant to the requirements of the Securities Exchange Act of 1934, ExamWorks Group, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

 

 

 

 

 

ExamWorks Group, Inc.

 

 

 

 

 

       

Date: August 8, 2016   

By:

/s/ J. Miguel Fernandez de Castro

 

 

 

J. Miguel Fernandez de Castro

 

    Chief Financial Officer and Senior Executive  

 

 

Vice President