0001345138-17-000001.txt : 20170124 0001345138-17-000001.hdr.sgml : 20170124 20170124163540 ACCESSION NUMBER: 0001345138-17-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170124 DATE AS OF CHANGE: 20170124 EFFECTIVENESS DATE: 20170124 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Specialty Surgical Center, LLC CENTRAL INDEX KEY: 0001345138 IRS NUMBER: 000000000 STATE OF INCORPORATION: CA FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-279128 FILM NUMBER: 17544123 BUSINESS ADDRESS: STREET 1: 40 BURTON HILLS BLVD STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 6152345900 MAIL ADDRESS: STREET 1: 40 BURTON HILLS BLVD STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 FORMER COMPANY: FORMER CONFORMED NAME: Specialty Surgical Center LLC DATE OF NAME CHANGE: 20051123 D 1 primary_doc.xml X0707 D LIVE 0001345138 Specialty Surgical Center, LLC 40 BURTON HILLS BLVD SUITE 500 NASHVILLE TN TENNESSEE 37215 6152345900 CALIFORNIA Specialty Surgical Center LLC Limited Liability Company true . Surgery Partners, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . SymbionARC Management Services, Inc. 40 Burton HIlls Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . Specialty Surgical Center of Beverly HIlls, L.P. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . SMBISS Beverly Hills, LLC 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Class B and Administrative Member of Issuer Peter Cornell, M.D. 8670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer James Khodabakhsh, M.D. 8670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer Jeffery Sherman, M.D. 8670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer Graham Woolf, M.D. 8670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer Matthew Lublin, M.D. 3670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer Michel Levesque, M.D. 3670 Wilshire Blvd. Suite 300 Beverly Hills CA CALIFORNIA 90211 Director Class A Governing Board Member of Issuer George Goodwin 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B Governing Board Member of Issuer Ryan Blickenstaff 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B Governing Board Member of Issuer Danny Bundren 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B Governing Board Member of Issuer Michael T. Doyle 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer President and Chief Executive Officer of Administrative Member Teresa Sparks 40 Burton HIlls Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Executive Vice President and Chief Financial Officer of Administrative Member Dennis Dean 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Senior Vice President and Controller of Administrative Member Jennifer B. Baldock 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Senior Vice President and Secretary of Administrative Member Hospitals and Physicians Decline to Disclose 06b false true false true true Contribution of assets by Eye Surgery Center of Beverly Hills, LLC (Transferor) to the Company in exchange for cash and Company units, which units are authorized to distribute directly to Transferor's owners. 15000 792000 0 792000 false 0 0 0 0 false Specialty Surgical Center, LLC /s/ Jennifer B. Baldock Jennifer B. Baldock Senior Vice President and Secretary of Administrative Member 2017-01-24