0001345687-13-000001.txt : 20131203 0001345687-13-000001.hdr.sgml : 20131203 20131203115051 ACCESSION NUMBER: 0001345687-13-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20131203 DATE AS OF CHANGE: 20131203 EFFECTIVENESS DATE: 20131203 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Specialty Surgical Center of Thousand Oaks, LLC CENTRAL INDEX KEY: 0001345687 IRS NUMBER: 000000000 STATE OF INCORPORATION: CA FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-207284 FILM NUMBER: 131253679 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 of Thousand Oaks LLC DATE OF NAME CHANGE: 20051130 D 1 primary_doc.xml X0707 D LIVE 0001345687 Specialty Surgical Center of Thousand Oaks, LLC 40 BURTON HILLS BLVD SUITE 500 NASHVILLE TN TENNESSEE 37215 6152345900 CALIFORNIA Specialty Surgical Center of Thousand Oaks LLC Limited Liability Company true . Symbion Holdings Corporation 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . Symbion, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . Symbion Ambulatory Resource Centres, 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 . SMBISS Thousand Oaks, LLC 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Promoter Administrative Member and Class B Member of Issuer . Specialty Surgical Center of Thousand Oaks, L.P. 40 Burton HIlls Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Andrew A. Brooks, M.D. 696 Hampshire Road Suite 100 Westlake Village CA CALIFORNIA 91361 Director Class A Governing Board Member David Chi, M.D. 696 Hampshire Road Suite 100 Westlake Village CA CALIFORNIA 91361 Director Class A Governing Board Member Glenn Cohen, M.D. 696 Hampshire Road Suite 100 Westlake Village CA CALIFORNIA 91361 Director Class A Governing Board Member Mark Farnum, M.D. 696 Hampshire Road Suite 100 Westlake Village CA CALIFORNIA 91361 Director Class A Governing Board Member George Goodwin 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B Governing Board Member and Vice President of Administrative Member G. Miles Kennedy 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Director Class B Governing Board Member and Assistant Secretary of Administrative Member Clifford G. Adlerz 40 Burton HIlls Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Chief Executive Officer and President of Administrative Member Jennifer B. Baldock 40 Burton Hills Blvds. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President and Secretary of Administrative Member Kenneth C. Mitchell 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Administrative Member Teresa F. Sparks 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Chief Financial Officer and Vice President of Administrative Member Anthony Taparo 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Administrative Member John Crysel 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Administrative Member Ronald L. Brank 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Assistant Secretary of Administrative Member Darrel Naish 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Assistant Secretary of Administrative Member Hospitals and Physicians Decline to Disclose 06b false true false true false 17261 John Riddle 2441613 Brown, Gibbs, Lang & Company Securities, Inc. 20540 One Magnificent Mile 980 North Michigan, Suite 1880 Chicago IL ILLINOIS 60611 CA CALIFORNIA false 1465113 0 1465113 false 0 25000 0 0 The gross proceeds from sale of the 84.88 Units will be used to fund a special distribution to the existing Members immediately prior to the closing of this offering to compensate such members for their dilution of their membership interests. false Specialty Surgical Center of Thousand Oaks, LLC Jennifer B. Baldock Jennifer B. Baldock Vice President and Secretary 2013-12-03