0001621611-14-000001.txt : 20141008 0001621611-14-000001.hdr.sgml : 20141008 20141008111357 ACCESSION NUMBER: 0001621611-14-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20141008 DATE AS OF CHANGE: 20141008 EFFECTIVENESS DATE: 20141008 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Cape Coral Ambulatory Surgery Center, LLC CENTRAL INDEX KEY: 0001621611 IRS NUMBER: 203711421 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-226019 FILM NUMBER: 141147235 BUSINESS ADDRESS: STREET 1: 40 BURTON HILLS BLVD. STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 615-234-5900 MAIL ADDRESS: STREET 1: 40 BURTON HILLS BLVD. STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 D 1 primary_doc.xml X0707 D LIVE 0001621611 Cape Coral Ambulatory Surgery Center, LLC 40 BURTON HILLS BLVD. SUITE 500 NASHVILLE TN TENNESSEE 37215 615-234-5900 FLORIDA None None 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 . SymbionARC Management Services, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . SMBIMS Florida I, LLC 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Class B Member of Issuer . Cape Outpatient Surgical Team, LLC 2721 Del Prado Blvd. Suite 160 Cape Coral FL FLORIDA 33908 Promoter Class A Member of Issuer John C. Kagan 2721 Del Prado Blvd. Suite 160 Cape Coral FL FLORIDA 33908 Director Member of Board of Managers of Issuer Wayne Isaacson 2721 Del Prado Blvd. Suite 160 Cape Coral FL FLORIDA 33908 Director Member of Board of Managers of Issuer Jeff Bruener 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Member of Board of Managers of Issuer Clifford D. Adlerz 40 Burton Hills Blvd. Suite 500 Nashvile TN TENNESSEE 37215 Executive Officer Chief Executive Officer and President of Class B Member Jennifer B. Baldock 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President and Secretary of Class B Member Kenneth C. Mitchell 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Class B Member Teresa F. Sparks 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Chief Financial Officer and Vice President of Class B Member Anthony Taparo 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Member of Board of Managers of Issuer and Vice President of Class B Member George Goodwin 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Class B Member John Crysel 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Vice President of Class B Member Miles Kennedy 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Assistant Secretary of Class B Member Ronald L. Brank 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Assistant Secretary of Class B Member Darrel Naish 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Assistant Secretary of Class B Member Hospitals and Physicians Decline to Disclose 06b false true false true false 10000 250000 0 250000 false 0 0 0 0 The gross proceeds from the sale of the first 18.28 Units will be used to fund the working capital needs of Issuer. Proceeds from the remaining Units sold will be used to redeem the same number of Units from the Class B Member. false Cape Coral Ambulatory Surgery Center, LLC Jennifer B. Baldock Jennifer B. Baldock Vice President and Secretary of Class B Member 2014-10-08