0001014100-15-000019.txt : 20150814 0001014100-15-000019.hdr.sgml : 20150814 20150814093155 ACCESSION NUMBER: 0001014100-15-000019 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20150814 DATE AS OF CHANGE: 20150814 EFFECTIVENESS DATE: 20150814 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Prestige Physicians Group IPA, LLC CENTRAL INDEX KEY: 0001650904 IRS NUMBER: 474240429 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-245777 FILM NUMBER: 151052888 BUSINESS ADDRESS: STREET 1: 1 UNION AVE. STREET 2: P.O. BOX 2439 CITY: BALA CYNWYD STATE: PA ZIP: 19004 BUSINESS PHONE: 267-238-5602 MAIL ADDRESS: STREET 1: 1 UNION AVE. STREET 2: P.O. BOX 2439 CITY: BALA CYNWYD STATE: PA ZIP: 19004 D 1 primary_doc.xml X0707 D LIVE 0001650904 Prestige Physicians Group IPA, LLC 1 UNION AVE. BALA CYNWYD PA PENNSYLVANIA 19004 267-238-5602 DELAWARE None None Limited Liability Company true 2015 Rainosek Richele 1 Union Ave. P.O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Representative of Class B Manager Oung Thain 1 Union Ave. P.O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Class A Manager Donna M. Gavarone 1 Union Ave. P.O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Class A Manager Andrew S. Poulshock 1 Union Ave. P.O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Class A Manager John V. Tumasz 1 Union Ave. P.O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Class A Manager Joseph Pongonis 1 Union Ave. P. O. Box 2439 Bala Cynwyd PA PENNSYLVANIA 19004 Director Promoter Class A Manager Hospitals and Physicians Decline to Disclose 06b false 2015-08-06 false true false 1250 56250 28750 27500 false 5 0 0 0 false Prestige Physicians Group IPA, LLC /s/ Richele Rainosek Richele Rainosek Class B Manager Representative 2015-08-12