0001665636-16-000001.txt : 20160204 0001665636-16-000001.hdr.sgml : 20160204 20160204165350 ACCESSION NUMBER: 0001665636-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160204 DATE AS OF CHANGE: 20160204 EFFECTIVENESS DATE: 20160204 FILER: COMPANY DATA: COMPANY CONFORMED NAME: United ASC Holding Company, LLC CENTRAL INDEX KEY: 0001665636 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-256778 FILM NUMBER: 161389019 BUSINESS ADDRESS: STREET 1: 40 BURTON HILLS BLVD. STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 615-234-5935 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 0001665636 United ASC Holding Company, LLC 40 BURTON HILLS BLVD. SUITE 500 NASHVILLE TN TENNESSEE 37215 615-234-5935 DELAWARE None None Limited Liability Company true 2016 . Surgery Center Holdings, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . Surgery Partners, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter . NovaMed Acquisition Company, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Class B Member and Administrative Member of Issuer John Blanck 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B 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 Chad Baldwin 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Director Class B Governing Board Member of Issuer Jennifer B. Baldock 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Executive Officer of Surgery Center Holdings, Inc. and Administrative Member Hospitals and Physicians Decline to Disclose 06b false 2016-02-01 false true true The offering involved an exchange of interests in two entities for membership interests in a newly formed holding company. 0 18376107 18376107 0 false 5 0 0 0 false United ASC Holding Company, LLC /s/ Jennifer B. Baldock Jennifer B. Baldock Senior Vice President and Secretary of Administrative Member 2016-02-04