0001677276-16-000001.txt : 20160620 0001677276-16-000001.hdr.sgml : 20160620 20160620141953 ACCESSION NUMBER: 0001677276-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160620 DATE AS OF CHANGE: 20160620 EFFECTIVENESS DATE: 20160620 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Palm Bay Ambulatory Surgical Center, LLC CENTRAL INDEX KEY: 0001677276 IRS NUMBER: 384005324 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-265386 FILM NUMBER: 161721875 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 0001677276 Palm Bay Ambulatory Surgical Center, LLC 40 BURTON HILLS BLVD. SUITE 500 NASHVILLE TN TENNESSEE 37215 615-234-5900 DELAWARE None None Limited Liability Company true 2016 . Surgery Center Holdings, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Class B Member and Administrative Member of Issuer . Surgery Partners, Inc. 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Promoter Michael T. Doyle 40 Burton Hills Blvd. Suite 500 Nashville TN TENNESSEE 37215 Executive Officer Chief Executive Officer and President of Administrative Member Teresa F. 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 Corporate 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 false 32000 1600000 0 1600000 false 0 0 0 0 false Palm Bay Ambulatory Surgical Center, LLC /s/ Jennifer B. Baldock Jennifer B. Baldock Senior Vice President and Secretary of Administrative Member 2016-06-20