0001683659-16-000001.txt : 20160907 0001683659-16-000001.hdr.sgml : 20160907 20160907165645 ACCESSION NUMBER: 0001683659-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160907 DATE AS OF CHANGE: 20160907 EFFECTIVENESS DATE: 20160907 FILER: COMPANY DATA: COMPANY CONFORMED NAME: MONTICELLO SURGERY CENTER, LLC CENTRAL INDEX KEY: 0001683659 IRS NUMBER: 813593057 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-270217 FILM NUMBER: 161873939 BUSINESS ADDRESS: STREET 1: 1013 HART BLVD. CITY: MONTICELLO STATE: MN ZIP: 55362 BUSINESS PHONE: (763) 295-2945 MAIL ADDRESS: STREET 1: 1013 HART BLVD. CITY: MONTICELLO STATE: MN ZIP: 55362 D 1 primary_doc.xml X0707 D LIVE 0001683659 MONTICELLO SURGERY CENTER, LLC 1013 HART BLVD. MONTICELLO MN MINNESOTA 55362 (763) 295-2945 MINNESOTA None None Limited Liability Company true 2016 Jason Halvorson 1001 Hart Blvd. Monticello MN MINNESOTA 55362 Executive Officer Director Member of Board of Governors of LLC Reed Martin 600 S. Cliff Ave. Sioux Falls SD SOUTH DAKOTA 57104 Executive Officer Eric Schaefer 3300 Oakdale Ave. Robbinsdale MN MINNESOTA 55422 Director Member of Board of Governors of LLC Mary Ellen Wells 1013 Hart Blvd. Monticello MN MINNESOTA 55362 Director Member of Board of Governors of LLC Other Health Care Decline to Disclose 06b false 2016-08-26 false true false 5000 100000 20000 80000 false 2 0 0 0 false MONTICELLO SURGERY CENTER, LLC /s/Jason Halvorson Jason Halvorson Chairperson 2016-09-07