0001692826-16-000001.txt : 20161221 0001692826-16-000001.hdr.sgml : 20161221 20161221121123 ACCESSION NUMBER: 0001692826-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161221 DATE AS OF CHANGE: 20161221 EFFECTIVENESS DATE: 20161221 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Portland Surgery Center, LLC CENTRAL INDEX KEY: 0001692826 IRS NUMBER: 813129674 STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-276745 FILM NUMBER: 162063318 BUSINESS ADDRESS: STREET 1: 9205 SW BARNES ROAD CITY: PORTLAND STATE: OR ZIP: 97225 BUSINESS PHONE: 205-545-2734 MAIL ADDRESS: STREET 1: 569 BROOKWOOD VILLAGE, SUITE 901 CITY: BIRMINGHAM STATE: AL ZIP: 35209 D 1 primary_doc.xml X0707 D LIVE 0001692826 Portland Surgery Center, LLC 569 Brookwood Village Suite 901 Birmingham AL ALABAMA 35209 205-545-2734 OREGON None None Limited Liability Company true 2016 Tom W.F. DeWeerdt 569 Brookwood Village Suite 901 Birmingham AL ALABAMA 35209 Executive Officer Phillip R. Prince 569 Brookwood Village Suite 901 Birmingham AL ALABAMA 35209 Executive Officer Richard L. Sharff, Jr. 569 Brookwood Village Suite 901 Birmingham AL ALABAMA 35209 Executive Officer Other Health Care Decline to Disclose 06b false true false true false 14000 SCA Development, LLC 35451 None None 569 Brookwood Village Suite 901 Birmingham AL ALABAMA 35209 OR OREGON false 686000 0 686000 false 0 25000 0 0 false Portland Surgery Center, LLC Richard L. Sharff, Jr. Richard L. Sharff, Jr. VP of SCA-Portland, LLC, Sole Member 2016-12-21