0001719282-18-000001.txt : 20181023 0001719282-18-000001.hdr.sgml : 20181023 20181023110240 ACCESSION NUMBER: 0001719282-18-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20181023 DATE AS OF CHANGE: 20181023 EFFECTIVENESS DATE: 20181023 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Covenant Surgical Holdings Corp CENTRAL INDEX KEY: 0001719282 IRS NUMBER: 822406263 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-297022 FILM NUMBER: 181133527 BUSINESS ADDRESS: STREET 1: 401 COMMERCE STREET STREET 2: SUITE 600 CITY: NASHVILLE STATE: TN ZIP: 37219 BUSINESS PHONE: 615-345-6900 MAIL ADDRESS: STREET 1: 401 COMMERCE STREET STREET 2: SUITE 600 CITY: NASHVILLE STATE: TN ZIP: 37219 D/A 1 primary_doc.xml X0708 D/A LIVE 0001719282 Covenant Surgical Holdings Corp 401 COMMERCE STREET SUITE 600 NASHVILLE TN TENNESSEE 37219 615-345-6900 DELAWARE KKR Cosmo Holdings Corporation None Corporation true 2017 James C. Momtazee Kohlberg Kravis Roberts & Co. L.P. 2800 Sand Hill Road, Suite 200 Menlo Park CA CALIFORNIA 94025 Director Max C. Lin Kohlberg Kravis Roberts & Co. L.P. 2800 Sand Hill Road, Suite 200 Menlo Park CA CALIFORNIA 94025 Director Arjun Arora Kohlberg Kravis Roberts & Co. L.P. 2800 Sand Hill Road, Suite 200 Menlo Park CA CALIFORNIA 94025 Director Lew Little, Jr. Covenant Surgical Partners, Inc. 401 Commerce Street, Suite 600 Nashville TN TENNESSEE 37219 Executive Officer Director Dale W. Polley, Jr. Covenant Surgical Partners, Inc. 401 Commerce Street, Suite 600 Nashville TN TENNESSEE 37219 Executive Officer Rich Fogle Covenant Surgical Partners, Inc. 401 Commerce Street, Suite 600 Nashville TN TENNESSEE 37219 Executive Officer Chad Stevens Covenant Surgical Partners, Inc. 401 Commerce Street, Suite 600 Nashville TN TENNESSEE 37219 Executive Officer Justin Ezell Covenant Surgical Partners, Inc. 401 Commerce Street, Suite 600 Nashville TN TENNESSEE 37219 Executive Officer Hospitals and Physicians Decline to Disclose 06b true 0001719282-17-000001 true true true true false 0 Indefinite 0 Indefinite false 0 0 0 0 false Covenant Surgical Holdings Corp /s/ Dale W. Polley, Jr. Dale W. Polley, Jr. Executive VP, Chief Development Officer and Secretary 2018-10-23