0001731569-18-000003.txt : 20181231 0001731569-18-000003.hdr.sgml : 20181231 20181231120014 ACCESSION NUMBER: 0001731569-18-000003 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06c FILED AS OF DATE: 20181231 DATE AS OF CHANGE: 20181231 EFFECTIVENESS DATE: 20181231 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CountrySide Lakes Senior Housing DST CENTRAL INDEX KEY: 0001731569 IRS NUMBER: 826780946 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-306423 FILM NUMBER: 181259073 BUSINESS ADDRESS: STREET 1: 11248 STRANG LINE ROAD CITY: LENEXA STATE: KS ZIP: 66215 BUSINESS PHONE: 913-283-7804 MAIL ADDRESS: STREET 1: 11248 STRANG LINE ROAD CITY: LENEXA STATE: KS ZIP: 66215 D/A 1 primary_doc.xml X0708 D/A LIVE 0001731569 CountrySide Lakes Senior Housing DST 16829 W. 116th Street LENEXA KS KANSAS 66219 913-283-7804 DELAWARE None None Other Statutory Trust true 2017 N/A BP Senior Housing, LLC 16829 W. 116th Street Lenexa KS KANSAS 66219 Executive Officer SPONSOR OF ISSUER N/A Shepherd Health, LLC 6538 Collins Avenue, #313 Miami Beach FL FLORIDA 33141 Executive Officer SPONSOR OF ISSUER N/A SLF-SH CountrySide Lakes, LLC 6538 Collins Avenue, #313 Miami Beach FL FLORIDA 33141 Executive Officer MANAGER OF ISSUER Daniel T. Brewer 16829 W. 116th Street Lenexa KS KANSAS 66219 Executive Officer MANAGER OF ISSUER'S MANAGER Christine Menedis 6538 Collins Avenue, #313 Miami Beach FL FLORIDA 33141 Executive Officer MANAGER OF SPONSOR Other Real Estate $5,000,001 - $25,000,000 06c true 0001731569-18-000002 2018-02-27 true true true Beneficial Interests In Delaware Statutory Trust false 100000 11225850 3256156 7969694 Regarding Item 11, The Issuer may accept smaller investments in the Sponsor's sole discretion. false 14 100000 true 15000 true 315000 true Item 16 reflects marketing, advisory and due diligence fees payable to certain of the Related Persons. false CountrySide Lakes Senior Housing DST Kirsten S. Ellis Kirsten S. Ellis Attorney for Issuer 2018-12-31