0001140361-18-028026.txt : 20180611 0001140361-18-028026.hdr.sgml : 20180611 20180611153246 ACCESSION NUMBER: 0001140361-18-028026 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06c FILED AS OF DATE: 20180611 DATE AS OF CHANGE: 20180611 EFFECTIVENESS DATE: 20180611 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Embree Kay Shawnee Hospital, LLC CENTRAL INDEX KEY: 0001740400 IRS NUMBER: 824774129 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-314331 FILM NUMBER: 18891874 BUSINESS ADDRESS: STREET 1: 4747 WILLIAMS DRIVE CITY: GEORGETOWN STATE: TX ZIP: 78633 BUSINESS PHONE: 512-819-4768 MAIL ADDRESS: STREET 1: 4747 WILLIAMS DRIVE CITY: GEORGETOWN STATE: TX ZIP: 78633 D 1 primary_doc.xml X0708 D LIVE 0001740400 Embree Kay Shawnee Hospital, LLC 4747 WILLIAMS DRIVE GEORGETOWN TX TEXAS 78633 512-819-4700 DELAWARE None None Limited Liability Company true 2018 JIM EMBREE 4747 WILLIAMS DRIVE GEORGETOWN TX TEXAS 78633 Director Mr. Embree is the Chairman of the Board for the Embree Group of Companies, which includes Embree Capital Markets Group, Inc., the Manager of the Issuer. PHILLIP ANNIS 4747 WILLIAMS DRIVE GEORGETOWN TX TEXAS 78633 Executive Officer Director Mr. Annis is the Executive Vice President of Embree Capital Markets Group, Inc., the Manager of the Issuer. ROCKY HARDIN 4747 WILLIAMS DRIVE GEORGETOWN TX TEXAS 78633 Director Executive Officer Mr. Hardin is the President of Embree Capital Markets Group, Inc., the Manager of the Issuer. JOSIAH BYRNES 4747 WILLIAMS DRIVE GEORGETOWN TX TEXAS 78633 Executive Officer Mr. Byrnes is the Vice President of Embree Capital Markets Group, Inc., the Manager of the Issuer. DWIGHT KAY 46-E PENINSULA CENTER DRIVE #382 ROLLING HILLS ESTATES CA CALIFORNIA 90274 Promoter Mr. Kay is the Founder and CEO of Kay Properties and Investments, LLC, a co-sponsor of the Issuer. CHAY LAPIN 46-E PENINSULA CENTER DRIVE #382 ROLLING HILLS ESTATES CA CALIFORNIA 90274 Promoter Mr. Lapin is the Senior Vice President of Kay Properties and Investments, LLC, a co-sponsor of the Issuer. JASON SALMON 104 WEST 40TH STREET 5TH FLOOR NEW YORK NY NEW YORK 10018 Promoter BETTY FRIANT 1101 PENNSYLVANIA AVENUE, N.W. SUITE 300 WASHINGTON DC DISTRICT OF COLUMBIA 20004 Promoter Commercial Decline to Disclose 06c false 2018-05-30 false true false 50000 WealthForge Securities, LLC 152550 None None 6800 Paragon Place Suite 200 Richmond VA VIRGINIA 23230 All States false 3600000 215000 3385000 false 3 216000 0 This represents the maximum amount of sales commissions and dealer fees payable if the maximum offering amount is sold. 378000 true If the maximum offering amount is sold, certain of the related persons identified in Item 3 will indirectly receive compensation through fees and commissions payable by the issuer totaling approximately $378,000. false Embree Kay Shawnee Hospital, LLC /s/ Rob Borchardt Rob Borchardt Authorized Signatory 2018-06-07