0001812134-20-000001.txt : 20200514 0001812134-20-000001.hdr.sgml : 20200514 20200514161348 ACCESSION NUMBER: 0001812134-20-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20200514 DATE AS OF CHANGE: 20200514 EFFECTIVENESS DATE: 20200514 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Kelsey-Seybold Medical Group, PLLC CENTRAL INDEX KEY: 0001812134 IRS NUMBER: 760386391 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-366975 FILM NUMBER: 20877905 BUSINESS ADDRESS: STREET 1: 2727 W. HOLCOMBE BLVD STREET 2: 4TH FLOOR ADMINISTRATION CITY: HOUSTON STATE: TX ZIP: 77025 BUSINESS PHONE: 7134420795 MAIL ADDRESS: STREET 1: 2727 W. HOLCOMBE BLVD STREET 2: 4TH FLOOR ADMINISTRATION CITY: HOUSTON STATE: TX ZIP: 77025 FILER: COMPANY DATA: COMPANY CONFORMED NAME: KSMS Holdings, LLC CENTRAL INDEX KEY: 0001812164 IRS NUMBER: 842590138 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-366975-01 FILM NUMBER: 20877904 BUSINESS ADDRESS: STREET 1: 2727 W. HOLCOMBE BLVD STREET 2: 4TH FLOOR ADMINISTRATION CITY: HOUSTON STATE: TX ZIP: 77025 BUSINESS PHONE: 7134420795 MAIL ADDRESS: STREET 1: 2727 W. HOLCOMBE BLVD STREET 2: 4TH FLOOR ADMINISTRATION CITY: HOUSTON STATE: TX ZIP: 77025 D 1 primary_doc.xml X0708 D LIVE 0001812134 Kelsey-Seybold Medical Group, PLLC 2727 W. HOLCOMBE BLVD 4TH FLOOR ADMINISTRATION HOUSTON TX TEXAS 77025 7134420795 TEXAS None None Other Professional Limited Liability Company true 0001812164 KSMS Holdings, LLC 2727 W. HOLCOMBE BLVD 4TH FLOOR ADMINISTRATION HOUSTON TX TEXAS 77025 7134420795 TEXAS None None Limited Liability Company true 2019 Tony Lin 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Executive Officer Director Maher Daas 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Benjamin Dillon 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Fahim Farhat 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Jagjit Khairah 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Azam Kundi 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Executive Officer Director Robert Turner 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Jonathan Nelson 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Executive Officer Director Tejash Patel 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Rupa Puttappa 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Donnie Aga 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Victor Simms 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director John Schilling 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Jeffrey Rhodes 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Kendall Garrison 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Jack Larsen 2727 W. Holcombe Blvd. 4th Floor Administration Houston TX TEXAS 77025 Director Hospitals and Physicians Decline to Disclose 06b false 2020-04-30 false true false 0 14225830 14225830 0 false 115 0 0 0 None of the proceeds are designated for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. false Kelsey-Seybold Medical Group, PLLC \s\ Tony Lin Tony Lin Chairman of the Board of Managers 2020-05-14 KSMS Holdings, LLC \s\ Tony Lin Tony Lin Chairman of the Board of Managers 2020-05-14