0001899555-21-000001.txt : 20211221 0001899555-21-000001.hdr.sgml : 20211221 20211221102708 ACCESSION NUMBER: 0001899555-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211221 DATE AS OF CHANGE: 20211221 EFFECTIVENESS DATE: 20211221 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Hartzog Support Services, LLC CENTRAL INDEX KEY: 0001899555 IRS NUMBER: 872244376 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-426041 FILM NUMBER: 211507402 BUSINESS ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 FILER: COMPANY DATA: COMPANY CONFORMED NAME: IMAGEN DENTAL PARTNERS, LLC CENTRAL INDEX KEY: 0001819319 IRS NUMBER: 845189859 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-426041-01 FILM NUMBER: 211507403 BUSINESS ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD, SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: 480-590-5701 MAIL ADDRESS: STREET 1: 16220 N. SCOTTSDALE ROAD, SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 D 1 primary_doc.xml X0708 D LIVE 0001899555 Imagen Hartzog Support Services, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 480-590-5701 DELAWARE None None Limited Liability Company true 2021 0001819319 IMAGEN DENTAL PARTNERS, LLC 16220 N. SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 480-590-5701 DELAWARE None None Limited Liability Company true 2020 REZWAN MANJI 16220 N. SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 Executive Officer MICHAEL AUGINS 16220 N. SCOTTSDALE RD. SUITE 300 SCOTTSDALE AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Hartzog Support Services, LLC Other Health Care Decline to Disclose 06b false 2021-12-09 true true true 0 4636700 3986700 650000 false 1 0 0 0 true Imagen Hartzog Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2021-12-21