0001918065-22-000001.txt : 20220323 0001918065-22-000001.hdr.sgml : 20220323 20220323171719 ACCESSION NUMBER: 0001918065-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220323 DATE AS OF CHANGE: 20220323 EFFECTIVENESS DATE: 20220323 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Imagen Polk Support Services, LLC CENTRAL INDEX KEY: 0001918065 IRS NUMBER: 880767071 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-438663 FILM NUMBER: 22763915 BUSINESS ADDRESS: STREET 1: 16220 NORTH SCOTTSDALE ROAD STREET 2: SUITE 300 CITY: SCOTTSDALE STATE: AZ ZIP: 85254 BUSINESS PHONE: (480) 590-3396 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: 021-438663-01 FILM NUMBER: 22763916 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 0001918065 Imagen Polk Support Services, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2022 0001819319 IMAGEN DENTAL PARTNERS, LLC 16220 NORTH SCOTTSDALE ROAD SUITE 300 SCOTTSDALE AZ ARIZONA 85254 (480) 590-3396 DELAWARE None None Limited Liability Company true 2020 Rezwan Manji 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Rezwan Manji is an executive officer of Imagen Dental Partners, LLC and Imagen Polk Support Services, LLC. Michael Augins 16220 North Scottsdale Road Suite 300 Scottsdale AZ ARIZONA 85254 Executive Officer Michael Augins is an executive officer of Imagen Dental Partners, LLC and Imagen Polk Support Services, LLC. Other Health Care Decline to Disclose 06b false 2022-03-10 true true true 0 485000 335000 150000 false 1 0 0 0 true Imagen Polk Support Services, LLC /s/ Rezwan Manji Rezwan Manji Chief Executive Officer 2022-03-23