0000895527-21-000027.txt : 20210819 0000895527-21-000027.hdr.sgml : 20210819 20210819141908 ACCESSION NUMBER: 0000895527-21-000027 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210819 DATE AS OF CHANGE: 20210819 EFFECTIVENESS DATE: 20210819 FILER: COMPANY DATA: COMPANY CONFORMED NAME: One Nineteen GI ASC, LLC CENTRAL INDEX KEY: 0001878843 IRS NUMBER: 862162590 STATE OF INCORPORATION: AL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-410606 FILM NUMBER: 211189841 BUSINESS ADDRESS: STREET 1: 1550 W. MCEWEN DRIVE STREET 2: SUITE 350 CITY: NASHVILLE STATE: TN ZIP: 37067 BUSINESS PHONE: 708-492-0531 MAIL ADDRESS: STREET 1: 1550 W. MCEWEN DRIVE STREET 2: SUITE 350 CITY: NASHVILLE STATE: TN ZIP: 37067 D 1 primary_doc.xml X0708 D LIVE 0001878843 One Nineteen GI ASC, LLC 1550 W. MCEWEN DRIVE SUITE 350 NASHVILLE TN TENNESSEE 37067 708-492-0531 ALABAMA None None Limited Liability Company true 2021 Charles A. Dasher, Jr., M.D. c/o One Nineteen GI ASC, LLC 1550 W. McEwen Drive, Suite 350 Nashville TN TENNESSEE 37067 Executive Officer Brandon Williams c/o One Nineteen GI ASC, LLC 1550 W. McEwen Drive, Suite 350 Nashville TN TENNESSEE 37067 Executive Officer Hospitals and Physicians Decline to Disclose 06b false 2021-08-05 false true false 150552 602210 602210 0 false 4 0 0 0 false One Nineteen GI ASC, LLC /s/ Matt Lau Matt Lau Managing Member 2021-08-18