0000895527-21-000038.txt : 20211102 0000895527-21-000038.hdr.sgml : 20211102 20211102130053 ACCESSION NUMBER: 0000895527-21-000038 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211102 DATE AS OF CHANGE: 20211102 EFFECTIVENESS DATE: 20211102 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Palos Surgicenter, LLC CENTRAL INDEX KEY: 0001890916 IRS NUMBER: 364404305 STATE OF INCORPORATION: IL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-419492 FILM NUMBER: 211370093 BUSINESS ADDRESS: STREET 1: 7340 W. COLLEGE DRIVE STREET 2: #1 CITY: PALOS HEIGHTS STATE: IL ZIP: 60463 BUSINESS PHONE: 708-361-3233 MAIL ADDRESS: STREET 1: 7340 W. COLLEGE DRIVE STREET 2: #1 CITY: PALOS HEIGHTS STATE: IL ZIP: 60463 D 1 primary_doc.xml X0708 D LIVE 0001890916 Palos Surgicenter, LLC 7340 W. COLLEGE DRIVE #1 PALOS HEIGHTS IL ILLINOIS 60463 708-361-3233 ILLINOIS None None Limited Liability Company true Christopher Farley, MD c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Executive Officer Director William Kosmala, MD c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Director Muhamad Amine, MD c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Executive Officer Director Nicholas Speziale, MD c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Director Bob Ryan c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Director Amanda Nunkovich c/o Palos Surgicenter, LLC 7340 W. College Drive, #1 Palos Heights IL ILLINOIS 60463 Executive Officer Director Other Health Care Decline to Disclose 06b false 2021-09-15 false true false 18500 54999 30000 24999 false 1 0 0 0 false Palos Surgicenter, LLC /s/ Chris Farley, MD Chris Farley, MD President 2021-11-02