0001891975-21-000001.txt : 20211109 0001891975-21-000001.hdr.sgml : 20211109 20211109145735 ACCESSION NUMBER: 0001891975-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 504(b)(1)(i) ITEM INFORMATION: 06b FILED AS OF DATE: 20211109 DATE AS OF CHANGE: 20211109 EFFECTIVENESS DATE: 20211109 FILER: COMPANY DATA: COMPANY CONFORMED NAME: IU Health Southwest Fort Wayne Ambulatory Surgery Center, LLC CENTRAL INDEX KEY: 0001891975 IRS NUMBER: 000000000 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-420521 FILM NUMBER: 211391636 BUSINESS ADDRESS: STREET 1: FAIRBANKS HALL STREET 2: 340 W. 10TH STREET, 6TH FLOOR CITY: INDIANAPOLIS STATE: IN ZIP: 46202 BUSINESS PHONE: 317-962-9172 MAIL ADDRESS: STREET 1: FAIRBANKS HALL STREET 2: 340 W. 10TH STREET, 6TH FLOOR CITY: INDIANAPOLIS STATE: IN ZIP: 46202 D 1 primary_doc.xml X0708 D LIVE 0001891975 IU Health Southwest Fort Wayne Ambulatory Surgery Center, LLC FAIRBANKS HALL 340 W. 10TH STREET, 6TH FLOOR INDIANAPOLIS IN INDIANA 46202 317-962-9172 INDIANA None None Limited Liability Company true 2019 Derek Empie Fairbanks Hall 340 West 10th Street Indianapolis IN INDIANA 46202 Executive Officer Hospitals and Physicians Not Applicable 06b 04.1 false 2021-10-29 false true false 65000 Not Applicable None None None N/A N/A N/A XX Unknown 00000 IN INDIANA false 2795000 845000 1950000 true 3 13 0 0 0 false IU Health Southwest Fort Wayne Ambulatory Surgery Center, LLC /s/ David R. Kogan David R. Kogan President 2021-10-30