0001200876-23-000026.txt : 20231206 0001200876-23-000026.hdr.sgml : 20231206 20231206075706 ACCESSION NUMBER: 0001200876-23-000026 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20231206 DATE AS OF CHANGE: 20231206 EFFECTIVENESS DATE: 20231206 FILER: COMPANY DATA: COMPANY CONFORMED NAME: AdventHealth Surgery Center Daytona Beach, LLC CENTRAL INDEX KEY: 0001988751 IRS NUMBER: 922967648 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-498883 FILM NUMBER: 231468449 BUSINESS ADDRESS: STREET 1: 03 MEMORIAL MEDICAL PARKWAY CITY: DAYTONA BEACH STATE: FL ZIP: 32117 BUSINESS PHONE: 386-917-7749 MAIL ADDRESS: STREET 1: 03 MEMORIAL MEDICAL PARKWAY CITY: DAYTONA BEACH STATE: FL ZIP: 32117 D 1 primary_doc.xml X0708 D LIVE 0001988751 AdventHealth Surgery Center Daytona Beach, LLC 103 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL FLORIDA 32117 386-917-7749 FLORIDA AdventHealth Kissimmee Endoscopy Center, LLC None Limited Liability Company true 2021 n/a Surgical Investors & Advisors, LLC 3070 Windward Plaza Suite F204 Alpharetta GA GEORGIA 30005 Promoter Patty Shoults 2600 Westhall Lane 2nd Floor Maitland FL FLORIDA 32751 Executive Officer Mike Mazeres 2600 Westhall Lane 2nd Floor Maitland FL FLORIDA 32751 Executive Officer Shyroll Morris 103 Memorial Medical Parkway Daytona Beach FL FLORIDA 32117 Executive Officer Director Debora Thomas 305 Memorial Medical Parkway Suite 501 Daytona Beach FL FLORIDA 32117 Executive Officer Director Cory Domayer 305 Memorial Medical Parkway MOB 5th Floor, Suite 503 Daytona Beach FL FLORIDA 32117 Executive Officer Director Jake McKelvy 2600 Westhall Lane Suite 300 Maitland FL FLORIDA 32751 Executive Officer David Weis 301 Memorial Medical Parkway Suite 503 Daytona Beach FL FLORIDA 32117 Executive Officer Director John Lazarus 1061 Medical Center Drive Orange City FL FLORIDA 32763 Executive Officer Hospitals and Physicians Decline to Disclose 06b false 2023-11-30 false true false 35000 1715000 1050000 665000 false 15 0 0 0 false AdventHealth Surgery Center Daytona Beach, LLC /s/Shroll Morris Shyroll Morris President 2023-12-05