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Shelby Baptist Ambulatory Surgery Center, LLC

Details

Name: Shelby Baptist Ambulatory Surgery Center, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 02 Jun 2005 (19 years ago) (Companies founded in June 2005)
Entity Number: 000-464-957
Register Number: 000464957
ZIP code: 35205 (Companies in Jefferson, 35205)
County: Jefferson
Place of Formation: Shelby County
Principal Address: ALABASTER, AL
Registered Office Street Address: 1130 22ND STREET SOUTH, SUITE 1000BIRMINGHAM, AL 35205

Activities OUTPATIENT SURGERY CENTER

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538117841 2006-05-05 2013-10-17 1010 1ST ST N, ALABASTER, AL, 350078608, US 1010 1ST ST N, ALABASTER, AL, 350078608, US

Contacts
Phone +1 205-620-8400
Fax 2056208423

Authorized person
Name MR. MICHAEL TRENT PIVER
Role ADMINISTRATOR
Phone 2056208400

Taxonomy
Taxonomy Code 261QA1903X - Ambulatory Surgical Clinic/Center
State AL
Is Primary Yes

Central Index Key

CIK number Mailing Address Business Address Phone
1439649 1010 FIRST STREET NORTH, ALABASTER, AL, 35007 1010 FIRST STREET NORTH, ALABASTER, AL, 35007 205-620-8400

Filings since 2023-08-23
Form type D
File number 021-490509
Filing date 2023-08-23
File View File

Filings since 2013-06-04
Form type D
File number 021-197415
Filing date 2013-06-04
File View File

Filings since 2008-11-18
Form type REGDEX/A
File number 021-120077
Filing date 2008-11-18
File View File

Filings since 2008-07-07
Form type REGDEX
File number 021-120077
Filing date 2008-07-07
File View File

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2023 203150946 2024-09-19 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2024-09-19
Name of individual signing WILL HIGHTOWER
Valid signature Filed with authorized/valid electronic signature
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2022 203150946 2023-10-10 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 102
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2023-10-10
Name of individual signing WILL HIGHTOWER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2021 203150946 2022-10-10 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing WILL HIGHTOWER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2020 203150946 2021-10-06 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 95
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2019 203150946 2020-10-02 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2020-10-02
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2018 203150946 2019-10-09 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2056208400
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2017 203150946 2018-05-25 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2057161640
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2016 203150946 2017-10-02 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2057161640
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2015 203150946 2016-10-05 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2057161640
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2016-10-05
Name of individual signing CATHY KYSER
SHELBY BAPTIST AMBULATORY SURGERY CENTER 401(K) PLAN 2014 203150946 2015-10-15 SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621493
Sponsor’s telephone number 2057161640
Plan sponsor’s address 1010 FIRST STREET NORTH, SUITE 400, ALABASTER, AL, 35007

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing RICHARD MCGILL

Agent

Name Role
BLACK, KERRY Agent

Member

Name Role
SHELBY BAPTIST AFFINITY LLC Member

Related by officers

BLACK, KERRY

Baptist Physician Alliance, LLC Baptist Health Foundation Properties, Inc. Baptist Partnership Holdings, Inc. Shelby Baptist Affinity, LLC Prison Healthcare, LLC Walker Baptist Affinity, LLC Regency Holdings, LLC Hoover Baptist Medical Center, LLC Walker Regional Medical Center, Inc. Baptist Health Foundation, Inc.

Related by address

ALABASTER, AL

Alabaster Loan & Finance Co., Inc. Andress Engineering Associates, Inc. Electronic Service Company Gaskill Equipment Company Gillis Pharmacy Inc. Jones Office and School Supply Inc. Jack McGuire Excavating Co., Inc. Swope Alabaster Supply, Inc. Triple J Corporation Shelby Securities, Inc.

1130 22ND STREET SOUTH, SUITE 1000BIRMINGHAM, AL 35205

Baptist Health Foundation Properties, Inc. Baptist Partnership Holdings, Inc. Shelby Baptist Affinity, LLC Prison Healthcare, LLC Walker Baptist Affinity, LLC Regency Holdings, LLC Hoover Baptist Medical Center, LLC

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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