The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete. The reader should not assume that the information is accurate and complete. |
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM D
Notice of Exempt Offering of Securities
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OMB APPROVAL |
OMB Number: |
3235-0076 |
Estimated average burden |
hours per response: |
4.00 |
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1. Issuer's Identity
CIK (Filer ID Number) |
Previous Names |
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Entity Type |
0001744498 |
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Corporation |
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Limited Partnership |
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Limited Liability Company |
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General Partnership |
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Business Trust |
X |
Other (Specify) |
Delaware Statutory Trust |
Name of Issuer |
Arizona Healthcare DST |
Jurisdiction of Incorporation/Organization |
DELAWARE |
Year of Incorporation/Organization |
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Over Five Years Ago |
X |
Within Last Five Years (Specify Year) |
2018 |
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Yet to Be Formed |
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2. Principal Place of Business and Contact Information
Name of Issuer |
Arizona Healthcare DST |
Street Address 1 |
Street Address 2 |
2901 BUTTERFIELD ROAD |
City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
OAK BROOK |
ILLINOIS |
60523 |
630-218-8000 |
3. Related Persons
Last Name |
First Name |
Middle Name |
Inland Private |
Capital Corporation |
Street Address 1 |
Street Address 2 |
2901 Butterfield Road |
City |
State/Province/Country |
ZIP/PostalCode |
Oak Brook |
ILLINOIS |
60523 |
Relationship: |
|
Executive Officer |
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Director |
X |
Promoter |
Clarification of Response (if Necessary):
Sponsor of the issuer.
Last Name |
First Name |
Middle Name |
Arizona |
Healthcare, L.L.C. |
Street Address 1 |
Street Address 2 |
2901 Butterfield Road |
City |
State/Province/Country |
ZIP/PostalCode |
Oak Brook |
ILLINOIS |
60523 |
Relationship: |
|
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
Depositor of the Issuer.
Last Name |
First Name |
Middle Name |
Arizona Healthcare |
Exchange, L.L.C. |
Street Address 1 |
Street Address 2 |
2901 Butterfield Road |
City |
State/Province/Country |
ZIP/PostalCode |
Oak Brook |
ILLINOIS |
60523 |
Relationship: |
|
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
Signatory Trustee of the Issuer.
Last Name |
First Name |
Middle Name |
Lampi |
Keith |
Street Address 1 |
Street Address 2 |
2901 Butterfield Road |
City |
State/Province/Country |
ZIP/PostalCode |
Oak Brook |
ILLINOIS |
60523 |
Relationship: |
X |
Executive Officer |
|
Director |
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Promoter |
Clarification of Response (if Necessary):
Mr. Lampi is the President of Inland Private Capital Corporation, the Member of Arizona Healthcare Exchange, L.L.C., the Signatory Trustee of Arizona Healthcare DST.
4. Industry Group
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Agriculture |
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Banking & Financial Services |
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Commercial Banking |
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Insurance |
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Investing |
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Investment Banking |
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Pooled Investment Fund |
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Is the issuer registered as an investment company under the Investment Company Act of 1940? |
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Other Banking & Financial Services |
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Business Services |
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Energy |
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Health Care |
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Manufacturing |
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Real Estate |
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Retailing |
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Restaurants |
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Technology |
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Travel |
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Tourism & Travel Services |
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Other |
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5. Issuer Size
Revenue Range |
OR |
Aggregate Net Asset Value Range |
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No Revenues |
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No Aggregate Net Asset Value |
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$1 - $1,000,000 |
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$1 - $5,000,000 |
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$1,000,001 - $5,000,000 |
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$5,000,001 - $25,000,000 |
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$5,000,001 - $25,000,000 |
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$25,000,001 - $50,000,000 |
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$25,000,001 - $100,000,000 |
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$50,000,001 - $100,000,000 |
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Over $100,000,000 |
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Over $100,000,000 |
X |
Decline to Disclose |
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Decline to Disclose |
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Not Applicable |
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Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
| |
Rule 504(b)(1) (not (i), (ii) or (iii)) |
| |
Rule 504 (b)(1)(i) |
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Rule 504 (b)(1)(ii) |
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Rule 504 (b)(1)(iii) |
| X |
Rule 506(b) |
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Rule 506(c) |
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Securities Act Section 4(a)(5) |
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Investment Company Act Section 3(c) |
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Section 3(c)(1) |
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Section 3(c)(9) |
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Section 3(c)(2) |
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Section 3(c)(10) |
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Section 3(c)(3) |
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Section 3(c)(11) |
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Section 3(c)(4) |
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Section 3(c)(12) |
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Section 3(c)(5) |
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Section 3(c)(13) |
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Section 3(c)(6) |
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Section 3(c)(14) |
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7. Type of Filing
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New Notice |
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Date of First Sale |
2018-06-08 |
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First Sale Yet to Occur |
X |
Amendment |
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? |
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9. Type(s) of Securities Offered (select all that apply)
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Equity |
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Pooled Investment Fund Interests |
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Debt |
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Tenant-in-Common Securities |
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Option, Warrant or Other Right to Acquire Another Security |
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Mineral Property Securities |
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Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security |
X |
Other (describe) |
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Beneficial interests in Delaware Statutory Trust reflecting beneficial interests in real estate. |
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? |
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Clarification of Response (if Necessary):
11. Minimum Investment
Minimum investment accepted from any outside investor |
$25,000
|
USD |
12. Sales Compensation
Recipient |
Recipient CRD Number |
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None |
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Brian Perkins |
5630932 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
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None |
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Colorado Financial Service Corporation |
104343 |
Street Address 1 |
Street Address 2 |
304 Inverness Way South, |
STE 355 |
City |
State/Province/Country |
ZIP/Postal Code |
Centinnial |
COLORADO |
80112 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Nathaniel M. Kuhn |
4624143 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Concorde Investment Servies, LLC |
151604 |
Street Address 1 |
Street Address 2 |
120 W. Eastman, Suite 300 |
City |
State/Province/Country |
ZIP/Postal Code |
Arlington Heights |
ILLINOIS |
60004 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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David B. Levinson |
705929 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Westpark Capital, Inc. |
39914 |
Street Address 1 |
Street Address 2 |
1600 Dove Street, Suite 250 |
City |
State/Province/Country |
ZIP/Postal Code |
Newport Beach |
CALIFORNIA |
92660 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
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None |
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Daniel Mercer |
6698392 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Colorado Financial Service Corporation |
104343 |
Street Address 1 |
Street Address 2 |
4020 East Saint Joesph Way |
City |
State/Province/Country |
ZIP/Postal Code |
Phoenix |
ARIZONA |
85018 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Jeff Olson |
2192677 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Northland Securities, Inc. |
40258 |
Street Address 1 |
Street Address 2 |
150 South Fifth, Suite 3300 |
City |
State/Province/Country |
ZIP/Postal Code |
Minneapolis |
MINNESOTA |
55402 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Mark Gopen |
2989672 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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National Securities Corporation |
7569 |
Street Address 1 |
Street Address 2 |
35-30 Francis Lewis Blvd., Suite 205 |
City |
State/Province/Country |
ZIP/Postal Code |
Flushing |
NEW YORK |
11358 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
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None |
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Gary Conley |
52159 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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American Investors Company |
385 |
Street Address 1 |
Street Address 2 |
1600 Valley River Drive, Suite 385 |
City |
State/Province/Country |
ZIP/Postal Code |
Eugene |
OREGON |
97401 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Jeffrey McKay |
818303 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Voya Financial Advisors, Inc. |
2882 |
Street Address 1 |
Street Address 2 |
6000 Southcenter Blvd., Suite 70 |
City |
State/Province/Country |
ZIP/Postal Code |
Tukwila |
WASHINGTON |
98188 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Ronald York |
4308987 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Triad Advisors LLC |
25803 |
Street Address 1 |
Street Address 2 |
4814 Outlook Drive, STE 104 |
City |
State/Province/Country |
ZIP/Postal Code |
Wall |
NEW JERSEY |
07753 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Leslie Pappas |
1735372 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Lightpath Capital, Inc. |
34617 |
Street Address 1 |
Street Address 2 |
160 Saratga Ave., Unit 110 |
City |
State/Province/Country |
ZIP/Postal Code |
Santa Clara |
CALIFORNIA |
95051 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Tom Velken |
1600404 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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sigma Financial Coporation |
14303 |
Street Address 1 |
Street Address 2 |
1078 Carol Lane #203 |
City |
State/Province/Country |
ZIP/Postal Code |
Lafayette |
CALIFORNIA |
94549 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
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None |
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Scott Sheehan |
2328614 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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DFPG Investments, Inc. |
155576 |
Street Address 1 |
Street Address 2 |
2 Orr Hatch Drive |
City |
State/Province/Country |
ZIP/Postal Code |
Conrwall |
NEW YORK |
12518 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
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None |
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RCX Capital Group, LLC |
114290 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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RCX Capital Group, LLC |
114290 |
Street Address 1 |
Street Address 2 |
12707 High Bluff Drive, Suite 200 |
City |
State/Province/Country |
ZIP/Postal Code |
San Diego |
CALIFORNIA |
92130 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
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All States |
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Recipient |
Recipient CRD Number |
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None |
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Dan L. Werry |
4721789 |
(Associated) Broker or Dealer |
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None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Lighthose Capital Group, LLC |
169135 |
Street Address 1 |
Street Address 2 |
200 S. Los Robles Ave., STE 210 |
City |
State/Province/Country |
ZIP/Postal Code |
Pasadena |
CALIFORNIA |
91101 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
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None |
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Joseph A. Graziano |
2442582 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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TFS Securities, Inc. |
20626 |
Street Address 1 |
Street Address 2 |
847 Braodway |
City |
State/Province/Country |
ZIP/Postal Code |
Bayonne |
NEW JERSEY |
07002 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
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Steven T. Novotny |
4263690 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Cambridge Investment Research, Inc. |
39543 |
Street Address 1 |
Street Address 2 |
18 Corporate Woods Blvd. Floor 2 |
City |
State/Province/Country |
ZIP/Postal Code |
Albany |
NEW YORK |
12211 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
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Judith Odell |
4492738 |
(Associated) Broker or Dealer |
|
None |
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(Associated) Broker or Dealer CRD Number |
|
None |
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Cambridge Investment Research, Inc. |
39543 |
Street Address 1 |
Street Address 2 |
18 Corporate Woods Blvd. Floor 2 |
City |
State/Province/Country |
ZIP/Postal Code |
Albany |
NEW YORK |
12211 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
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Robert Smith |
1412333 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Concorde Investment Services, LLC |
151604 |
Street Address 1 |
Street Address 2 |
5000 Meadows Road, STE 230 |
City |
State/Province/Country |
ZIP/Postal Code |
Lake Oswego |
OREGON |
97035 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
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Lesile B. Goldstein |
1300590 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Securities America, Inc. |
10205 |
Street Address 1 |
Street Address 2 |
626 Busse Hwy |
City |
State/Province/Country |
ZIP/Postal Code |
Park Ridge |
ILLINOIS |
60068 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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Recipient |
Recipient CRD Number |
|
None |
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Andrew Martz |
5118326 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Western International Securities, Inc. |
39262 |
Street Address 1 |
Street Address 2 |
8560 W. Sunset Blvd., STE 500 |
City |
State/Province/Country |
ZIP/Postal Code |
West Hollywood |
CALIFORNIA |
90069 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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Recipient |
Recipient CRD Number |
|
None |
|
John H. Ferguson |
494764 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
ighthouse Capital Corp. |
169135 |
Street Address 1 |
Street Address 2 |
1055 E. Colorado Blvd., STE 310 |
City |
State/Province/Country |
ZIP/Postal Code |
Pasadena |
CALIFORNIA |
91106 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
|
Paul M. Getty |
6470002 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Lightpath Capital, Inc. |
34617 |
Street Address 1 |
Street Address 2 |
2025 Gateway Place, STE 485 |
City |
State/Province/Country |
ZIP/Postal Code |
San Jose |
CALIFORNIA |
95110 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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|
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Recipient |
Recipient CRD Number |
|
None |
|
Daniel J. Luke |
432353 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
DFPG Investments, Inc. |
155576 |
Street Address 1 |
Street Address 2 |
9017 S. Riverside Dr., STE 200 |
City |
State/Province/Country |
ZIP/Postal Code |
Sandy |
UTAH |
84070 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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Recipient |
Recipient CRD Number |
|
None |
|
Christina Nielson |
4866971 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Primex |
29394 |
Street Address 1 |
Street Address 2 |
650 Town Center Drive, STE 1400 |
City |
State/Province/Country |
ZIP/Postal Code |
Costa Mesa |
CALIFORNIA |
92626 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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Recipient |
Recipient CRD Number |
|
None |
|
Karen R. Codman |
2774511 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
FSC Sercurities Corporation |
7461 |
Street Address 1 |
Street Address 2 |
1165 E. San Antonio Drive, STE G |
City |
State/Province/Country |
ZIP/Postal Code |
Long Beach |
CALIFORNIA |
90807 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Eric J. Flaim |
4618103 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
APW Capital, Inc. |
43814 |
Street Address 1 |
Street Address 2 |
1 New Hampshire Drive, STE 125 |
City |
State/Province/Country |
ZIP/Postal Code |
Portsmouth |
NEW HAMPSHIRE |
03801 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Chay T. Lapin |
6275140 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Welathforge Securities, LLC |
152550 |
Street Address 1 |
Street Address 2 |
819 North Harbor Drive, Suite 400 |
City |
State/Province/Country |
ZIP/Postal Code |
Redondo Beach |
CALIFORNIA |
90277 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Joshua S. Griffin |
4664355 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Parkland Sercurities, LLC |
115368 |
Street Address 1 |
Street Address 2 |
6312 South Fiddlers Green |
Circle 300 E |
City |
State/Province/Country |
ZIP/Postal Code |
Greenwood Village |
COLORADO |
80111 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Dennis I. Weiss |
462338 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
American Investors Company |
38 |
Street Address 1 |
Street Address 2 |
8569 Cordes Circle, STE 1 |
City |
State/Province/Country |
ZIP/Postal Code |
Germantown |
TENNESSEE |
38139 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
John G. Chess |
4812430 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Investacorp, Inc. |
7684 |
Street Address 1 |
Street Address 2 |
4263 Gavin Lane |
City |
State/Province/Country |
ZIP/Postal Code |
Columbus |
OHIO |
43220 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Eric S. Scaff |
5281210 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Concorde Investment Services, LLC |
151604 |
Street Address 1 |
Street Address 2 |
300 Montomery Street, STE 631 |
City |
State/Province/Country |
ZIP/Postal Code |
San Francisco |
CALIFORNIA |
94101 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Michael A. Bendix |
5379777 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
DFPG Investments, Inc. |
155576 |
Street Address 1 |
Street Address 2 |
903 Springwood Lane |
City |
State/Province/Country |
ZIP/Postal Code |
Encinitas |
CALIFORNIA |
92024 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Jason A. Salmon |
6081963 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Wealthforge Securities, LLC |
152550 |
Street Address 1 |
Street Address 2 |
104 West 40th Street 5th Floor |
City |
State/Province/Country |
ZIP/Postal Code |
New York |
NEW YORK |
10018 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Donald S. Meredith |
1867703 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Lightpath Capital, Inc. |
34617 |
Street Address 1 |
Street Address 2 |
1453 Third Street Promenade, STE 315 |
City |
State/Province/Country |
ZIP/Postal Code |
Los Angeles |
CALIFORNIA |
90401 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Joshua C. Koehnen |
4551444 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Independent Financial Group, LLC |
7717 |
Street Address 1 |
Street Address 2 |
12531 High Bluff Drive #100 |
City |
State/Province/Country |
ZIP/Postal Code |
San Diego |
CALIFORNIA |
92130 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Paul L. Soriano |
3097786 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Sagepoint Financial, Inc. |
133763 |
Street Address 1 |
Street Address 2 |
615 Pikoi Street, STE 1205 |
City |
State/Province/Country |
ZIP/Postal Code |
Honolulu |
HAWAII |
96814 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Keith W. Patterson |
2131574 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Investacorp, Inc. |
7684 |
Street Address 1 |
Street Address 2 |
77 Sugar Creek Center Blvd. |
City |
State/Province/Country |
ZIP/Postal Code |
Sugarland |
TEXAS |
77478 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Trudy D. Haussmann |
1596890 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Securities America, Inc. |
10205 |
Street Address 1 |
Street Address 2 |
23201 Lake Center Drive, STE 300 |
City |
State/Province/Country |
ZIP/Postal Code |
Lake Forest |
CALIFORNIA |
92630 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Daniel P. Raupp |
4079107 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Concorde Investment Services, LLC |
151604 |
Street Address 1 |
Street Address 2 |
417 East Main Street Floor |
City |
State/Province/Country |
ZIP/Postal Code |
Port Jefferson |
NEW YORK |
11777 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Jason C. Cook |
4349388 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Berthel, Fisher & Company Financial Services, Inc. |
13609 |
Street Address 1 |
Street Address 2 |
108 A South Maple Street |
City |
State/Province/Country |
ZIP/Postal Code |
Graham |
NORTH CAROLINA |
27253 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Taylor D. Ashland |
5732470 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
DFPG Investments, Inc. |
155576 |
Street Address 1 |
Street Address 2 |
670 Superior Court, STE 210 |
City |
State/Province/Country |
ZIP/Postal Code |
Medford |
OREGON |
97504 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
13. Offering and Sales Amounts
Total Offering Amount |
$26,152,407
|
USD |
|
Total Amount Sold |
$19,915,099
|
USD |
Total Remaining to be Sold |
$6,237,308
|
USD |
|
Clarification of Response (if Necessary):
14. Investors
|
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering. |
|
|
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: |
|
15. Sales Commissions & Finder's Fees Expenses
Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions |
$130,760,200
|
USD |
|
Finders' Fees |
$0
|
USD |
|
Clarification of Response (if Necessary):
16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
Clarification of Response (if Necessary):
Estimate of certain fees, including Dealer Fee & Placement Agent Fee, and offering and organizational expenses that may accrue to one or more Related Persons.Signature and Submission
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission
In submitting this notice, each issuer named above is: |
- Notifying the SEC and/or each State in which this notice is filed of the offering of
securities described and undertaking to furnish them, upon written request, in the accordance with applicable
law, the information furnished to offerees.*
- Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator
or other legally designated officer of the State in which the issuer maintains its principal
place of business and any State in which this notice is filed, as its agents for service of
process, and agreeing that these persons may accept service on its behalf, of any notice,
process or pleading, and further agreeing that such service may be made by registered or
certified mail, in any Federal or state action, administrative proceeding, or arbitration
brought against the issuer in any place subject to the jurisdiction of the United States, if the
action, proceeding or arbitration (a) arises out of any activity in connection with the
offering of securities that is the subject of this notice, and (b) is founded, directly or
indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange
Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the
Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii)
the laws of the State in which the issuer maintains its principal place of business or any State
in which this notice is filed.
- Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).
|
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
Issuer |
Signature |
Name of Signer |
Title |
Date |
Arizona Healthcare DST |
/s/ Keith Lampi |
Keith Lampi |
President of the Member of the Signatory Trustee |
2018-07-26 |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets
Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to
require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes
of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot
routinely require offering materials under this undertaking or otherwise and can require offering materials only to the
extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.