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          <BusinessNameLine1Txt>AMBULATORY SURGERY CENTER PATIENT SAFETY ORGANIZATION LLC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>304 WEST MAIN STREET STE 2 BOX 305</AddressLine1Txt>
          <CityNm>AVON</CityNm>
          <StateAbbreviationCd>CT</StateAbbreviationCd>
          <ZIPCd>06001</ZIPCd>
        </USAddress>
        <EIN>203421470</EIN>
        <PrimaryActivitiesTxt>PATIENT SAFETY ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CT</LegalDomicileStateCd>
        <TotalIncomeAmt>98050</TotalIncomeAmt>
        <EndOfYearAssetsAmt>294480</EndOfYearAssetsAmt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
      </IdDisregardedEntitiesGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>