Disclosure of Facility Ownership

In compliance with Federal law, you, your representative or surrogate have the right to know if your physician has a financial interest in this facility. This notice advices you that the following entity and physicians have ownership in Affinity Orthopedics ASC, LLC.

Hospital Partner

• Grandview Medical Center

Physicians

• Michael F. Blum, M.D.
• George R. Booker, M.D.
• Winston T. Capel, M.D.
• S. Evan Carstensen, M.D.
• Ryan T. Cordry, M.D.
• William S. Craig IV, M.D.
• Daryl G. Dykes, M.D.
• Christopher A. Heck, M.D.
• Jonathan A. Isbell, M.D.
• John S. Kirchner, M.D.
• William D. Klauss, M.D.
• Adam M. Lukasiewicz, M.D.
• Michael D. Smith, M.D.

If you have questions of concerns regarding this notice, please feel free to ask to speak with a representative of Birmingham Musculoskeletal Institute. We welcome you as a patient and value our relationship with you.