Taylorville Skilled Nursing & Rehab LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 0244560159 Enrollment ID O20190919000477

Linked facilitiesFacilities

StatesStates

28 parties: 20 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Shalom Lichtman	2163649047	Individual	5% or Greater Indirect Ownership Interest; Corporate Officer; Operational/Managerial Control	19.94
Light Man LLC	3577925130	Organization	Operational/Managerial Control	—
Lacy Clark	6406188739	Individual	Operational/Managerial Control; ADP of the SNF	—
Pavinderpal S Gill	9234182288	Individual	Operational/Managerial Control; ADP of the SNF	—
Capital Finance LLC	8123282514	Organization	5% or Greater Security Interest; Operational/Managerial Control	—
Crest Illinois Holdco LLC	1355672403	Organization	5% or Greater Direct Ownership Interest	100
Ecfjc Trust	2163914466	Organization	5% or Greater Indirect Ownership Interest	20.81
Mrs Windy City State Trust	6709369374	Organization	5% or Greater Indirect Ownership Interest	20.81
IL M Trust	4880177450	Organization	5% or Greater Indirect Ownership Interest	7.55
Jcecf Trust	3274025572	Organization	5% or Greater Indirect Ownership Interest	1.1
Tsdama Trust	6608368907	Organization	5% or Greater Indirect Ownership Interest	—
Crest I Tbd Holdco LLC	8820580129	Organization	Indirect Ownership Interest	100
Unknown party	2466928601	Individual	Indirect Ownership Interest	2.16
Unknown party	8527534767	Individual	Indirect Ownership Interest	1.62
Unknown party	9638645880	Organization	Indirect Ownership Interest	1.1
Unknown party	1254807498	Individual	Indirect Ownership Interest	1
Unknown party	3072089218	Individual	Indirect Ownership Interest	1
Unknown party	5294201448	Organization	Indirect Ownership Interest	1
Unknown party	7618443854	Individual	Indirect Ownership Interest	1
Unknown party	3476029638	Organization	ADP of the SNF	—
Unknown party	1759857915	Organization	ADP of the SNF	—
Unknown party	3072089234	Organization	ADP of the SNF	—
Unknown party	4587130745	Organization	ADP of the SNF	—
Unknown party	6709352958	Organization	ADP of the SNF	—
Unknown party	9830665090	Organization	ADP of the SNF	—

Shalom LichtmanPAC 2163649047
Individual19.945% or Greater Indirect Ownership Interest; Corporate Officer
Light Man LLCPAC 3577925130
OrganizationOperational/Managerial Control
Lacy ClarkPAC 6406188739
IndividualOperational/Managerial Control; ADP of the SNF
Pavinderpal S GillPAC 9234182288
IndividualOperational/Managerial Control; ADP of the SNF
Capital Finance LLCPAC 8123282514
Organization5% or Greater Security Interest; Operational/Managerial Control
Crest Illinois Holdco LLCPAC 1355672403
Organization1005% or Greater Direct Ownership Interest
Ecfjc TrustPAC 2163914466
Organization20.815% or Greater Indirect Ownership Interest
Mrs Windy City State TrustPAC 6709369374
Organization20.815% or Greater Indirect Ownership Interest
IL M TrustPAC 4880177450
Organization7.555% or Greater Indirect Ownership Interest
Jcecf TrustPAC 3274025572
Organization1.15% or Greater Indirect Ownership Interest
Tsdama TrustPAC 6608368907
Organization5% or Greater Indirect Ownership Interest
Crest I Tbd Holdco LLCPAC 8820580129
Organization100Indirect Ownership Interest
Unknown partyPAC 2466928601
Individual2.16Indirect Ownership Interest
Unknown partyPAC 8527534767
Individual1.62Indirect Ownership Interest
Unknown partyPAC 9638645880
Organization1.1Indirect Ownership Interest
Unknown partyPAC 1254807498
Individual1Indirect Ownership Interest
Unknown partyPAC 3072089218
Individual1Indirect Ownership Interest
Unknown partyPAC 5294201448
Organization1Indirect Ownership Interest
Unknown partyPAC 7618443854
Individual1Indirect Ownership Interest
Unknown partyPAC 3476029638
OrganizationADP of the SNF
Unknown partyPAC 1759857915
OrganizationADP of the SNF
Unknown partyPAC 3072089234
OrganizationADP of the SNF
Unknown partyPAC 4587130745
OrganizationADP of the SNF
Unknown partyPAC 6709352958
OrganizationADP of the SNF
Unknown partyPAC 9830665090
OrganizationADP of the SNF

Show all 28 parties (3 more)

Name	Owner/control PAC	Type	Role(s)	%
Shalom Lichtman	2163649047	Individual	5% or Greater Indirect Ownership Interest; Corporate Officer; Operational/Managerial Control	19.94
Light Man LLC	3577925130	Organization	Operational/Managerial Control	—
Lacy Clark	6406188739	Individual	Operational/Managerial Control; ADP of the SNF	—
Pavinderpal S Gill	9234182288	Individual	Operational/Managerial Control; ADP of the SNF	—
Capital Finance LLC	8123282514	Organization	5% or Greater Security Interest; Operational/Managerial Control	—
Crest Illinois Holdco LLC	1355672403	Organization	5% or Greater Direct Ownership Interest	100
Ecfjc Trust	2163914466	Organization	5% or Greater Indirect Ownership Interest	20.81
Mrs Windy City State Trust	6709369374	Organization	5% or Greater Indirect Ownership Interest	20.81
IL M Trust	4880177450	Organization	5% or Greater Indirect Ownership Interest	7.55
Jcecf Trust	3274025572	Organization	5% or Greater Indirect Ownership Interest	1.1
Tsdama Trust	6608368907	Organization	5% or Greater Indirect Ownership Interest	—
Crest I Tbd Holdco LLC	8820580129	Organization	Indirect Ownership Interest	100
Unknown party	2466928601	Individual	Indirect Ownership Interest	2.16
Unknown party	8527534767	Individual	Indirect Ownership Interest	1.62
Unknown party	9638645880	Organization	Indirect Ownership Interest	1.1
Unknown party	1254807498	Individual	Indirect Ownership Interest	1
Unknown party	3072089218	Individual	Indirect Ownership Interest	1
Unknown party	5294201448	Organization	Indirect Ownership Interest	1
Unknown party	7618443854	Individual	Indirect Ownership Interest	1
Unknown party	3476029638	Organization	ADP of the SNF	—
Unknown party	1759857915	Organization	ADP of the SNF	—
Unknown party	3072089234	Organization	ADP of the SNF	—
Unknown party	4587130745	Organization	ADP of the SNF	—
Unknown party	6709352958	Organization	ADP of the SNF	—
Unknown party	9830665090	Organization	ADP of the SNF	—
Unknown party	0345716502	Organization	ADP of the SNF	—
Unknown party	6103392360	Organization	ADP of the SNF	—
Unknown party	8820564081	Organization	ADP of the SNF	—

Shalom LichtmanPAC 2163649047
Individual19.945% or Greater Indirect Ownership Interest; Corporate Officer
Light Man LLCPAC 3577925130
OrganizationOperational/Managerial Control
Lacy ClarkPAC 6406188739
IndividualOperational/Managerial Control; ADP of the SNF
Pavinderpal S GillPAC 9234182288
IndividualOperational/Managerial Control; ADP of the SNF
Capital Finance LLCPAC 8123282514
Organization5% or Greater Security Interest; Operational/Managerial Control
Crest Illinois Holdco LLCPAC 1355672403
Organization1005% or Greater Direct Ownership Interest
Ecfjc TrustPAC 2163914466
Organization20.815% or Greater Indirect Ownership Interest
Mrs Windy City State TrustPAC 6709369374
Organization20.815% or Greater Indirect Ownership Interest
IL M TrustPAC 4880177450
Organization7.555% or Greater Indirect Ownership Interest
Jcecf TrustPAC 3274025572
Organization1.15% or Greater Indirect Ownership Interest
Tsdama TrustPAC 6608368907
Organization5% or Greater Indirect Ownership Interest
Crest I Tbd Holdco LLCPAC 8820580129
Organization100Indirect Ownership Interest
Unknown partyPAC 2466928601
Individual2.16Indirect Ownership Interest
Unknown partyPAC 8527534767
Individual1.62Indirect Ownership Interest
Unknown partyPAC 9638645880
Organization1.1Indirect Ownership Interest
Unknown partyPAC 1254807498
Individual1Indirect Ownership Interest
Unknown partyPAC 3072089218
Individual1Indirect Ownership Interest
Unknown partyPAC 5294201448
Organization1Indirect Ownership Interest
Unknown partyPAC 7618443854
Individual1Indirect Ownership Interest
Unknown partyPAC 3476029638
OrganizationADP of the SNF
Unknown partyPAC 1759857915
OrganizationADP of the SNF
Unknown partyPAC 3072089234
OrganizationADP of the SNF
Unknown partyPAC 4587130745
OrganizationADP of the SNF
Unknown partyPAC 6709352958
OrganizationADP of the SNF
Unknown partyPAC 9830665090
OrganizationADP of the SNF
Unknown partyPAC 0345716502
OrganizationADP of the SNF
Unknown partyPAC 6103392360
OrganizationADP of the SNF
Unknown partyPAC 8820564081
OrganizationADP of the SNF

Linked facilities

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Taylorville Skld Nur & Rehab Taylorville Skilled Nursing & Rehab LLC 81 residents		Other disclo…	3.42	Ovr★★★★☆Stf★★☆☆☆Ins★★★★☆QM★★★☆☆	81

Taylorville Skld Nur & Rehab
Taylorville Skilled Nursing & Rehab LLC
Other disclosed role81 res3.42 HPRD
Overall 4Staffing Staff 2

Ownership history

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
09/01/2019	Taylorville Skld Nur & Rehab	Taylorville Skilled Nursing & Rehab LLC	Covenant Care Meadow Manor, LLC	Buyer

09/01/2019
Taylorville Skld Nur & Rehab (Buyer)
Covenant Care Meadow Manor, LLC → Taylorville Skilled Nursing & Rehab LLC

Related CMS associates

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Name match to Taylorville Skilled Nursing & Rehab LLC in FEC filings. Similar names may appear—confirm on FEC.gov.

Owners & control parties

Linked facilities

Ownership history

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