Buffalo Grove Skilled Nursing Facility LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 0749641553 Enrollment ID O20230726002059

Linked facilitiesFacilities

StatesStates

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Cibc Bank Usa	8426229584	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Legacy Healthcare Financial Services LLC	5799046132	Organization	Operational/Managerial Control; ADP of the SNF	—
Melissa Dominowski	1850773359	Individual	Operational/Managerial Control; ADP of the SNF	—
Menachem Shabat	3072526219	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Steven S Kim	8022177229	Individual	Operational/Managerial Control; ADP of the SNF	—
Gpn Family Trust U/A/D 4/28/08	5294988994	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	59.5
Doros Generation Trust U/A/D 1/3/12	6901110428	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	25.5
Oakway Operations LLC	6103212279	Organization	5% or Greater Direct Ownership Interest	15
Unknown party	2163997578	Individual	Indirect Ownership Interest	4.9
Unknown party	3072088483	Individual	Indirect Ownership Interest	4.9
Unknown party	6709351117	Individual	Indirect Ownership Interest	2.6
Unknown party	7517432925	Individual	Indirect Ownership Interest	2.6
Buffalo Grove Property Holdings, LLC	7810462223	Organization	5% or Greater Security Interest; ADP of the SNF	100
Roth & Co, LLP	3173053162	Organization	ADP of the SNF	—
Unknown party	8527533934	Individual	ADP of the SNF	—

Cibc Bank UsaPAC 8426229584
Organization1005% or Greater Security Interest; Operational/Managerial Control
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationOperational/Managerial Control; ADP of the SNF
Melissa DominowskiPAC 1850773359
IndividualOperational/Managerial Control; ADP of the SNF
Menachem ShabatPAC 3072526219
IndividualOperational/Managerial Control; Managing Control - Governing Body
Steven S KimPAC 8022177229
IndividualOperational/Managerial Control; ADP of the SNF
Gpn Family Trust U/A/D 4/28/08PAC 5294988994
Organization59.55% or Greater Direct Ownership Interest; ADP of the SNF
Doros Generation Trust U/A/D 1/3/12PAC 6901110428
Organization25.55% or Greater Direct Ownership Interest; ADP of the SNF
Oakway Operations LLCPAC 6103212279
Organization155% or Greater Direct Ownership Interest
Unknown partyPAC 2163997578
Individual4.9Indirect Ownership Interest
Unknown partyPAC 3072088483
Individual4.9Indirect Ownership Interest
Unknown partyPAC 6709351117
Individual2.6Indirect Ownership Interest
Unknown partyPAC 7517432925
Individual2.6Indirect Ownership Interest
Buffalo Grove Property Holdings, LLCPAC 7810462223
Organization1005% or Greater Security Interest; ADP of the SNF
Roth & Co, LLPPAC 3173053162
OrganizationADP of the SNF
Unknown partyPAC 8527533934
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Warren Barr Buffalo Grove Buffalo Grove Skilled Nursing Facility LLC 167 residents		Other disclo…	3.27	Ovr★★★☆☆Stf★★☆☆☆Ins★★★☆☆QM★★★★☆	167

Warren Barr Buffalo Grove
Buffalo Grove Skilled Nursing Facility LLC
Other disclosed role167 res3.27 HPRD
Overall 3Staffing Staff 2

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
06/01/2023	Warren Barr Buffalo Grove	Buffalo Grove Skilled Nursing Facility LLC	Symphony Buffalo Grove LLC	Buyer

06/01/2023
Warren Barr Buffalo Grove (Buyer)
Symphony Buffalo Grove LLC → Buffalo Grove Skilled Nursing Facility LLC

Related CMS associates

Name match to Buffalo Grove Skilled Nursing Facility LLC in FEC filings. Similar names may appear—confirm on FEC.gov.