Raven Lake Healthcare Inc

Enrollment entity

Provider / enrollment organization Enrollment PAC 0941720254 Enrollment ID O20250217002772

Linked facilitiesFacilities

StatesStates

18 parties: 2 organizations · 16 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Magen Ann Smith	1456897602	Individual	Operational/Managerial Control; ADP of the SNF	—
Rocky Top Healthcare LLC	9133569874	Organization	5% or Greater Direct Ownership Interest	100
The Ensign Group Inc	3476460494	Organization	5% or Greater Indirect Ownership Interest	100
Ami Sato	3870022825	Individual	Corporate Officer	0
Barry Port	2466457627	Individual	Corporate Officer; Corporate Director	0
Brent Thatcher	6002200995	Individual	Corporate Officer	0
Soon Burnam	9739195553	Individual	Corporate Officer	0
Spencer W Burton	7810131604	Individual	Corporate Officer	0
Suzanne D Snapper	7719025261	Individual	Corporate Officer; Corporate Director	0
Ann Scott Blouin	1456693217	Individual	Corporate Director	0
Barry M Smith	0648415562	Individual	Corporate Director	0
Christopher R Christensen	5193632107	Individual	Corporate Director	0
Daren Shaw	6002072196	Individual	Corporate Director	0
John O Agwunobi	2668527953	Individual	Corporate Director	0
Mark V Parkinson	5890681118	Individual	Corporate Director	0
Swati Abbott	6901335330	Individual	Corporate Director	0
Tyler Albrechtsen	1052653680	Individual	Corporate Director	0
Luis C Pannocchia	3072609809	Individual	ADP of the SNF	—

Magen Ann SmithPAC 1456897602
IndividualOperational/Managerial Control; ADP of the SNF
Rocky Top Healthcare LLCPAC 9133569874
Organization1005% or Greater Direct Ownership Interest
The Ensign Group IncPAC 3476460494
Organization1005% or Greater Indirect Ownership Interest
Ami SatoPAC 3870022825
Individual0Corporate Officer
Barry PortPAC 2466457627
Individual0Corporate Officer; Corporate Director
Brent ThatcherPAC 6002200995
Individual0Corporate Officer
Soon BurnamPAC 9739195553
Individual0Corporate Officer
Spencer W BurtonPAC 7810131604
Individual0Corporate Officer
Suzanne D SnapperPAC 7719025261
Individual0Corporate Officer; Corporate Director
Ann Scott BlouinPAC 1456693217
Individual0Corporate Director
Barry M SmithPAC 0648415562
Individual0Corporate Director
Christopher R ChristensenPAC 5193632107
Individual0Corporate Director
Daren ShawPAC 6002072196
Individual0Corporate Director
John O AgwunobiPAC 2668527953
Individual0Corporate Director
Mark V ParkinsonPAC 5890681118
Individual0Corporate Director
Swati AbbottPAC 6901335330
Individual0Corporate Director
Tyler AlbrechtsenPAC 1052653680
Individual0Corporate Director
Luis C PannocchiaPAC 3072609809
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Tri State Health and Rehabilitation Center Raven Lake Healthcare Inc 101 residents		Other disclo…	3.44	Ovr★☆☆☆☆Stf★★☆☆☆Ins★☆☆☆☆QM★★★☆☆	101

Tri State Health and Rehabilitation Center
Raven Lake Healthcare Inc
Other disclosed role101 res3.44 HPRD
Overall 1Staffing Staff 2

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
01/01/2024	Tri State Health and Rehabilitation Center	Raven Lake Healthcare Inc	Tri State Manor LLC	Buyer

01/01/2024
Tri State Health and Rehabilitation Center (Buyer)
Tri State Manor LLC → Raven Lake Healthcare Inc

Related CMS associates

Name match to Raven Lake Healthcare Inc in FEC filings. Similar names may appear—confirm on FEC.gov.