Village Care of King LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 1658656863 Enrollment ID O20170329002681

Linked facilitiesFacilities

StatesStates

15 parties: 11 organizations · 4 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Saber Governance LLC	4082946025	Organization	Operational/Managerial Control	100
Amy Musick	3274913611	Individual	W-2 Managing Employee	100
Autumn Corporation	9133117351	Organization	5% or Greater Direct Ownership Interest	100
Wwbv Holdings LLC	1355677733	Organization	5% or Greater Indirect Ownership Interest	100
Shh Holdings LLC	9537495916	Organization	5% or Greater Indirect Ownership Interest	100
Saber Healthcare Holdings LLC	0547443889	Organization	5% or Greater Indirect Ownership Interest	100
Shg Autumn, LLC	6103119904	Organization	5% or Greater Indirect Ownership Interest	100
Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020	9638330749	Organization	5% or Greater Indirect Ownership Interest	67
Wiw Dynasty LLC	6800150111	Organization	5% or Greater Indirect Ownership Interest	67
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020)	2163758541	Organization	5% or Greater Indirect Ownership Interest	33
Bnv Dynasty LLC	4789091513	Organization	5% or Greater Indirect Ownership Interest	33
Benjamin N Volpe	4880850502	Individual	Corporate Officer; Corporate Director	0, 50
William I Weisberg	7113834037	Individual	Corporate Officer; Corporate Director	0, 50
Gregory Nicoluzakis	3870829252	Individual	Corporate Officer	0
Shg Management LLC	4082046800	Organization	Other	0

Saber Governance LLCPAC 4082946025
Organization100Operational/Managerial Control
Amy MusickPAC 3274913611
Individual100W-2 Managing Employee
Autumn CorporationPAC 9133117351
Organization1005% or Greater Direct Ownership Interest
Wwbv Holdings LLCPAC 1355677733
Organization1005% or Greater Indirect Ownership Interest
Shh Holdings LLCPAC 9537495916
Organization1005% or Greater Indirect Ownership Interest
Saber Healthcare Holdings LLCPAC 0547443889
Organization1005% or Greater Indirect Ownership Interest
Shg Autumn, LLCPAC 6103119904
Organization1005% or Greater Indirect Ownership Interest
Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020PAC 9638330749
Organization675% or Greater Indirect Ownership Interest
Wiw Dynasty LLCPAC 6800150111
Organization675% or Greater Indirect Ownership Interest
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020)PAC 2163758541
Organization335% or Greater Indirect Ownership Interest
Bnv Dynasty LLCPAC 4789091513
Organization335% or Greater Indirect Ownership Interest
Benjamin N VolpePAC 4880850502
Individual0, 50Corporate Officer; Corporate Director
William I WeisbergPAC 7113834037
Individual0, 50Corporate Officer; Corporate Director
Gregory NicoluzakisPAC 3870829252
Individual0Corporate Officer
Shg Management LLCPAC 4082046800
Organization0Other

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Village Care of King Village Care of King LLC 89 residents		Other disclo…	3.58	Ovr★☆☆☆☆Stf★☆☆☆☆Ins★★☆☆☆QM★★★★☆	89

Village Care of King
Village Care of King LLC
Other disclosed role89 res3.58 HPRD
Overall 1Staffing Staff 1

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
04/01/2017	Village Care of King	Village Care of King LLC	Autumn Corporation	Buyer

04/01/2017
Village Care of King (Buyer)
Autumn Corporation → Village Care of King LLC

Related CMS associates

Name match to Village Care of King LLC in FEC filings. Similar names may appear—confirm on FEC.gov.