Fort Madison Health Center Operations LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 1759719826 Enrollment ID O20200324001339

Linked facilitiesFacilities

StatesStates

4 parties: 1 organizations · 3 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Dawn Fullhart	4385016617	Individual	W-2 Managing Employee	100
Mark Holtkamp	2769810480	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; Corporate Director	50, 100
Kevin Kidwell	3678901394	Individual	5% or Greater Direct Ownership Interest; Corporate Director	50
Lee County Bank	1850729575	Organization	5% or Greater Security Interest	100

Dawn FullhartPAC 4385016617
Individual100W-2 Managing Employee
Mark HoltkampPAC 2769810480
Individual50, 1005% or Greater Direct Ownership Interest; Corporate Officer
Kevin KidwellPAC 3678901394
Individual505% or Greater Direct Ownership Interest; Corporate Director
Lee County BankPAC 1850729575
Organization1005% or Greater Security Interest

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Birkwood Village of Fort Madison Fort Madison Health Center Operations LLC 61 residents		Other disclo…	4.52	Ovr★★★☆☆Stf★★★☆☆Ins★★★☆☆QM★★★★☆	61

Birkwood Village of Fort Madison
Fort Madison Health Center Operations LLC
Other disclosed role61 res4.52 HPRD
Overall 3Staffing Staff 3

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
03/01/2020	Birkwood Village of Fort Madison	Fort Madison Health Center Operations LLC	Fort Madison Health Center, Inc.	Buyer

03/01/2020
Birkwood Village of Fort Madison (Buyer)
Fort Madison Health Center, Inc. → Fort Madison Health Center Operations LLC

Related CMS associates

Name match to Fort Madison Health Center Operations LLC in FEC filings. Similar names may appear—confirm on FEC.gov.