Legacy Village Healthcare LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 1850440561 Enrollment ID O20090528000310

Linked facilitiesFacilities

StatesStates

17 parties: 6 organizations · 11 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Western States Lodging	6204985914	Organization	5% or Greater Direct Ownership Interest; Operational/Managerial Control	76.8
Lance Brown Dearden	7416334982	Individual	Operational/Managerial Control; ADP of the SNF	—
Rachael Stubbs	7416943246	Individual	Operational/Managerial Control; ADP of the SNF	—
Taylors Tcu	6103975818	Organization	5% or Greater Direct Ownership Interest	23.2
Western Lodging & Development, LLC	6901119874	Organization	5% or Greater Indirect Ownership Interest	84
Mark Hampton	7012066681	Individual	5% or Greater Indirect Ownership Interest	50
Corey Fairholm	0244543114	Individual	5% or Greater Indirect Ownership Interest	50
Exmar Company, LLC	9335279983	Organization	5% or Greater Indirect Ownership Interest	50
Gary Griffiths	3375692080	Individual	5% or Greater Indirect Ownership Interest	50
Paul Fairholm	6002965712	Individual	5% or Greater Indirect Ownership Interest	50
Richard Miles	0749339455	Individual	5% or Greater Indirect Ownership Interest	50
Richard White	1557410263	Individual	5% or Greater Indirect Ownership Interest	50
Stephen Miles	7012066723	Individual	5% or Greater Indirect Ownership Interest	50
The Miles Group	4880724434	Organization	5% or Greater Indirect Ownership Interest	50
David R Webster	5193874808	Individual	5% or Greater Indirect Ownership Interest	45
Fairholm Holdings, LLC	0244360899	Organization	5% or Greater Indirect Ownership Interest	16
George Kirk Olsen	6406807411	Individual	Indirect Ownership Interest	5

Western States LodgingPAC 6204985914
Organization76.85% or Greater Direct Ownership Interest; Operational/Managerial Control
Lance Brown DeardenPAC 7416334982
IndividualOperational/Managerial Control; ADP of the SNF
Rachael StubbsPAC 7416943246
IndividualOperational/Managerial Control; ADP of the SNF
Taylors TcuPAC 6103975818
Organization23.25% or Greater Direct Ownership Interest
Western Lodging & Development, LLCPAC 6901119874
Organization845% or Greater Indirect Ownership Interest
Mark HamptonPAC 7012066681
Individual505% or Greater Indirect Ownership Interest
Corey FairholmPAC 0244543114
Individual505% or Greater Indirect Ownership Interest
Exmar Company, LLCPAC 9335279983
Organization505% or Greater Indirect Ownership Interest
Gary GriffithsPAC 3375692080
Individual505% or Greater Indirect Ownership Interest
Paul FairholmPAC 6002965712
Individual505% or Greater Indirect Ownership Interest
Richard MilesPAC 0749339455
Individual505% or Greater Indirect Ownership Interest
Richard WhitePAC 1557410263
Individual505% or Greater Indirect Ownership Interest
Stephen MilesPAC 7012066723
Individual505% or Greater Indirect Ownership Interest
The Miles GroupPAC 4880724434
Organization505% or Greater Indirect Ownership Interest
David R WebsterPAC 5193874808
Individual455% or Greater Indirect Ownership Interest
Fairholm Holdings, LLCPAC 0244360899
Organization165% or Greater Indirect Ownership Interest
George Kirk OlsenPAC 6406807411
Individual5Indirect Ownership Interest

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Legacy Village Rehabilitation Legacy Village Healthcare LLC 36 residents		Other disclo…	—	Ovr★★☆☆☆Stf★☆☆☆☆Ins★★★☆☆QM★★★★☆	36

Legacy Village Rehabilitation
Legacy Village Healthcare LLC
Other disclosed role36 res
Overall 2Staffing Staff 1

Related CMS associates

Name match to Legacy Village Healthcare LLC in FEC filings. Similar names may appear—confirm on FEC.gov.