Evergreen Health and Rehabilitation Center LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 3274661087 Enrollment ID O20100514000167

Linked facilitiesFacilities

StatesStates

64 parties: 30 organizations · 34 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Optum Management Solutions. Inc	2062845829	Organization	Operational/Managerial Control; ADP of the SNF; Indirect Ownership Interest	1.08
Khaled Imam	3375687338	Individual	Operational/Managerial Control; ADP of the SNF	—
Keri Sikora	9032529763	Individual	Operational/Managerial Control; ADP of the SNF	—
Robert Sharon	9830517457	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Lyudmila Gourov	9638676216	Individual	Operational/Managerial Control	—
Rajan Patel	6002020146	Individual	Operational/Managerial Control; Managing Control - Governing Body	—
Om Holdco, LLC	9335572197	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	100
Charles Franklin LLC	4284019514	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Charles Westland LLC	0941700942	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Paar 108 LLC	3375928609	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Snw LLC	2466837794	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Hemant Shah 2018 Irrevocable Trust	5193100428	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	29.7
Optalis LP Investors 1, LLC	3870093867	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	10
Pinal R. Patel 2017 Irrevocable Trust F/B/O Aarna R. Patel	0547645871	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Pinal R. Patel 2017 Irrevocable Trust F/B/O Ansh R. Patel	9739564063	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Pinal R. Patel 2020 Irrevocable Family Trust Uad 10-6-2020	8729463054	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Rajan G Patel 2020 Irr Fam Tr Uad 12-3-2020	6002291333	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Unknown party	3577060144	Organization	Indirect Ownership Interest	1.53
Unknown party	8820595499	Organization	Indirect Ownership Interest	1.4
Unknown party	8123525706	Individual	Indirect Ownership Interest	0.4
Unknown party	9830696400	Organization	Indirect Ownership Interest	0.38
Unknown party	6305343989	Individual	Indirect Ownership Interest	0.33
Unknown party	8224535893	Individual	Indirect Ownership Interest	0.33
Unknown party	4284131863	Individual	Indirect Ownership Interest	0.3
Unknown party	1658878228	Organization	Indirect Ownership Interest	0.3

Optum Management Solutions. IncPAC 2062845829
Organization1.08Operational/Managerial Control; ADP of the SNF
Khaled ImamPAC 3375687338
IndividualOperational/Managerial Control; ADP of the SNF
Keri SikoraPAC 9032529763
IndividualOperational/Managerial Control; ADP of the SNF
Robert SharonPAC 9830517457
IndividualOperational/Managerial Control; Managing Control - Governing Body
Lyudmila GourovPAC 9638676216
IndividualOperational/Managerial Control
Rajan PatelPAC 6002020146
IndividualOperational/Managerial Control; Managing Control - Governing Body
Om Holdco, LLCPAC 9335572197
Organization1005% or Greater Direct Ownership Interest; ADP of the SNF
Charles Franklin LLCPAC 4284019514
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Charles Westland LLCPAC 0941700942
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Paar 108 LLCPAC 3375928609
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Snw LLCPAC 2466837794
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Hemant Shah 2018 Irrevocable TrustPAC 5193100428
Organization29.75% or Greater Indirect Ownership Interest; ADP of the SNF
Optalis LP Investors 1, LLCPAC 3870093867
Organization105% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2017 Irrevocable Trust F/B/O Aarna R. PatelPAC 0547645871
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2017 Irrevocable Trust F/B/O Ansh R. PatelPAC 9739564063
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2020 Irrevocable Family Trust Uad 10-6-2020PAC 8729463054
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Rajan G Patel 2020 Irr Fam Tr Uad 12-3-2020PAC 6002291333
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Unknown partyPAC 3577060144
Organization1.53Indirect Ownership Interest
Unknown partyPAC 8820595499
Organization1.4Indirect Ownership Interest
Unknown partyPAC 8123525706
Individual0.4Indirect Ownership Interest
Unknown partyPAC 9830696400
Organization0.38Indirect Ownership Interest
Unknown partyPAC 6305343989
Individual0.33Indirect Ownership Interest
Unknown partyPAC 8224535893
Individual0.33Indirect Ownership Interest
Unknown partyPAC 4284131863
Individual0.3Indirect Ownership Interest
Unknown partyPAC 1658878228
Organization0.3Indirect Ownership Interest

Show all 64 parties (39 more)

Name	Owner/control PAC	Type	Role(s)	%
Optum Management Solutions. Inc	2062845829	Organization	Operational/Managerial Control; ADP of the SNF; Indirect Ownership Interest	1.08
Khaled Imam	3375687338	Individual	Operational/Managerial Control; ADP of the SNF	—
Keri Sikora	9032529763	Individual	Operational/Managerial Control; ADP of the SNF	—
Robert Sharon	9830517457	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Lyudmila Gourov	9638676216	Individual	Operational/Managerial Control	—
Rajan Patel	6002020146	Individual	Operational/Managerial Control; Managing Control - Governing Body	—
Om Holdco, LLC	9335572197	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	100
Charles Franklin LLC	4284019514	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Charles Westland LLC	0941700942	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Paar 108 LLC	3375928609	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Snw LLC	2466837794	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	30
Hemant Shah 2018 Irrevocable Trust	5193100428	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	29.7
Optalis LP Investors 1, LLC	3870093867	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	10
Pinal R. Patel 2017 Irrevocable Trust F/B/O Aarna R. Patel	0547645871	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Pinal R. Patel 2017 Irrevocable Trust F/B/O Ansh R. Patel	9739564063	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Pinal R. Patel 2020 Irrevocable Family Trust Uad 10-6-2020	8729463054	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Rajan G Patel 2020 Irr Fam Tr Uad 12-3-2020	6002291333	Organization	5% or Greater Indirect Ownership Interest; ADP of the SNF	7.5
Unknown party	3577060144	Organization	Indirect Ownership Interest	1.53
Unknown party	8820595499	Organization	Indirect Ownership Interest	1.4
Unknown party	8123525706	Individual	Indirect Ownership Interest	0.4
Unknown party	9830696400	Organization	Indirect Ownership Interest	0.38
Unknown party	6305343989	Individual	Indirect Ownership Interest	0.33
Unknown party	8224535893	Individual	Indirect Ownership Interest	0.33
Unknown party	4284131863	Individual	Indirect Ownership Interest	0.3
Unknown party	1658878228	Organization	Indirect Ownership Interest	0.3
Unknown party	5395242960	Organization	Indirect Ownership Interest	0.23
Unknown party	1850898420	Individual	Indirect Ownership Interest	0.21
Unknown party	0941707525	Individual	Indirect Ownership Interest	0.2
Unknown party	0648777227	Individual	Indirect Ownership Interest	0.17
Unknown party	2567969140	Individual	Indirect Ownership Interest	0.17
Unknown party	4587161161	Individual	Indirect Ownership Interest	0.17
Unknown party	6103323779	Organization	Indirect Ownership Interest	0.17
Unknown party	0244737815	Organization	Indirect Ownership Interest	0.13
Unknown party	1759888324	Organization	Indirect Ownership Interest	0.13
Unknown party	2668979220	Organization	Indirect Ownership Interest	0.13
Unknown party	2769989342	Individual	Indirect Ownership Interest	0.13
Unknown party	4486151065	Individual	Indirect Ownership Interest	0.13
Unknown party	4587161153	Individual	Indirect Ownership Interest	0.13
Unknown party	5597262162	Individual	Indirect Ownership Interest	0.13
Unknown party	6204333867	Organization	Indirect Ownership Interest	0.13
Unknown party	6204333883	Individual	Indirect Ownership Interest	0.13
Unknown party	6305343971	Individual	Indirect Ownership Interest	0.13
Unknown party	6507363173	Individual	Indirect Ownership Interest	0.13
Unknown party	7012414683	Organization	Indirect Ownership Interest	0.13
Unknown party	7214434885	Individual	Indirect Ownership Interest	0.13
Unknown party	4385141969	Individual	Indirect Ownership Interest	0.11
Unknown party	0749787323	Individual	Indirect Ownership Interest	0.1
Unknown party	2466959044	Individual	Indirect Ownership Interest	0.1
Unknown party	2668979246	Individual	Indirect Ownership Interest	0.1
Unknown party	4385141951	Organization	Indirect Ownership Interest	0.1
Unknown party	4486151040	Organization	Indirect Ownership Interest	0.1
Unknown party	6103323787	Individual	Indirect Ownership Interest	0.1
Unknown party	8022515600	Individual	Indirect Ownership Interest	0.1
Unknown party	9032616602	Individual	Indirect Ownership Interest	0.1
Unknown party	8820595408	Individual	Indirect Ownership Interest	0.08
Unknown party	0840797429	Individual	Indirect Ownership Interest	0.07
Unknown party	3779080346	Individual	Indirect Ownership Interest	0.07
Unknown party	9931606506	Organization	Indirect Ownership Interest	0.07
Unknown party	5890292460	Organization	ADP of the SNF	—
Unknown party	1456858034	Individual	ADP of the SNF	—
Cliftonlarsonallen LLP	1456885441	Organization	ADP of the SNF	—
Marianne B Conner	6608930672	Individual	ADP of the SNF	—
Merchants Bank of Indiana	3779083779	Organization	5% or Greater Mortgage Interest	80
East West Bank	7517190077	Organization	5% or Greater Security Interest	10

Optum Management Solutions. IncPAC 2062845829
Organization1.08Operational/Managerial Control; ADP of the SNF
Khaled ImamPAC 3375687338
IndividualOperational/Managerial Control; ADP of the SNF
Keri SikoraPAC 9032529763
IndividualOperational/Managerial Control; ADP of the SNF
Robert SharonPAC 9830517457
IndividualOperational/Managerial Control; Managing Control - Governing Body
Lyudmila GourovPAC 9638676216
IndividualOperational/Managerial Control
Rajan PatelPAC 6002020146
IndividualOperational/Managerial Control; Managing Control - Governing Body
Om Holdco, LLCPAC 9335572197
Organization1005% or Greater Direct Ownership Interest; ADP of the SNF
Charles Franklin LLCPAC 4284019514
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Charles Westland LLCPAC 0941700942
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Paar 108 LLCPAC 3375928609
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Snw LLCPAC 2466837794
Organization305% or Greater Indirect Ownership Interest; ADP of the SNF
Hemant Shah 2018 Irrevocable TrustPAC 5193100428
Organization29.75% or Greater Indirect Ownership Interest; ADP of the SNF
Optalis LP Investors 1, LLCPAC 3870093867
Organization105% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2017 Irrevocable Trust F/B/O Aarna R. PatelPAC 0547645871
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2017 Irrevocable Trust F/B/O Ansh R. PatelPAC 9739564063
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Pinal R. Patel 2020 Irrevocable Family Trust Uad 10-6-2020PAC 8729463054
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Rajan G Patel 2020 Irr Fam Tr Uad 12-3-2020PAC 6002291333
Organization7.55% or Greater Indirect Ownership Interest; ADP of the SNF
Unknown partyPAC 3577060144
Organization1.53Indirect Ownership Interest
Unknown partyPAC 8820595499
Organization1.4Indirect Ownership Interest
Unknown partyPAC 8123525706
Individual0.4Indirect Ownership Interest
Unknown partyPAC 9830696400
Organization0.38Indirect Ownership Interest
Unknown partyPAC 6305343989
Individual0.33Indirect Ownership Interest
Unknown partyPAC 8224535893
Individual0.33Indirect Ownership Interest
Unknown partyPAC 4284131863
Individual0.3Indirect Ownership Interest
Unknown partyPAC 1658878228
Organization0.3Indirect Ownership Interest
Unknown partyPAC 5395242960
Organization0.23Indirect Ownership Interest
Unknown partyPAC 1850898420
Individual0.21Indirect Ownership Interest
Unknown partyPAC 0941707525
Individual0.2Indirect Ownership Interest
Unknown partyPAC 0648777227
Individual0.17Indirect Ownership Interest
Unknown partyPAC 2567969140
Individual0.17Indirect Ownership Interest
Unknown partyPAC 4587161161
Individual0.17Indirect Ownership Interest
Unknown partyPAC 6103323779
Organization0.17Indirect Ownership Interest
Unknown partyPAC 0244737815
Organization0.13Indirect Ownership Interest
Unknown partyPAC 1759888324
Organization0.13Indirect Ownership Interest
Unknown partyPAC 2668979220
Organization0.13Indirect Ownership Interest
Unknown partyPAC 2769989342
Individual0.13Indirect Ownership Interest
Unknown partyPAC 4486151065
Individual0.13Indirect Ownership Interest
Unknown partyPAC 4587161153
Individual0.13Indirect Ownership Interest
Unknown partyPAC 5597262162
Individual0.13Indirect Ownership Interest
Unknown partyPAC 6204333867
Organization0.13Indirect Ownership Interest
Unknown partyPAC 6204333883
Individual0.13Indirect Ownership Interest
Unknown partyPAC 6305343971
Individual0.13Indirect Ownership Interest
Unknown partyPAC 6507363173
Individual0.13Indirect Ownership Interest
Unknown partyPAC 7012414683
Organization0.13Indirect Ownership Interest
Unknown partyPAC 7214434885
Individual0.13Indirect Ownership Interest
Unknown partyPAC 4385141969
Individual0.11Indirect Ownership Interest
Unknown partyPAC 0749787323
Individual0.1Indirect Ownership Interest
Unknown partyPAC 2466959044
Individual0.1Indirect Ownership Interest
Unknown partyPAC 2668979246
Individual0.1Indirect Ownership Interest
Unknown partyPAC 4385141951
Organization0.1Indirect Ownership Interest
Unknown partyPAC 4486151040
Organization0.1Indirect Ownership Interest
Unknown partyPAC 6103323787
Individual0.1Indirect Ownership Interest
Unknown partyPAC 8022515600
Individual0.1Indirect Ownership Interest
Unknown partyPAC 9032616602
Individual0.1Indirect Ownership Interest
Unknown partyPAC 8820595408
Individual0.08Indirect Ownership Interest
Unknown partyPAC 0840797429
Individual0.07Indirect Ownership Interest
Unknown partyPAC 3779080346
Individual0.07Indirect Ownership Interest
Unknown partyPAC 9931606506
Organization0.07Indirect Ownership Interest
Unknown partyPAC 5890292460
OrganizationADP of the SNF
Unknown partyPAC 1456858034
IndividualADP of the SNF
Cliftonlarsonallen LLPPAC 1456885441
OrganizationADP of the SNF
Marianne B ConnerPAC 6608930672
IndividualADP of the SNF
Merchants Bank of IndianaPAC 3779083779
Organization805% or Greater Mortgage Interest
East West BankPAC 7517190077
Organization105% or Greater Security Interest

Linked facilities

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Evergreen Health and Rehabilitation Center Evergreen Health and Rehabilitation Center LLC 157 residents		Other disclo…	3.91	Ovr★★★☆☆Stf★★☆☆☆Ins★★☆☆☆QM★★★★★	157

Evergreen Health and Rehabilitation Center
Evergreen Health and Rehabilitation Center LLC
Other disclosed role157 res3.91 HPRD
Overall 3Staffing Staff 2

Related CMS associates

FEC political contributions FEC contributions Beta

Name match to Evergreen Health and Rehabilitation Center LLC in FEC filings. Similar names may appear—confirm on FEC.gov.

Owners & control parties

Linked facilities

FEC political contributions FEC contributions Beta How it works

FEC political contributions FEC contributions Beta