Redfield Sd Skilled Nursing Facility, LLC

Mixed CMS roles

Provider / enrollment organization Enrollment PAC 3870821044 Enrollment ID O20190826003201

Linked facilitiesFacilities

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Bokf, Na	0648188896	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Randall Waldner	1254609506	Individual	Operational/Managerial Control; ADP of the SNF	—
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Diane Forgey	4284644469	Individual	Operational/Managerial Control; ADP of the SNF	—
Menachem Shabat	3072526219	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Doros Generation Trust U/A/D 1/3/12	6901110428	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	42.5
Gpn Family Trust U/A/D 4/28/08	5294988994	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	42.5
Oakway Operations LLC	6103212279	Organization	5% or Greater Direct Ownership Interest	15
Unknown party	0345733549	Individual	Indirect Ownership Interest	4.9
Unknown party	2163915364	Individual	Indirect Ownership Interest	4.9
Unknown party	1254824451	Individual	Indirect Ownership Interest	2.6
Unknown party	4981197183	Individual	Indirect Ownership Interest	2.6
Redfield Sd Property Holdings, LLC	6305339508	Organization	5% or Greater Security Interest; ADP of the SNF	100
Roth & Co, LLP	3173053162	Organization	ADP of the SNF	—
Legacy Healthcare Financial Services LLC	5799046132	Organization	ADP of the SNF	—

Bokf, NaPAC 0648188896
Organization1005% or Greater Security Interest; Operational/Managerial Control
Randall WaldnerPAC 1254609506
IndividualOperational/Managerial Control; ADP of the SNF
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
Diane ForgeyPAC 4284644469
IndividualOperational/Managerial Control; ADP of the SNF
Menachem ShabatPAC 3072526219
IndividualOperational/Managerial Control; Managing Control - Governing Body
Doros Generation Trust U/A/D 1/3/12PAC 6901110428
Organization42.55% or Greater Direct Ownership Interest; ADP of the SNF
Gpn Family Trust U/A/D 4/28/08PAC 5294988994
Organization42.55% or Greater Direct Ownership Interest; ADP of the SNF
Oakway Operations LLCPAC 6103212279
Organization155% or Greater Direct Ownership Interest
Unknown partyPAC 0345733549
Individual4.9Indirect Ownership Interest
Unknown partyPAC 2163915364
Individual4.9Indirect Ownership Interest
Unknown partyPAC 1254824451
Individual2.6Indirect Ownership Interest
Unknown partyPAC 4981197183
Individual2.6Indirect Ownership Interest
Redfield Sd Property Holdings, LLCPAC 6305339508
Organization1005% or Greater Security Interest; ADP of the SNF
Roth & Co, LLPPAC 3173053162
OrganizationADP of the SNF
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Avantara Redfield Redfield Sd Skilled Nursing Facility, LLC 50 residents		Other disclo…	3.03	Ovr★★☆☆☆Stf★★★☆☆Ins★★☆☆☆QM★★☆☆☆	50

Avantara Redfield
Redfield Sd Skilled Nursing Facility, LLC
Other disclosed role50 res3.03 HPRD
Overall 2Staffing Staff 3

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
07/01/2019	Avantara Redfield	Redfield Sd Skilled Nursing Facility, LLC	Redfield Care and Rehabilitation Center LLC	Buyer

07/01/2019
Avantara Redfield (Buyer)
Redfield Care and Rehabilitation Center LLC → Redfield Sd Skilled Nursing Facility, LLC

Related CMS associates

Name match to Redfield Sd Skilled Nursing Facility, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.