Nsh Lake Mills LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 3971879503 Enrollment ID O20171025002456

Linked facilitiesFacilities

StatesStates

5 parties: 2 organizations · 3 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
North Shore Healthcare LLC	3779867148	Organization	Operational/Managerial Control	100
Troy T Baumann	3870895907	Individual	5% or Greater Indirect Ownership Interest; Corporate Director; W-2 Managing Employee	40, 100
Nshf Operations LLC	9436425162	Organization	5% or Greater Direct Ownership Interest	100
Jeffrey C Hoehn	3678500899	Individual	5% or Greater Indirect Ownership Interest; Corporate Director	40, 100
David Mills	2567379241	Individual	5% or Greater Indirect Ownership Interest	20

North Shore Healthcare LLCPAC 3779867148
Organization100Operational/Managerial Control
Troy T BaumannPAC 3870895907
Individual40, 1005% or Greater Indirect Ownership Interest; Corporate Director
Nshf Operations LLCPAC 9436425162
Organization1005% or Greater Direct Ownership Interest
Jeffrey C HoehnPAC 3678500899
Individual40, 1005% or Greater Indirect Ownership Interest; Corporate Director
David MillsPAC 2567379241
Individual205% or Greater Indirect Ownership Interest

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Lake Mills Health Services Nsh Lake Mills LLC 28 residents		Other disclo…	3.54	Ovr★★☆☆☆Stf★★★★☆Ins★★☆☆☆QM★★★☆☆	28

Lake Mills Health Services
Nsh Lake Mills LLC
Other disclosed role28 res3.54 HPRD
Overall 2Staffing Staff 4

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
10/01/2017	Lake Mills Health Services	Nsh Lake Mills LLC	Fmg Mulberry Street Wisconsin LLC	Buyer

10/01/2017
Lake Mills Health Services (Buyer)
Fmg Mulberry Street Wisconsin LLC → Nsh Lake Mills LLC

Related CMS associates

Name match to Nsh Lake Mills LLC in FEC filings. Similar names may appear—confirm on FEC.gov.