Rc North Sd Skilled Nursing Facility LLC

Mixed CMS roles

Provider / enrollment organization Enrollment PAC 4082942263 Enrollment ID O20190826003555

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
Travis Ptacek	5092087486	Individual	Operational/Managerial Control; ADP of the SNF	—
Celina Lohre	8426386327	Individual	Operational/Managerial Control; ADP of the SNF	—
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Legacy Healthcare Financial Services LLC	5799046132	Organization	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	3173019619	Individual	Indirect Ownership Interest	4.9
Unknown party	9436645975	Individual	Indirect Ownership Interest	4.9
Unknown party	0345736880	Individual	Indirect Ownership Interest	2.6
Unknown party	5991291437	Individual	Indirect Ownership Interest	2.6
Roth & Co, LLP	3173053162	Organization	ADP of the SNF	—
Rc North Sd Property Holdings, LLC	2466948997	Organization	ADP of the SNF	—

Bokf, NaPAC 0648188896
Organization1005% or Greater Security Interest; Operational/Managerial Control
Travis PtacekPAC 5092087486
IndividualOperational/Managerial Control; ADP of the SNF
Celina LohrePAC 8426386327
IndividualOperational/Managerial Control; ADP of the SNF
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationOperational/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 3173019619
Individual4.9Indirect Ownership Interest
Unknown partyPAC 9436645975
Individual4.9Indirect Ownership Interest
Unknown partyPAC 0345736880
Individual2.6Indirect Ownership Interest
Unknown partyPAC 5991291437
Individual2.6Indirect Ownership Interest
Roth & Co, LLPPAC 3173053162
OrganizationADP of the SNF
Rc North Sd Property Holdings, LLCPAC 2466948997
OrganizationADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Avantara North Rc North Sd Skilled Nursing Facility LLC 66 residents		Other disclo…	3.06	Ovr★★★☆☆Stf★★★☆☆Ins★★★☆☆QM★★☆☆☆	66

Avantara North
Rc North Sd Skilled Nursing Facility LLC
Other disclosed role66 res3.06 HPRD
Overall 3Staffing Staff 3

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
07/01/2019	Avantara North	Rc North Sd Skilled Nursing Facility LLC	Black Hills Care and Rehabilitation Center LLC	Buyer

07/01/2019
Avantara North (Buyer)
Black Hills Care and Rehabilitation Center LLC → Rc North Sd Skilled Nursing Facility LLC

Related CMS associates

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