Saint Cloud Sd Skilled Nursing Facility, LLC

Mixed CMS roles

Provider / enrollment organization Enrollment PAC 4284962499 Enrollment ID O20190827000849

Linked facilitiesFacilities

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Truist Bank	9335631274	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Travis Ptacek	5092087486	Individual	Operational/Managerial Control; ADP of the SNF	—
Ashaley Altena	6406342682	Individual	Operational/Managerial Control; ADP of the SNF	—
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; 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	0941796122	Individual	Indirect Ownership Interest	4.9
Unknown party	8123514304	Individual	Indirect Ownership Interest	4.9
Unknown party	1850887035	Individual	Indirect Ownership Interest	2.6
Unknown party	9032605217	Individual	Indirect Ownership Interest	2.6
Saint Cloud Sd Property Holdings, LLC	6608362884	Organization	5% or Greater Security Interest; ADP of the SNF	100
Rsm Us LLP	6305077611	Organization	ADP of the SNF	—
Legacy Healthcare Financial Services LLC	5799046132	Organization	ADP of the SNF	—

Truist BankPAC 9335631274
Organization1005% or Greater Security Interest; Operational/Managerial Control
Travis PtacekPAC 5092087486
IndividualOperational/Managerial Control; ADP of the SNF
Ashaley AltenaPAC 6406342682
IndividualOperational/Managerial Control; ADP of the SNF
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
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 0941796122
Individual4.9Indirect Ownership Interest
Unknown partyPAC 8123514304
Individual4.9Indirect Ownership Interest
Unknown partyPAC 1850887035
Individual2.6Indirect Ownership Interest
Unknown partyPAC 9032605217
Individual2.6Indirect Ownership Interest
Saint Cloud Sd Property Holdings, LLCPAC 6608362884
Organization1005% or Greater Security Interest; ADP of the SNF
Rsm Us LLPPAC 6305077611
OrganizationADP of the SNF
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Avantara Saint Cloud Saint Cloud Sd Skilled Nursing Facility, LLC 72 residents		Other disclo…	3.12	Ovr★☆☆☆☆Stf★☆☆☆☆Ins★★☆☆☆QM★★☆☆☆	72

Avantara Saint Cloud
Saint Cloud Sd Skilled Nursing Facility, LLC
Other disclosed role72 res3.12 HPRD
Overall 1Staffing Staff 1

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
07/01/2019	Avantara Saint Cloud	Saint Cloud Sd Skilled Nursing Facility, LLC	Bella Vista Care and Rehabilitation Center LLC	Buyer

07/01/2019
Avantara Saint Cloud (Buyer)
Bella Vista Care and Rehabilitation Center LLC → Saint Cloud Sd Skilled Nursing Facility, LLC

Related CMS associates

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