Evergreen at Ely LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 4486612751 Enrollment ID O20050106000247

Linked facilitiesFacilities

StatesStates

5 parties: 3 organizations · 2 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Inez Thayer	2062873508	Individual	W-2 Managing Employee	0
Whitepinecare	0941675052	Organization	5% or Greater Direct Ownership Interest	100
Josekutty Jose	9638401409	Individual	5% or Greater Indirect Ownership Interest; Corporate Director	100
2015 Cep Trust	8729357538	Organization	Other	0
Cep Holdings LLC	0244546372	Organization	Other	—

Inez ThayerPAC 2062873508
Individual0W-2 Managing Employee
WhitepinecarePAC 0941675052
Organization1005% or Greater Direct Ownership Interest
Josekutty JosePAC 9638401409
Individual1005% or Greater Indirect Ownership Interest; Corporate Director
2015 Cep TrustPAC 8729357538
Organization0Other
Cep Holdings LLCPAC 0244546372
OrganizationOther

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
White Pine Care Center Evergreen at Ely LLC 33 residents		Other disclo…	—	Ovr★★☆☆☆Stf★☆☆☆☆Ins★★★☆☆QM★★★☆☆	33

White Pine Care Center
Evergreen at Ely LLC
Other disclosed role33 res
Overall 2Staffing Staff 1

Related CMS associates

Name match to Evergreen at Ely LLC in FEC filings. Similar names may appear—confirm on FEC.gov.