Williamston Nursing Facility Operations Company, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6002228541 Enrollment ID O20201207002978

Linked facilitiesFacilities

StatesStates

11 parties: 3 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Carrolton Facility Management, LLC	5890106348	Organization	Operational/Managerial Control; ADP of the SNF	100
Carrol Saunders Roberson	4587574850	Individual	Operational/Managerial Control; ADP of the SNF; Indirect Ownership Interest	50
Sonya Rozier	0446161756	Individual	Operational/Managerial Control; ADP of the SNF	—
C. Saunders Roberson, Jr., As Trustee of the Judith Roberson Dixon Irr	4981015435	Organization	5% or Greater Direct Ownership Interest	37.5
C. Saunders Roberson, Jr., Trustee of the Carol Saunders Roberson Fami	0547672081	Organization	5% or Greater Direct Ownership Interest	12.5
Deborah Powell Figlewski	3678483948	Individual	5% or Greater Direct Ownership Interest	12.5
Denise Russell	7517378060	Individual	5% or Greater Direct Ownership Interest	12.5
Earl Powell	8426469974	Individual	5% or Greater Direct Ownership Interest	12.5
John Powell	9335550888	Individual	5% or Greater Direct Ownership Interest	12.5
Unknown party	8527546753	Individual	ADP of the SNF	—
Unknown party	7618455841	Individual	ADP of the SNF	—

Carrolton Facility Management, LLCPAC 5890106348
Organization100Operational/Managerial Control; ADP of the SNF
Carrol Saunders RobersonPAC 4587574850
Individual50Operational/Managerial Control; ADP of the SNF
Sonya RozierPAC 0446161756
IndividualOperational/Managerial Control; ADP of the SNF
C. Saunders Roberson, Jr., As Trustee of the Judith Roberson Dixon IrrPAC 4981015435
Organization37.55% or Greater Direct Ownership Interest
C. Saunders Roberson, Jr., Trustee of the Carol Saunders Roberson FamiPAC 0547672081
Organization12.55% or Greater Direct Ownership Interest
Deborah Powell FiglewskiPAC 3678483948
Individual12.55% or Greater Direct Ownership Interest
Denise RussellPAC 7517378060
Individual12.55% or Greater Direct Ownership Interest
Earl PowellPAC 8426469974
Individual12.55% or Greater Direct Ownership Interest
John PowellPAC 9335550888
Individual12.55% or Greater Direct Ownership Interest
Unknown partyPAC 8527546753
IndividualADP of the SNF
Unknown partyPAC 7618455841
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
The Carrolton of Williamston Williamston Nursing Facility Operations Company, LLC 119 residents		Other disclo…	2.70	Ovr★★☆☆☆Stf★★☆☆☆Ins★★☆☆☆QM★★☆☆☆	119

The Carrolton of Williamston
Williamston Nursing Facility Operations Company, LLC
Other disclosed role119 res2.70 HPRD
Overall 2Staffing Staff 2

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
10/01/2020	The Carrolton of Williamston	Williamston Nursing Facility Operations Company, LLC	Tar River Ltc Group, LLC	Buyer

10/01/2020
The Carrolton of Williamston (Buyer)
Tar River Ltc Group, LLC → Williamston Nursing Facility Operations Company, LLC

Related CMS associates

Name match to Williamston Nursing Facility Operations Company, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.