Northwest, Incorporated

Mixed CMS roles

Provider / enrollment organization Enrollment PAC 6002714516 Enrollment ID O20191001000660

Linked facilitiesFacilities

6 parties: 3 organizations · 3 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
William Brett Coble	4688733926	Individual	Corporate Director; Operational/Managerial Control	100
Kristy Deroin	0244531754	Individual	Operational/Managerial Control	—
Bridges Esop, Inc	0648660134	Organization	5% or Greater Direct Ownership Interest	100
Bridges Employee Stock Ownership Trust	2466842950	Organization	5% or Greater Indirect Ownership Interest	100
Amity Care, LLC	7315856580	Organization	ADP of the SNF	—
Robert Duncan	8426562760	Individual	ADP of the SNF	—

William Brett CoblePAC 4688733926
Individual100Corporate Director; Operational/Managerial Control
Kristy DeroinPAC 0244531754
IndividualOperational/Managerial Control
Bridges Esop, IncPAC 0648660134
Organization1005% or Greater Direct Ownership Interest
Bridges Employee Stock Ownership TrustPAC 2466842950
Organization1005% or Greater Indirect Ownership Interest
Amity Care, LLCPAC 7315856580
OrganizationADP of the SNF
Robert DuncanPAC 8426562760
IndividualADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Fairmont Skilled Nursing and Therapy Northwest, Incorporated 94 residents		Other disclo…	4.06	Ovr★★☆☆☆Stf★★★★☆Ins★★☆☆☆QM★★☆☆☆	94

Fairmont Skilled Nursing and Therapy
Northwest, Incorporated
Other disclosed role94 res4.06 HPRD
Overall 2Staffing Staff 4

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
07/01/2019	Fairmont Skilled Nursing and Therapy	Northwest, Incorporated	City of Pauls Valley	Buyer

07/01/2019
Fairmont Skilled Nursing and Therapy (Buyer)
City of Pauls Valley → Northwest, Incorporated

Related CMS associates

Name match to Northwest, Incorporated in FEC filings. Similar names may appear—confirm on FEC.gov.