Chc Heritage Square Nursing Center, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6406100346 Enrollment ID O20181113002029

Linked facilitiesFacilities

StatesStates

12 parties: 4 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Philander Smith	2163820705	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
David Barker	7113443946	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Pamela Wilkes	7911423744	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Care Systems, LLC	8224554043	Organization	Operational/Managerial Control; ADP of the SNF	—
Pharmacy Consults, LLC	2860928041	Organization	Operational/Managerial Control; ADP of the SNF	—
Bwdv Holdings, LLC	6507382322	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	100
Boyd Thompson Wright	1850201591	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; ADP of the SNF	50
David Vann	4284988122	Individual	5% or Greater Direct Ownership Interest; Corporate Officer; ADP of the SNF	50
Blake Wright	3779973755	Individual	5% or Greater Indirect Ownership Interest; Corporate Officer	10, 0
First Arkansas Bank and Trust	1951827773	Organization	5% or Greater Mortgage Interest; ADP of the SNF	100
Larry M Mcginnis	2769918952	Individual	ADP of the SNF	—
Mark Hahn	3375584931	Individual	ADP of the SNF	—

Philander SmithPAC 2163820705
IndividualOperational/Managerial Control; Managing Control - Governing Body
David BarkerPAC 7113443946
IndividualOperational/Managerial Control; Managing Control - Governing Body
Pamela WilkesPAC 7911423744
IndividualOperational/Managerial Control; Managing Control - Governing Body
Care Systems, LLCPAC 8224554043
OrganizationOperational/Managerial Control; ADP of the SNF
Pharmacy Consults, LLCPAC 2860928041
OrganizationOperational/Managerial Control; ADP of the SNF
Bwdv Holdings, LLCPAC 6507382322
Organization1005% or Greater Direct Ownership Interest; ADP of the SNF
Boyd Thompson WrightPAC 1850201591
Individual505% or Greater Direct Ownership Interest; Corporate Officer
David VannPAC 4284988122
Individual505% or Greater Direct Ownership Interest; Corporate Officer
Blake WrightPAC 3779973755
Individual10, 05% or Greater Indirect Ownership Interest; Corporate Officer
First Arkansas Bank and TrustPAC 1951827773
Organization1005% or Greater Mortgage Interest; ADP of the SNF
Larry M McginnisPAC 2769918952
IndividualADP of the SNF
Mark HahnPAC 3375584931
IndividualADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Heritage Square Healthcare Center Chc Heritage Square Nursing Center, LLC 76 residents		Other disclo…	3.76	Ovr★★★★☆Stf★★★☆☆Ins★★★★☆QM★★☆☆☆	76

Heritage Square Healthcare Center
Chc Heritage Square Nursing Center, LLC
Other disclosed role76 res3.76 HPRD
Overall 4Staffing Staff 3

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
11/01/2018	Heritage Square Healthcare Center	Chc Heritage Square Nursing Center, LLC	Heritage Square Nursing and Rehabilitation Center, Inc.	Buyer

11/01/2018
Heritage Square Healthcare Center (Buyer)
Heritage Square Nursing and Rehabilitation Center, Inc. → Chc Heritage Square Nursing Center, LLC

Related CMS associates

Name match to Chc Heritage Square Nursing Center, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.