Phs Lake Minnetonka LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6406970532 Enrollment ID O20100826000517

Linked facilitiesFacilities

StatesStates

8 parties: 3 organizations · 5 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Phs Management, LLC	5193901049	Organization	Operational/Managerial Control; ADP of the SNF	100
Presbyterian Homes Housing and Assisted Living, Inc.	7618996059	Organization	5% or Greater Direct Ownership Interest; Operational/Managerial Control; ADP of the SNF	100
Shaylee V Sokoloski	5799279865	Individual	Operational/Managerial Control; ADP of the SNF	—
Jonathan David Fletcher	4789194366	Individual	Corporate Officer; Corporate Director	50, 33
Mark T Meyer	3274441639	Individual	Corporate Officer; Corporate Director	50, 33
Mark A Pederson	3274567094	Individual	Corporate Director	33
Heidi A Peterson	5698285278	Individual	ADP of the SNF	—
Northeast Bank	3476891318	Organization	5% or Greater Mortgage Interest; 5% or Greater Security Interest	75

Phs Management, LLCPAC 5193901049
Organization100Operational/Managerial Control; ADP of the SNF
Presbyterian Homes Housing and Assisted Living, Inc.PAC 7618996059
Organization1005% or Greater Direct Ownership Interest; Operational/Managerial Control
Shaylee V SokoloskiPAC 5799279865
IndividualOperational/Managerial Control; ADP of the SNF
Jonathan David FletcherPAC 4789194366
Individual50, 33Corporate Officer; Corporate Director
Mark T MeyerPAC 3274441639
Individual50, 33Corporate Officer; Corporate Director
Mark A PedersonPAC 3274567094
Individual33Corporate Director
Heidi A PetersonPAC 5698285278
IndividualADP of the SNF
Northeast BankPAC 3476891318
Organization755% or Greater Mortgage Interest; 5% or Greater Security Interest

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Lake Minnetonka Shores Phs Lake Minnetonka LLC 54 residents		Other disclo…	4.26	Ovr★★★★★Stf★★★★★Ins★★★★☆QM★★☆☆☆	54

Lake Minnetonka Shores
Phs Lake Minnetonka LLC
Other disclosed role54 res4.26 HPRD
Overall 5Staffing Staff 5

Related CMS associates

Name match to Phs Lake Minnetonka LLC in FEC filings. Similar names may appear—confirm on FEC.gov.