Hazard Nursing Home, Inc.

Enrollment entity

Provider / enrollment organization Enrollment PAC 6709921737 Enrollment ID O20101122000178

Linked facilitiesFacilities

StatesStates

8 parties: 2 organizations · 6 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Charlotte Thornsberry	1850587510	Individual	W-2 Managing Employee; Operational/Managerial Control	—
Seky Holding Co	8628008570	Organization	5% or Greater Direct Ownership Interest	100
Fcltc Holdings Inc	3779858154	Organization	5% or Greater Indirect Ownership Interest	100
Terry E Forcht	1153238076	Individual	5% or Greater Indirect Ownership Interest	98.5
David Witt	4587850243	Individual	Corporate Officer; Corporate Director	—
Jackie Willis	6305032061	Individual	Corporate Officer	—
Roger Alsip	2769634211	Individual	Corporate Officer; Corporate Director	—
Wesley Tipton	8022383405	Individual	Corporate Officer; Corporate Director	—

Charlotte ThornsberryPAC 1850587510
IndividualW-2 Managing Employee; Operational/Managerial Control
Seky Holding CoPAC 8628008570
Organization1005% or Greater Direct Ownership Interest
Fcltc Holdings IncPAC 3779858154
Organization1005% or Greater Indirect Ownership Interest
Terry E ForchtPAC 1153238076
Individual98.55% or Greater Indirect Ownership Interest
David WittPAC 4587850243
IndividualCorporate Officer; Corporate Director
Jackie WillisPAC 6305032061
IndividualCorporate Officer
Roger AlsipPAC 2769634211
IndividualCorporate Officer; Corporate Director
Wesley TiptonPAC 8022383405
IndividualCorporate Officer; Corporate Director

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Hazard Health and Rehabilitation Center Hazard Nursing Home, Inc. 184 residents		Other disclo…	4.72	Ovr★☆☆☆☆Stf★★★★☆Ins★☆☆☆☆QM★☆☆☆☆	184

Hazard Health and Rehabilitation Center
Hazard Nursing Home, Inc.
Other disclosed role184 res4.72 HPRD
Overall 1Staffing Staff 4

Related CMS associates

Name match to Hazard Nursing Home, Inc. in FEC filings. Similar names may appear—confirm on FEC.gov.