Highland Ridge Care Center, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6901821925 Enrollment ID O20110615000484

Linked facilitiesFacilities

StatesStates

16 parties: 3 organizations · 13 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Phs Management, LLC	5193901049	Organization	Operational/Managerial Control; ADP of the SNF	100
Brandon Phelps	4880810548	Individual	Operational/Managerial Control; ADP of the SNF	—
Victoria R Hadley	6204329402	Individual	Operational/Managerial Control; ADP of the SNF	—
Jerry Mark Hudson	8729996186	Individual	Operational/Managerial Control; ADP of the SNF	—
Mark T Meyer	3274441639	Individual	Corporate Officer; Operational/Managerial Control; ADP of the SNF	—
Williamsburg Retirement Community Inc	5395764765	Organization	5% or Greater Direct Ownership Interest	100
Jonathan David Fletcher	4789194366	Individual	Corporate Officer	50
Daniel J Olson	8729571922	Individual	Corporate Director	14.29
Duane W Larson	7810074366	Individual	Corporate Director	14.29
Curtis Lee Blythe	0941229397	Individual	Corporate Director	14.29
Daniel A Lindh	4183532542	Individual	Corporate Director	14.29
Marcia Ann Kinzenbaw	7113946567	Individual	Corporate Director	14.29
Mary Ann Blythe	6406875855	Individual	Corporate Director	14.29
Susan Holden Mccurry	4486673837	Individual	Corporate Director	14.29
Unknown party	5294228490	Individual	ADP of the SNF	—
Hills Bank and Trust Company	3072786896	Organization	5% or Greater Mortgage Interest; 5% or Greater Security Interest	75

Phs Management, LLCPAC 5193901049
Organization100Operational/Managerial Control; ADP of the SNF
Brandon PhelpsPAC 4880810548
IndividualOperational/Managerial Control; ADP of the SNF
Victoria R HadleyPAC 6204329402
IndividualOperational/Managerial Control; ADP of the SNF
Jerry Mark HudsonPAC 8729996186
IndividualOperational/Managerial Control; ADP of the SNF
Mark T MeyerPAC 3274441639
IndividualCorporate Officer; Operational/Managerial Control
Williamsburg Retirement Community IncPAC 5395764765
Organization1005% or Greater Direct Ownership Interest
Jonathan David FletcherPAC 4789194366
Individual50Corporate Officer
Daniel J OlsonPAC 8729571922
Individual14.29Corporate Director
Duane W LarsonPAC 7810074366
Individual14.29Corporate Director
Curtis Lee BlythePAC 0941229397
Individual14.29Corporate Director
Daniel A LindhPAC 4183532542
Individual14.29Corporate Director
Marcia Ann KinzenbawPAC 7113946567
Individual14.29Corporate Director
Mary Ann BlythePAC 6406875855
Individual14.29Corporate Director
Susan Holden MccurryPAC 4486673837
Individual14.29Corporate Director
Unknown partyPAC 5294228490
IndividualADP of the SNF
Hills Bank and Trust CompanyPAC 3072786896
Organization755% or Greater Mortgage Interest; 5% or Greater Security Interest

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Highland Ridge Care Center, LLC 51 residents		Other disclo…	4.10	Ovr★★★☆☆Stf★★★★★Ins★★☆☆☆QM★★★☆☆	51

Highland Ridge Care Center, LLC
Other disclosed role51 res4.10 HPRD
Overall 3Staffing Staff 5

Related CMS associates

Name match to Highland Ridge Care Center, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.