Watertown Sd Skilled Nursing Facility, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 7911235130 Enrollment ID O20190827001390

Linked facilitiesFacilities

StatesStates

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Truist Bank	9335631274	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Lynna Speier	4082942107	Individual	Operational/Managerial Control; ADP of the SNF	—
Aaron B Shives	6608918362	Individual	Operational/Managerial Control; ADP of the SNF	—
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Menachem Shabat	3072526219	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Doros Generation Trust U/A/D 1/3/12	6901110428	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	42.5
Gpn Family Trust U/A/D 4/28/08	5294988994	Organization	5% or Greater Direct Ownership Interest; ADP of the SNF	42.5
Oakway Operations LLC	6103212279	Organization	5% or Greater Direct Ownership Interest	15
Unknown party	4082190137	Individual	Indirect Ownership Interest	4.9
Unknown party	6800372954	Individual	Indirect Ownership Interest	4.9
Unknown party	5991281040	Individual	Indirect Ownership Interest	2.6
Unknown party	7618453762	Individual	Indirect Ownership Interest	2.6
Watertown Sd Property Holdings, LLC	5294211348	Organization	5% or Greater Security Interest; ADP of the SNF	100
Rsm Us LLP	6305077611	Organization	ADP of the SNF	—
Legacy Healthcare Financial Services LLC	5799046132	Organization	ADP of the SNF	—

Truist BankPAC 9335631274
Organization1005% or Greater Security Interest; Operational/Managerial Control
Lynna SpeierPAC 4082942107
IndividualOperational/Managerial Control; ADP of the SNF
Aaron B ShivesPAC 6608918362
IndividualOperational/Managerial Control; ADP of the SNF
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
Menachem ShabatPAC 3072526219
IndividualOperational/Managerial Control; Managing Control - Governing Body
Doros Generation Trust U/A/D 1/3/12PAC 6901110428
Organization42.55% or Greater Direct Ownership Interest; ADP of the SNF
Gpn Family Trust U/A/D 4/28/08PAC 5294988994
Organization42.55% or Greater Direct Ownership Interest; ADP of the SNF
Oakway Operations LLCPAC 6103212279
Organization155% or Greater Direct Ownership Interest
Unknown partyPAC 4082190137
Individual4.9Indirect Ownership Interest
Unknown partyPAC 6800372954
Individual4.9Indirect Ownership Interest
Unknown partyPAC 5991281040
Individual2.6Indirect Ownership Interest
Unknown partyPAC 7618453762
Individual2.6Indirect Ownership Interest
Watertown Sd Property Holdings, LLCPAC 5294211348
Organization1005% or Greater Security Interest; ADP of the SNF
Rsm Us LLPPAC 6305077611
OrganizationADP of the SNF
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationADP of the SNF

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Avantara Watertown Watertown Sd Skilled Nursing Facility, LLC 47 residents		Other disclo…	3.57	Ovr★☆☆☆☆Stf★★★☆☆Ins★☆☆☆☆QM★★☆☆☆	47

Avantara Watertown
Watertown Sd Skilled Nursing Facility, LLC
Other disclosed role47 res3.57 HPRD
Overall 1Staffing Staff 3

1 CMS ownership change record (showing 1)

Effective	Facility	Buyer	Seller	Side
07/01/2019	Avantara Watertown	Watertown Sd Skilled Nursing Facility, LLC	Watertown Care and Rehabilitation Center LLC	Buyer

07/01/2019
Avantara Watertown (Buyer)
Watertown Care and Rehabilitation Center LLC → Watertown Sd Skilled Nursing Facility, LLC

Related CMS associates

Name match to Watertown Sd Skilled Nursing Facility, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.