Lake Norden Sd Skilled Nursing Facility, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 8628306651 Enrollment ID O20190828002589

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
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
Margaret Grimm	3375553548	Individual	Operational/Managerial Control; ADP of the SNF	—
Menachem Shabat	3072526219	Individual	Operational/Managerial Control; Managing Control - Governing Body; ADP of the SNF	—
William W Devine	6608865324	Individual	Operational/Managerial Control; 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	4981199031	Individual	Indirect Ownership Interest	4.9
Unknown party	6709371859	Individual	Indirect Ownership Interest	4.9
Unknown party	5890280945	Individual	Indirect Ownership Interest	2.6
Unknown party	7517452667	Individual	Indirect Ownership Interest	2.6
Lake Norden Sd Property Holdings, LLC	7810482965	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
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
Margaret GrimmPAC 3375553548
IndividualOperational/Managerial Control; ADP of the SNF
Menachem ShabatPAC 3072526219
IndividualOperational/Managerial Control; Managing Control - Governing Body
William W DevinePAC 6608865324
IndividualOperational/Managerial Control; ADP of the SNF
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 4981199031
Individual4.9Indirect Ownership Interest
Unknown partyPAC 6709371859
Individual4.9Indirect Ownership Interest
Unknown partyPAC 5890280945
Individual2.6Indirect Ownership Interest
Unknown partyPAC 7517452667
Individual2.6Indirect Ownership Interest
Lake Norden Sd Property Holdings, LLCPAC 7810482965
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 Lake Norden Lake Norden Sd Skilled Nursing Facility, LLC 47 residents		Other disclo…	3.23	Ovr★★★★★Stf★★★★☆Ins★★★★☆QM★★★★★	47

Avantara Lake Norden
Lake Norden Sd Skilled Nursing Facility, LLC
Other disclosed role47 res3.23 HPRD
Overall 5Staffing Staff 4

1 CMS ownership change record (showing 1)

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

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

Related CMS associates

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