Groton Sd Skilled Nursing Facility LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 8628306685 Enrollment ID O20190828004245

Linked facilitiesFacilities

StatesStates

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Bokf, Na	0648188896	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Brenda Carda	6901392430	Individual	Operational/Managerial Control; ADP of the SNF	—
Brandon D Steger	5092946079	Individual	Operational/Managerial Control; ADP of the SNF	—
Legacy Healthcare Financial Services LLC	5799046132	Organization	Operational/Managerial Control; 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	0547756074	Individual	Indirect Ownership Interest	4.9
Unknown party	6901392422	Individual	Indirect Ownership Interest	4.9
Unknown party	2365938891	Individual	Indirect Ownership Interest	2.6
Unknown party	8729574256	Individual	Indirect Ownership Interest	2.6
Groton Sd Property Holdings, LLC	8123514643	Organization	5% or Greater Security Interest; ADP of the SNF	100
Roth & Co, LLP	3173053162	Organization	ADP of the SNF	—
Unknown party	5294221719	Individual	ADP of the SNF	—

Bokf, NaPAC 0648188896
Organization1005% or Greater Security Interest; Operational/Managerial Control
Brenda CardaPAC 6901392430
IndividualOperational/Managerial Control; ADP of the SNF
Brandon D StegerPAC 5092946079
IndividualOperational/Managerial Control; ADP of the SNF
Legacy Healthcare Financial Services LLCPAC 5799046132
OrganizationOperational/Managerial Control; ADP of the SNF
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 0547756074
Individual4.9Indirect Ownership Interest
Unknown partyPAC 6901392422
Individual4.9Indirect Ownership Interest
Unknown partyPAC 2365938891
Individual2.6Indirect Ownership Interest
Unknown partyPAC 8729574256
Individual2.6Indirect Ownership Interest
Groton Sd Property Holdings, LLCPAC 8123514643
Organization1005% or Greater Security Interest; ADP of the SNF
Roth & Co, LLPPAC 3173053162
OrganizationADP of the SNF
Unknown partyPAC 5294221719
IndividualADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Avantara Groton Groton Sd Skilled Nursing Facility LLC 40 residents		Other disclo…	3.72	Ovr★★☆☆☆Stf★★★☆☆Ins★★★☆☆QM★☆☆☆☆	40

Avantara Groton
Groton Sd Skilled Nursing Facility LLC
Other disclosed role40 res3.72 HPRD
Overall 2Staffing Staff 3

1 CMS ownership change record (showing 1)

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

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

Related CMS associates

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