Arrowhead Sd Skilled Nursing Facility LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 9032447099 Enrollment ID O20190828003995

Linked facilitiesFacilities

StatesStates

15 parties: 7 organizations · 8 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Truist Bank	6709306079	Organization	5% or Greater Security Interest; Operational/Managerial Control	100
Travis Ptacek	5092087486	Individual	Operational/Managerial Control; ADP of the SNF	—
Sharon Martin	2264686781	Individual	Operational/Managerial Control; ADP of the SNF	—
Chaim Rajchenbach	4284547977	Individual	Operational/Managerial Control; Managing Control - Governing Body; 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	4880186113	Individual	Indirect Ownership Interest	4.9
Unknown party	6608368931	Individual	Indirect Ownership Interest	4.9
Unknown party	5799277026	Individual	Indirect Ownership Interest	2.6
Unknown party	7416449749	Individual	Indirect Ownership Interest	2.6
Arrowhead Sd Property Holdings, LLC	1052803384	Organization	5% or Greater Security Interest; ADP of the SNF	100
Rsm Us LLP	6305077611	Organization	ADP of the SNF	—

Truist BankPAC 6709306079
Organization1005% or Greater Security Interest; Operational/Managerial Control
Travis PtacekPAC 5092087486
IndividualOperational/Managerial Control; ADP of the SNF
Sharon MartinPAC 2264686781
IndividualOperational/Managerial Control; ADP of the SNF
Chaim RajchenbachPAC 4284547977
IndividualOperational/Managerial Control; Managing Control - Governing Body
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 4880186113
Individual4.9Indirect Ownership Interest
Unknown partyPAC 6608368931
Individual4.9Indirect Ownership Interest
Unknown partyPAC 5799277026
Individual2.6Indirect Ownership Interest
Unknown partyPAC 7416449749
Individual2.6Indirect Ownership Interest
Arrowhead Sd Property Holdings, LLCPAC 1052803384
Organization1005% or Greater Security Interest; ADP of the SNF
Rsm Us LLPPAC 6305077611
OrganizationADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Avantara Arrowhead Arrowhead Sd Skilled Nursing Facility LLC 59 residents		Other disclo…	3.52	Ovr★☆☆☆☆Stf★★☆☆☆Ins★☆☆☆☆QM★★☆☆☆	59

Avantara Arrowhead
Arrowhead Sd Skilled Nursing Facility LLC
Other disclosed role59 res3.52 HPRD
Overall 1Staffing Staff 2

1 CMS ownership change record (showing 1)

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

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

Related CMS associates

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