David Kleis II, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 9436451622 Enrollment ID O20170216002515

Linked facilitiesFacilities

StatesStates

5 parties: 1 organizations · 4 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Madelyn V Smith	1456262559	Individual	W-2 Managing Employee	100
Charis Tr Dtd 12/22/2016	9436432549	Organization	5% or Greater Direct Ownership Interest	98
Denise Steve	8921403163	Individual	Corporate Officer	100
Emmanuel Beltran David	5294643292	Individual	Corporate Officer	100
Antonio Tibayan Quion	4183533094	Individual	Corporate Officer	—

Madelyn V SmithPAC 1456262559
Individual100W-2 Managing Employee
Charis Tr Dtd 12/22/2016PAC 9436432549
Organization985% or Greater Direct Ownership Interest
Denise StevePAC 8921403163
Individual100Corporate Officer
Emmanuel Beltran DavidPAC 5294643292
Individual100Corporate Officer
Antonio Tibayan QuionPAC 4183533094
IndividualCorporate Officer

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Vista Real Post Acute David Kleis II, LLC 55 residents		Other disclo…	4.24	Ovr★★★★☆Stf★★★★☆Ins★★★☆☆QM★★★★★	55

Vista Real Post Acute
David Kleis II, LLC
Other disclosed role55 res4.24 HPRD
Overall 4Staffing Staff 4

Related CMS associates

Name match to David Kleis II, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.