Tar River Ltc Group, LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 9739360785 Enrollment ID O20110223000845, O20110413000568 (+1)

Linked facilitiesFacilities

StatesStates

13 parties: 2 organizations · 11 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Principle Long Term Care, Inc.	5193906386	Organization	5% or Greater Direct Ownership Interest; Operational/Managerial Control; ADP of the SNF	50
Joetta Barker	7214396225	Individual	Operational/Managerial Control; ADP of the SNF	—
Meredith Turner	9032441415	Individual	Operational/Managerial Control; ADP of the SNF	—
Gale R Boice	2860737442	Individual	Corporate Officer; ADP of the SNF; Operational/Managerial Control	—
Jeffrey Francis Severa	7618942475	Individual	Managing Control - Governing Body; ADP of the SNF	—
Brandi Lassiter	0547672768	Individual	Managing Control - Governing Body; ADP of the SNF	—
Francis M Taylor	0648233395	Individual	Managing Control - Governing Body; ADP of the SNF	—
Principle It Services, Inc.	7810178001	Organization	5% or Greater Direct Ownership Interest	50
Robert O'neil Hill	1557279130	Individual	5% or Greater Indirect Ownership Interest; ADP of the SNF; 5% or Greater Direct Ownership Interest	20.6
Stephen Britt Hill	2466360045	Individual	5% or Greater Indirect Ownership Interest; ADP of the SNF; 5% or Greater Direct Ownership Interest	20.02
Raymond Gregg Hill	0648188227	Individual	5% or Greater Indirect Ownership Interest; ADP of the SNF; 5% or Greater Direct Ownership Interest	18.47
Dianne Johnson	3274714464	Individual	Corporate Director; Corporate Officer	—
Steven Earl Skahill	1052218039	Individual	ADP of the SNF	—

Principle Long Term Care, Inc.PAC 5193906386
Organization505% or Greater Direct Ownership Interest; Operational/Managerial Control
Joetta BarkerPAC 7214396225
IndividualOperational/Managerial Control; ADP of the SNF
Meredith TurnerPAC 9032441415
IndividualOperational/Managerial Control; ADP of the SNF
Gale R BoicePAC 2860737442
IndividualCorporate Officer; ADP of the SNF
Jeffrey Francis SeveraPAC 7618942475
IndividualManaging Control - Governing Body; ADP of the SNF
Brandi LassiterPAC 0547672768
IndividualManaging Control - Governing Body; ADP of the SNF
Francis M TaylorPAC 0648233395
IndividualManaging Control - Governing Body; ADP of the SNF
Principle It Services, Inc.PAC 7810178001
Organization505% or Greater Direct Ownership Interest
Robert O'neil HillPAC 1557279130
Individual20.65% or Greater Indirect Ownership Interest; ADP of the SNF
Stephen Britt HillPAC 2466360045
Individual20.025% or Greater Indirect Ownership Interest; ADP of the SNF
Raymond Gregg HillPAC 0648188227
Individual18.475% or Greater Indirect Ownership Interest; ADP of the SNF
Dianne JohnsonPAC 3274714464
IndividualCorporate Director; Corporate Officer
Steven Earl SkahillPAC 1052218039
IndividualADP of the SNF

Facility	Location	% Own.	HPRD	Ratings	Census	Flags
Chowan River Nursing and Rehabilitation Center Tar River Ltc Group, LLC 57 residents		Other disclo…	3.61	Ovr★★★★☆Stf★★★☆☆Ins★★★★☆QM★★★★☆	57

Chowan River Nursing and Rehabilitation Center
Tar River Ltc Group, LLC
Other disclosed role57 res3.61 HPRD
Overall 4Staffing Staff 3

2 CMS ownership change records (showing 2)

Effective	Facility	Buyer	Seller	Side
10/01/2020	The Carrolton of Plymouth	The Carrolton of Plymouth, LLC	Tar River Ltc Group, LLC	Seller
10/01/2020	The Carrolton of Williamston	Williamston Nursing Facility Operations Company, LLC	Tar River Ltc Group, LLC	Seller

10/01/2020
The Carrolton of Plymouth (Seller)
Tar River Ltc Group, LLC → The Carrolton of Plymouth, LLC
10/01/2020
The Carrolton of Williamston (Seller)
Tar River Ltc Group, LLC → Williamston Nursing Facility Operations Company, LLC

Related CMS associates

Name match to Tar River Ltc Group, LLC in FEC filings. Similar names may appear—confirm on FEC.gov.