Public record

CMS Skilled Nursing Facility All Owners

Associate id: 6002724085 · 50 matching records

Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648188623
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2012-01-01
First name - owner
JOHN
Middle name - owner
D
Last name - owner
PIDGEON
Title - owner
CHAIRMAN
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648632307
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-07-01
Organization name - owner
RICHMOND IN OPERATING COMPANY, LLC
Address line 1 - owner
100 MERRICK RD
Address line 2 - owner
STE 418
City - owner
ROCKVILLE CENTRE
State - owner
NY
Zip code - owner
115704800
Percentage ownership
0
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
Y
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648632307
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
Organization name - owner
RICHMOND IN OPERATING COMPANY, LLC
Address line 1 - owner
100 MERRICK RD
Address line 2 - owner
STE 418
City - owner
ROCKVILLE CENTRE
State - owner
NY
Zip code - owner
115704800
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
Y
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0749747996
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-11-14
First name - owner
ERIKA
Last name - owner
GILMAN
Title - owner
BOARD MEMBER
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0749747996
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2025-11-14
First name - owner
ERIKA
Last name - owner
GILMAN
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0941551477
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2018-09-03
First name - owner
MERRY
Last name - owner
GOODWIN
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0941551477
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2018-09-03
First name - owner
MERRY
Last name - owner
GOODWIN
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3577543115
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-07-01
First name - owner
JAMES
Middle name - owner
R
Last name - owner
REIS
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3577543115
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-07-31
First name - owner
JAMES
Middle name - owner
R
Last name - owner
REIS
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3779671698
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2012-01-01
First name - owner
MARION
Middle name - owner
E
Last name - owner
SHORE
Title - owner
BOARD MEMBER
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3870545973
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2022-08-01
First name - owner
BRIAN
Last name - owner
RING
Title - owner
CEO
Percentage ownership
0
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6002724085
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2012-01-01
Organization name - owner
HENRY COUNTY MEMORIAL HOSPITAL
Doing business as name - owner
ALPHA HOME-A WATERS COMMUNITY
Address line 1 - owner
1000 N 16TH ST
City - owner
NEW CASTLE
State - owner
IN
Zip code - owner
473624319
Percentage ownership
100
Created for acquisition - owner
N
Corporation - owner
N
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
Y
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Parent company - owner
Y
Owned by another org or ind - owner
N
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6608260013
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2021-08-27
First name - owner
DEBORAH
Last name - owner
WARE
Title - owner
BOARD MEMBER
Percentage ownership
0
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8224497409
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-01-08
First name - owner
ISRAEL
Last name - owner
FRANKEL
Enrollment id
O20120206000281
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8224497409
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
First name - owner
ISRAEL
Last name - owner
FRANKEL
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0042698201
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
First name - owner
ELIZABETH
Last name - owner
PATTON
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648188623
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2012-01-01
First name - owner
JOHN
Middle name - owner
D
Last name - owner
PIDGEON
Title - owner
CHAIRMAN
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0749747996
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2025-11-14
First name - owner
ERIKA
Last name - owner
GILMAN
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3577543115
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
First name - owner
JAMES
Middle name - owner
R
Last name - owner
REIS
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3779671698
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2012-01-01
First name - owner
MARION
Middle name - owner
E
Last name - owner
SHORE
Title - owner
BOARD MEMBER
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3870545973
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2022-08-01
First name - owner
BRIAN
Last name - owner
RING
Title - owner
CEO
Percentage ownership
0
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6002724085
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2012-01-01
Organization name - owner
HENRY COUNTY MEMORIAL HOSPITAL
Doing business as name - owner
ALPHA HOME-A WATERS COMMUNITY
Address line 1 - owner
1000 N 16TH ST
City - owner
NEW CASTLE
State - owner
IN
Zip code - owner
473624319
Percentage ownership
100
Created for acquisition - owner
N
Corporation - owner
N
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
Y
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Parent company - owner
Y
Owned by another org or ind - owner
N
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6608260013
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2021-08-27
First name - owner
DEBORAH
Last name - owner
WARE
Title - owner
BOARD MEMBER
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6800258740
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-07-01
Organization name - owner
NEW CASTLE IN OPCO, LLC
Address line 1 - owner
100 MERRICK RD
Address line 2 - owner
STE 418
City - owner
ROCKVILLE CENTRE
State - owner
NY
Zip code - owner
115704800
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
Y
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6800258740
Type - owner
O
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
Organization name - owner
NEW CASTLE IN OPCO, LLC
Address line 1 - owner
100 MERRICK RD
Address line 2 - owner
STE 418
City - owner
ROCKVILLE CENTRE
State - owner
NY
Zip code - owner
115704800
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
Y
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8224497409
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2025-01-08
First name - owner
ISRAEL
Last name - owner
FRANKEL
Enrollment id
O20120208000734
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8224497409
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2025-01-13
First name - owner
ISRAEL
Last name - owner
FRANKEL
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648188623
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2013-01-01
First name - owner
JOHN
Middle name - owner
D
Last name - owner
PIDGEON
Title - owner
BOARD MEMBER
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648188623
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2013-01-01
First name - owner
JOHN
Middle name - owner
D
Last name - owner
PIDGEON
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0648188623
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2013-01-01
First name - owner
JOHN
Middle name - owner
D
Last name - owner
PIDGEON
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0749747996
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2025-11-14
First name - owner
ERIKA
Last name - owner
GILMAN
Title - owner
BOARD MEMBER
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
0749747996
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2025-11-14
First name - owner
ERIKA
Last name - owner
GILMAN
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
2769908318
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2013-01-01
Organization name - owner
MHRC, LLC
Address line 1 - owner
1415 W 52ND ST
City - owner
INDIANAPOLIS
State - owner
IN
Zip code - owner
462282316
Corporation - owner
N
Llc - owner
Y
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
Y
Other type text - owner
REAL ESTATE LESSOR
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3375640519
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2022-01-01
First name - owner
JOHN
Middle name - owner
M
Last name - owner
THOMAS
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3375640519
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2022-01-01
First name - owner
JOHN
Middle name - owner
M
Last name - owner
THOMAS
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3678728078
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2023-04-01
First name - owner
HEIDI
Middle name - owner
M
Last name - owner
WALLAR
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3678728078
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2023-04-01
First name - owner
HEIDI
Middle name - owner
M
Last name - owner
WALLAR
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3779671698
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2013-01-01
First name - owner
MARION
Middle name - owner
E
Last name - owner
SHORE
Title - owner
BOARD MEMBER
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3779671698
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2013-01-01
First name - owner
MARION
Middle name - owner
E
Last name - owner
SHORE
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3870545973
Type - owner
I
Role code - owner
40
Role text - owner
CORPORATE OFFICER
Association date - owner
2022-08-01
First name - owner
BRIAN
Last name - owner
RING
Title - owner
PRESIDENT/CEO
Percentage ownership
0
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
3870545973
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2022-08-01
First name - owner
BRIAN
Last name - owner
RING
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6002724085
Type - owner
O
Role code - owner
34
Role text - owner
5% OR GREATER DIRECT OWNERSHIP INTEREST
Association date - owner
2013-01-01
Organization name - owner
HENRY COUNTY MEMORIAL HOSPITAL
Doing business as name - owner
ALPHA HOME-A WATERS COMMUNITY
Address line 1 - owner
1000 N 16TH ST
City - owner
NEW CASTLE
State - owner
IN
Zip code - owner
473624319
Percentage ownership
100
Created for acquisition - owner
N
Corporation - owner
N
Llc - owner
N
Medical provider supplier - owner
N
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
Y
Other type text - owner
INDIANA COUNTY HOSPITAL
Parent company - owner
N
Owned by another org or ind - owner
N
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6305859869
Type - owner
O
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2013-01-01
Organization name - owner
MULBERRY HEALTH & RETIREMENT COMMUNITY, INC
Doing business as name - owner
MULBERRY COMMUNITY HEALTH SERVICES
Address line 1 - owner
502 W JACKSON ST
City - owner
MULBERRY
State - owner
IN
Zip code - owner
460589538
Percentage ownership
0
Corporation - owner
N
Llc - owner
N
Medical provider supplier - owner
Y
Management services company - owner
N
Medical staffing company - owner
N
Holding company - owner
N
Investment firm - owner
N
Financial institution - owner
N
Consulting firm - owner
N
For profit - owner
N
Non profit - owner
N
Private equity company - owner
N
Reit - owner
N
Chain home office - owner
N
Trust or trustee - owner
N
Other type - owner
N
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6608260013
Type - owner
I
Role code - owner
41
Role text - owner
CORPORATE DIRECTOR
Association date - owner
2021-08-27
First name - owner
DEBORAH
Last name - owner
WARE
Title - owner
BOARD MEMBER
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
6608260013
Type - owner
I
Role code - owner
71
Role text - owner
TRUSTEE OF THE SNF
Association date - owner
2021-08-07
First name - owner
DEBORAH
Last name - owner
WARE
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8123031689
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2013-01-01
First name - owner
JOHN
Last name - owner
MUTZ
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8123031689
Type - owner
I
Role code - owner
63
Role text - owner
MANAGING CONTROL - GOVERNING BODY
Association date - owner
2013-01-01
First name - owner
JOHN
Last name - owner
MUTZ
Title - owner
TREASURER
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
8123031689
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2013-01-01
First name - owner
JOHN
Last name - owner
MUTZ
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
9436111390
Type - owner
I
Role code - owner
43
Role text - owner
OPERATIONAL/MANAGERIAL CONTROL
Association date - owner
2022-01-01
First name - owner
KEVEN
Middle name - owner
W
Last name - owner
DODT
Enrollment id
O20130308000518
Associate id
6002724085
Organization name
HENRY COUNTY MEMORIAL HOSPITAL
Associate id - owner
9436111390
Type - owner
I
Role code - owner
72
Role text - owner
ADP OF THE SNF
Association date - owner
2022-01-01
First name - owner
KEVEN
Middle name - owner
W
Last name - owner
DODT

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