EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2014
|
611361028
|
2016-01-13
|
EVERGREEN REHABILITATION, LLC
|
294
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE. SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-01-13 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2014
|
611361028
|
2016-01-13
|
EVERGREEN REHABILITATION, LLC
|
391
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-01-13 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2013
|
611361028
|
2014-10-29
|
EVERGREEN REHABILITATION, LLC
|
210
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-29 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-29 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2013
|
611361028
|
2014-10-29
|
EVERGREEN REHABILITATION, LLC
|
290
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-29 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-29 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION DISABILITY BENEFIT LAW PL
|
2012
|
611361028
|
2014-01-17
|
EVERGREEN REHABILITATION LLC
|
101
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2010-07-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE STE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE STE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-01-17 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-01-17 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2014-01-08
|
EVERGREEN REHABILITATION, LLC
|
242
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-01-08 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-01-08 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2012
|
611361028
|
2014-01-08
|
EVERGREEN REHABILITATION, LLC
|
174
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-01-08 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-01-08 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2013-05-24
|
EVERGREEN REHABILITATION, LLC
|
135
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-22 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-22 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2013-05-24
|
EVERGREEN REHABILITATION, LLC
|
118
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-22 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-22 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
135
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2000-02-01
|
Business code |
624310
|
Sponsor’s telephone number |
5028971700
|
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
156
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133621P030193559603005.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION, LLC GROUP HEALTH PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
125
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133621P030193559603002.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
120
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133621P030193559603003.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
105
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133621P030193559603001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2012
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
118
|
|
Three-digit plan number (PN) |
502 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2011
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
234
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501135704P030193571171005.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2011
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
176
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501135704P030193571171004.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2010
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
192
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501141249P040011006272002.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2010
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
300
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501141249P040011006272001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP BENEFIT PLAN
|
2009
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
176
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133218P030193558723001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EVERGREEN REHABILITATION GROUP HEALTH PLAN
|
2009
|
611361028
|
2013-05-01
|
EVERGREEN REHABILITATION, LLC
|
288
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/01/20130501133242P030193558995001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2000-02-01 |
Business code |
624310 |
Sponsor’s telephone number |
5028971700 |
Plan sponsor’s mailing address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan sponsor’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Plan administrator’s name and address
Administrator’s EIN |
611361028 |
Plan administrator’s name |
EVERGREEN REHABILITATION, LLC |
Plan administrator’s
address |
136 ST. MATTHEWS AVE, SUITE 300, LOUISVILLE, KY, 40207 |
Administrator’s telephone number |
5028971700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-05-01 |
Name of individual signing |
LESLIE DEARING |
Valid signature |
Filed with authorized/valid electronic signature |
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