|
BENTON CHIROPRACTIC PLLC MEDOVA LIFESTYLE HEALTH PLAN
|
2022
|
270517681
|
2023-08-01
|
BENTON CHIROPRACTIC PLLC
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-05-01
|
| Business code |
621310
|
| Sponsor’s telephone number |
2705272007
|
| Plan sponsor’s
address |
152 BREEZE LN, CALVERT CITY, KY, 420299252
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2023-08-01 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BENTON CHIROPRACTIC PLLC MEDOVA LIFESTYLE HEALTH PLAN
|
2021
|
270517681
|
2023-02-15
|
BENTON CHIROPRACTIC PLLC
|
1
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2021-05-01
|
| Business code |
621310
|
| Sponsor’s telephone number |
2705272007
|
| Plan sponsor’s
address |
152 BREEZE LN, CALVERT CITY, KY, 420299252
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2023-02-15 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BENTON CHIROPRACTIC PLLC MEDOVA LIFESTYLE HEALTH PLAN
|
2020
|
270517681
|
2022-02-09
|
BENTON CHIROPRACTIC PLLC
|
1
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-05-01
|
| Business code |
621310
|
| Sponsor’s telephone number |
2705272007
|
| Plan sponsor’s
address |
152 BREEZE LN, CALVERT CITY, KY, 420299252
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2022-01-26 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
