|
ADVANCED PRIMARY CARE CBS BENEFIT PLAN
|
2023
|
813263078
|
2024-12-30
|
ADVANCED PRIMARY CARE
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2021-11-01
|
| Business code |
541400
|
| Sponsor’s telephone number |
6068316168
|
| Plan sponsor’s
address |
1100 OUR LADYS WAY, ASHLAND, KY, 41101
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
JOSEPH HSU |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2024-12-30 |
| Name of individual signing |
JOSEPH HSU |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ADVANCED PRIMARY CARE MEDOVA LIFESTYLE HEALTH PLAN
|
2022
|
813263078
|
2024-05-15
|
ADVANCED PRIMARY CARE
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-10-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6168316168
|
| Plan sponsor’s
address |
1100 OUR LADYS WAY STE 245, ASHLAND, KY, 411017049
|
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 |
2024-05-14 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ADVANCED PRIMARY CARE CBS BENEFIT PLAN
|
2022
|
813263078
|
2023-12-27
|
ADVANCED PRIMARY CARE
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2021-11-01
|
| Business code |
541400
|
| Sponsor’s telephone number |
6068316168
|
| Plan sponsor’s
address |
1100 OUR LADYS WAY, ASHLAND, KY, 41101
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2023-12-27 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ADVANCED PRIMARY CARE CBS BENEFIT PLAN
|
2021
|
813263078
|
2022-12-29
|
ADVANCED PRIMARY CARE
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2021-11-01
|
| Business code |
541400
|
| Sponsor’s telephone number |
6068316168
|
| Plan sponsor’s
address |
1100 OUR LADYS WAY, ASHLAND, KY, 41101
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2022-12-29 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ADVANCED PRIMARY CARE MEDOVA LIFESTYLE HEALTH PLAN
|
2020
|
813263078
|
2022-06-14
|
ADVANCED PRIMARY CARE
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-10-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6168316168
|
| Plan sponsor’s
address |
1100 OUR LADYS WAY STE 245, ASHLAND, KY, 411017049
|
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 |
2022-06-14 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
