CHARLES M JOHNSON MEDOVA LIFESTYLE HEALTH PLAN
|
2021
|
843361092
|
2023-10-05
|
CHARLES M JOHNSON
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2020-11-01
|
Business code |
111900
|
Sponsor’s telephone number |
2176229289
|
Plan sponsor’s
address |
20690 CHISM RD, GREENFIELD, IL, 620442024
|
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 |
2023-10-05 |
Name of individual signing |
ROBERT MOORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHARLES M JOHNSON MEDOVA LIFESTYLE HEALTH PLAN
|
2020
|
843361092
|
2022-07-28
|
CHARLES M JOHNSON
|
2
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2020-11-01
|
Business code |
111900
|
Sponsor’s telephone number |
2176229289
|
Plan sponsor’s
address |
20690 CHISM RD, GREENFIELD, IL, 620442024
|
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 |
2022-07-27 |
Name of individual signing |
ROBERT MOORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|