|
KLEMICK AND GAMPEL, P.A. MEDOVA LIFESTYLE HEALTH PLAN
|
2021
|
650122249
|
2024-08-29
|
KLEMICK AND GAMPEL, P.A.
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-09-01
|
| Business code |
541110
|
| Sponsor’s telephone number |
3058564577
|
| Plan sponsor’s
address |
1728 CORAL WAY STE 700, MIAMI, FL, 331452794
|
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 |
2024-08-29 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KLEMICK AND GAMPEL, P.A. MEDOVA LIFESTYLE HEALTH PLAN
|
2020
|
650122249
|
2022-05-15
|
KLEMICK AND GAMPEL, P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-09-01
|
| Business code |
541110
|
| Sponsor’s telephone number |
3058564577
|
| Plan sponsor’s
address |
1728 CORAL WAY STE 700, MIAMI, FL, 331452794
|
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 |
2022-05-15 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
