CCS FARMS, LLC

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

CCS FARMS MEDOVA LIFESTYLE HEALTH PLAN

2021

820676299

2023-12-04

CCS FARMS

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	2023-12-04
Name of individual signing	ROBERT MOORE
Valid signature	Filed with authorized/valid electronic signature

CCS FARMS MEDOVA LIFESTYLE HEALTH PLAN

2020

820676299

2022-05-15

CCS FARMS

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

Name and Address	Role	Appointment Date
COURTNEY C. SHEA, 1555 N ASTOR ST., APT 9W, CHICAGO, 60610	Agent	2017-11-08

Name and Address	Role	Appointment Date
SHEA, COURTNEY C., 1555 N ASTOR ST #9W, CHICAGO, IL, 60610	Manager	2024-10-27

Date of last update: 16 Jan 2025