HARLEY CHIROPRACTIC, LLC

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

HARLEY CHIROPRACTIC LLC MEDOVA LIFESTYLE HEALTH PLAN

2022

471884895

2023-07-07

HARLEY CHIROPRACTIC LLC

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	2023-07-07
Name of individual signing	ROBERT MOORE
Valid signature	Filed with authorized/valid electronic signature

HARLEY CHIROPRACTIC LLC MEDOVA LIFESTYLE HEALTH PLAN

2021

471884895

2022-09-30

HARLEY CHIROPRACTIC LLC

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	2022-09-29
Name of individual signing	ROBERT MOORE
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
KATHERINE L HARLEY, 221 N ANDERSON ST, SULLIVAN, 61951	Agent	2014-10-01

Name and Address	Role	Appointment Date
HARLEY DC, KATHERINE L, 3078 E 1300 NORTH RD, WINDSOR, IL, 61957	Manager	2014-10-01

Date of last update: 13 Jan 2025