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| Plan Name | MEDICAL INSURANCE PLAN |
| Plan identification number | 511 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MORAVIAN HOME, INC. DBA SALEMTOWNE |
| Employer identification number (EIN): | 560963926 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 511 | 2020-09-01 | ALLISON E. VESSELS | 2022-03-09 | ||
| 511 | 2020-09-01 | ALLISON E. VESSELS | 2023-01-18 | ||
| 511 | 2019-09-01 | BRIAN TUCKMANTEL | 2021-06-02 | ||
| 511 | 2018-09-01 | KATHY WILSON | 2020-06-05 | ||
| 511 | 2017-09-01 | KATHY WILSON | 2019-06-13 | ||
| 511 | 2016-09-01 | ||||
| 511 | 2015-09-01 | ||||
| 511 | 2014-09-01 | ||||
| 511 | 2013-09-01 | ||||
| 511 | 2012-09-01 | CAROLYN TWISDALE, CFO | |||
| 511 | 2011-09-01 | CAROLYN TWISDALE | |||
| 511 | 2009-09-01 | CAROLYN TWISDALE |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00630294 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 042420 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 042420 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 042420 |
| Policy instance | 1 |