ANESTHESIOLOGY OF PADUCAH, P.S.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1977-03-01
Business code	621111
Sponsor’s telephone number	5024428228
Plan sponsor’s address	2507 BROADWAY, PADUCAH, KY, 42001

Plan administrator’s name and address

Administrator’s EIN	610909857
Plan administrator’s name	ANESTHESIOLOGY OF PADUCAH, P.S.C.
Plan administrator’s address	2507 BROADWAY, PADUCAH, KY, 42001
Administrator’s telephone number	5024428228

Signature of

Role	Plan administrator
Date	2011-07-12
Name of individual signing	WILLIAM J PITMAN
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2011-07-12
Name of individual signing	MARY JO FARRIS CPA
Valid signature	Filed with incorrect/unrecognized electronic signature