MEMBERS INSURANCE SERVICES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	522130
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2018-06-08
Name of individual signing	JENNIFER T MEADE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	522130
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2017-05-22
Name of individual signing	JENNIFER T MEADE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	522130
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2016-07-18
Name of individual signing	JENNIFER T MEADE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	524210
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2015-06-03
Name of individual signing	JENNIFER T MANGIONE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	524210
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2014-06-02
Name of individual signing	JENNIFER T MANGIONE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	524210
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 405111829

Signature of

Role	Plan administrator
Date	2013-06-13
Name of individual signing	JENNIFER T MANGIONE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	524210
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 40511

Plan administrator’s name and address

Administrator’s EIN	611059580
Plan administrator’s name	MEMBERS INSURANCE SERVICES INC
Plan administrator’s address	440 PARK PL, LEXINGTON, KY, 40511
Administrator’s telephone number	8592544156

Signature of

Role	Plan administrator
Date	2012-03-19
Name of individual signing	JENNIFER MANGIONE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	524210
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 40511

Plan administrator’s name and address

Administrator’s EIN	611059580
Plan administrator’s name	MEMBERS INSURANCE SERVICES INC
Plan administrator’s address	440 PARK PL, LEXINGTON, KY, 40511
Administrator’s telephone number	8592544156

Signature of

Role	Plan administrator
Date	2011-05-03
Name of individual signing	JENNIFER MANGIONE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2000-01-01
Business code	522130
Sponsor’s telephone number	8592544156
Plan sponsor’s address	440 PARK PL, LEXINGTON, KY, 40511

Plan administrator’s name and address

Administrator’s EIN	611059580
Plan administrator’s name	MEMBERS INSURANCE SERVICES INC
Plan administrator’s address	440 PARK PL, LEXINGTON, KY, 40511
Administrator’s telephone number	8592544156

Signature of

Role	Plan administrator
Date	2010-07-07
Name of individual signing	JENNIFER MANGIONE
Valid signature	Filed with authorized/valid electronic signature