HOWARD EYE CARE, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	6062482549
Plan sponsor’s address	1403 E CUMBERLAND AVENUE, P O BOX 979, MIDDLESBORO, KY, 40965

Signature of

Role	Plan administrator
Date	2014-04-22
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2014-04-22
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	6062482549
Plan sponsor’s address	1403 E CUMBERLAND AVENUE, P O BOX 979, MIDDLESBORO, KY, 40965

Signature of

Role	Plan administrator
Date	2013-10-09
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2013-10-09
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2011-01-01
Business code	621111
Sponsor’s telephone number	6062482549
Plan sponsor’s address	1403 E CUMBERLAND AVENUE, P O BOX 979, MIDDLESBORO, KY, 40965

Plan administrator’s name and address

Administrator’s EIN	300106012
Plan administrator’s name	SOUTHEAST EYE ASSOCIATES, PLLC
Plan administrator’s address	1403 E CUMBERLAND AVENUE, P O BOX 979, MIDDLESBORO, KY, 40965
Administrator’s telephone number	6062482549

Signature of

Role	Plan administrator
Date	2012-03-15
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2012-03-15
Name of individual signing	LISA HOWARD
Valid signature	Filed with authorized/valid electronic signature