SANDRA GREEN MD, PSC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2010-01-01
Business code	621111
Sponsor’s telephone number	8592608923
Plan sponsor’s address	P.O. BOX 23491, LEXINGTON, KY, 40524

Plan administrator’s name and address

Administrator’s EIN	271630895
Plan administrator’s name	SANDRA GREEN MD PSC
Plan administrator’s address	P.O. BOX 23491, LEXINGTON, KY, 40524
Administrator’s telephone number	8592608923

Signature of

Role	Plan administrator
Date	2012-07-14
Name of individual signing	SANDRA GREEN
Valid signature	Filed with authorized/valid electronic signature