Leaving A Legacy, Inc.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-03-18
Business code	561900
Sponsor’s telephone number	2709255723
Plan sponsor’s mailing address	1216 KELLY DR, ELIZABETHTOWN, KY, 427012617
Plan sponsor’s address	1216 KELLY DR, ELIZABETHTOWN, KY, 427012617

Number of participants as of the end of the plan year

Active participants	1
Number of participants with account balances as of the end of the plan year	1

Signature of

Role	Plan administrator
Date	2017-07-31
Name of individual signing	KELLY TIPPLE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-03-18
Business code	561900
Sponsor’s telephone number	2709255723
Plan sponsor’s mailing address	1216 KELLY DRIVE, ELIZABETHTOWN, KY, 42701
Plan sponsor’s address	1216 KELLY DRIVE, ELIZABETHTOWN, KY, 42701

Number of participants as of the end of the plan year

Active participants	1
Number of participants with account balances as of the end of the plan year	1

Signature of

Role	Plan administrator
Date	2015-07-27
Name of individual signing	KELLY TIPPLE
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2015-07-27
Name of individual signing	KELLY TIPPLE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-03-18
Business code	561900
Sponsor’s telephone number	2709255723
Plan sponsor’s mailing address	1216 KELLY DRIVE, ELIZABETHTOWN, KY, 42701
Plan sponsor’s address	1216 KELLY DRIVE, ELIZABETHTOWN, KY, 42701

Plan administrator’s name and address

Administrator’s EIN	454823751
Plan administrator’s name	LEAVING A LEGACY, INC.
Plan administrator’s address	1216 KELLY DRIVE, ELIZABETHTOWN, KY, 42701
Administrator’s telephone number	2709255723

Number of participants as of the end of the plan year

Active participants	1
Number of participants with account balances as of the end of the plan year	1

Signature of

Role	Plan administrator
Date	2014-07-17
Name of individual signing	KELLY TIPPLE
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2014-07-17
Name of individual signing	KELLY TIPPLE
Valid signature	Filed with authorized/valid electronic signature