WORRELL INS AND FINANCIAL SERVICES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2023-01-01
Business code	524210
Sponsor’s telephone number	8595867000
Plan sponsor’s address	1892 PETERSBURG RD, HEBRON, KY, 41048

Signature of

Role	Plan administrator
Date	2024-06-04
Name of individual signing	ADAM WORRELL
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-06-04
Name of individual signing	ADAM WORRELL
Valid signature	Filed with authorized/valid electronic signature