SPORTS MEDICINE SURGICAL SPECIALISTS, PLLC

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Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2024-07-30
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2024-07-24
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2024-07-18
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2023-10-13
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2023-07-25
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2022-08-10
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2022-10-12
Name of individual signing	ANTHONY WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2021-10-15
Name of individual signing	ADAM WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2021-10-14
Name of individual signing	ADAM WARREN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2020-10-14
Name of individual signing	ADAM WARREN
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2020/10/06/20201006075030NAL0012162688001.pdf
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2020-10-06
Name of individual signing	ADAM WARREN
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2019/10/14/20191014123208P040082666919001.pdf
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2019-10-14
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2019/10/14/20191014115423P030043790191001.pdf
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2019-10-14
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2018/10/08/20181008121303P040258226721001.pdf
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2018-10-08
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2018/10/08/20181008121020P030009571721001.pdf
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2018-10-08
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/09/20171009153732P040005718025001.pdf
Three-digit plan number (PN)	002
Effective date of plan	2016-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2017-10-09
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/08/20171008124059P040188024391001.pdf
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621111
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, SUITE 215, LOUISVILLE, KY, 40205

Signature of

Role	Plan administrator
Date	2017-08-28
Name of individual signing	KEITH MYRICK
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2016/08/10/20160810071750P040006883575001.pdf
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621399
Sponsor’s telephone number	5027218288
Plan sponsor’s address	6400 DUTCHMAN'S PKWY, LOUISVILLE, KY, 40205