FAMILY DERMATOLOGY AND DERMATOPATHOLOGY, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2022-05-12
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2021-04-20
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2020-03-16
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2019-10-08
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2018-02-16
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2017-04-13
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-06-01
Business code	621111
Sponsor’s telephone number	5024951162
Plan sponsor’s address	2211 GREEN WAY #100, LOUISVILLE, KY, 40220

Signature of

Role	Plan administrator
Date	2016-05-27
Name of individual signing	ANDREA BURCH
Valid signature	Filed with authorized/valid electronic signature