Interventional Pain Consultants , PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-09-12
Business code	621111
Sponsor’s telephone number	8592681030
Plan sponsor’s address	425 LEWIS HARGETT CIRCLE, LEXINGTON, KY, 40503

Plan administrator’s name and address

Administrator’s EIN	202901242
Plan administrator’s name	INTERVENTIONAL PAIN CONSULTANTS
Plan administrator’s address	425 LEWIS HARGETT CIRCLE, LEXINGTON, KY, 40503
Administrator’s telephone number	8592681030

Signature of

Role	Plan administrator
Date	2010-10-07
Name of individual signing	LESLIE A. O'BRYAN
Valid signature	Filed with authorized/valid electronic signature