HARTFORD FAMILY MEDICINE CENTER, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Signature of

Role	Plan administrator
Date	2019-10-31
Name of individual signing	DEBBIE E. RODRIGUEZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Signature of

Role	Plan administrator
Date	2016-06-07
Name of individual signing	DEBBIE RODRIGUEZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Signature of

Role	Plan administrator
Date	2015-07-21
Name of individual signing	DEBBIE RODRIGUEZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Signature of

Role	Plan administrator
Date	2014-06-20
Name of individual signing	KIM STEELE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Signature of

Role	Plan administrator
Date	2013-06-17
Name of individual signing	KIM STEELE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621111
Sponsor’s telephone number	8602363000
Plan sponsor’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117

Plan administrator’s name and address

Administrator’s EIN	341986199
Plan administrator’s name	HARTFORD FAMILY MEDICINE CENTER,
Plan administrator’s address	345 NORTH MAIN STREET SUITE 245, WEST HARTFORD, CT, 06117
Administrator’s telephone number	8602363000

Signature of

Role	Plan administrator
Date	2012-07-26
Name of individual signing	KIM STEELE
Valid signature	Filed with authorized/valid electronic signature