SALTER & TAPSCOTT SURGICAL ASSOCIATES, LLC

Contacts

Phone	+1 205-933-6440
Fax	2059336442

Authorized person

Name	MISTY WILLIAMS
Role	OFFICE MANAGER
Phone	2059336440

Taxonomy

Taxonomy Code	208600000X - Surgery Physician
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2059336440
Plan sponsor’s address	2700 10TH AVENUE SOUTH, SUITE 402, BIRMINGHAM, AL, 35205

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2059336440
Plan sponsor’s address	2700 10TH AVENUE SOUTH, SUITE 402, BIRMINGHAM, AL, 35205

Signature of

Role	Plan administrator
Date	2015-07-22
Name of individual signing	SALLY SALTER-BLACKWELL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2059336440
Plan sponsor’s address	800 ST. VINCENTS DRIVE, NORTH TOWER STE 510, BIRMINGHAM, AL, 35205

Signature of

Role	Plan administrator
Date	2014-05-21
Name of individual signing	SALLY SALTER-BLACKWELL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2012-01-01
Business code	621111
Sponsor’s telephone number	2059336440
Plan sponsor’s mailing address	800 ST. VINCENTS DRIVE, NORTH TOWER STE 510, BIRMINGHAM, AL, 35205
Plan sponsor’s address	800 ST VINCENTS DRIVE, NORTH TOWER STE 510, BIRMINGHAM, AL, 35205

Plan administrator’s name and address

Administrator’s EIN	453719462
Plan administrator’s name	SAME

Number of participants as of the end of the plan year

Active participants	5
Number of participants with account balances as of the end of the plan year	5

Signature of

Role	Plan administrator
Date	2013-05-15
Name of individual signing	SALLY SALTER-BLACKWELL
Valid signature	Filed with authorized/valid electronic signature