Advanced Surgical Associates, P.C.

Contacts

Phone	+1 334-265-9225
Fax	3342659257

Authorized person

Name	VICTORIA DENNEY
Role	OFFICE MANAGER
Phone	3342659225

Taxonomy

Taxonomy Code	208600000X - Surgery Physician
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2002-01-01
Business code	621111
Sponsor’s telephone number	3342406655
Plan sponsor’s mailing address	1722 PINE STREET, SUITE 904, MONTGOMERY, AL, 36106
Plan sponsor’s address	1722 PINE STREET, SUITE 904, MONTGOMERY, AL, 36106

Plan administrator’s name and address

Administrator’s EIN	631159214
Plan administrator’s name	ADVANCED SURGICAL ASSOCIATES, P.C.
Plan administrator’s address	1722 PINE STREET, SUITE 904, MONTGOMERY, AL, 36106
Administrator’s telephone number	3342406655

Number of participants as of the end of the plan year

Active participants	0
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	0
Number of participants with account balances as of the end of the plan year	0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	0

Signature of

Role	Plan administrator
Date	2012-03-06
Name of individual signing	WESLEY H BARRY JR MD
Valid signature	Filed with authorized/valid electronic signature