Flint River Hospice, Inc.

Contacts

Phone	+1 205-261-3544
Fax	2056555523

Authorized person

Name	MR. SCOTT ANTHONY LITWIN
Role	DIRECTOR
Phone	2052613544

Taxonomy

Taxonomy Code	251G00000X - Community Based Hospice Care Agency
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Signature of

Role	Plan administrator
Date	2014-10-14
Name of individual signing	SARA LITWIN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Signature of

Role	Plan administrator
Date	2014-08-15
Name of individual signing	SARA LITWIN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Signature of

Role	Plan administrator
Date	2013-06-07
Name of individual signing	SARA LITWIN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Plan administrator’s name and address

Administrator’s EIN	203310540
Plan administrator’s name	FLINT RIVER HOSPICE, INC.
Plan administrator’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235
Administrator’s telephone number	2056555523

Signature of

Role	Plan administrator
Date	2012-06-12
Name of individual signing	SARA LITWIN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Plan administrator’s name and address

Administrator’s EIN	203310540
Plan administrator’s name	FLINT RIVER HOSPICE, INC.
Plan administrator’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235
Administrator’s telephone number	2056555523

Signature of

Role	Plan administrator
Date	2011-07-08
Name of individual signing	SARA LITWIN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-06-01
Business code	623000
Sponsor’s telephone number	2056555523
Plan sponsor’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235

Plan administrator’s name and address

Administrator’s EIN	203310540
Plan administrator’s name	FLINT RIVER HOSPICE, INC.
Plan administrator’s address	6308 KIDRON PLACE, BIRMINGHAM, AL, 35235
Administrator’s telephone number	2056555523

Signature of

Role	Plan administrator
Date	2010-10-09
Name of individual signing	FRANK HARRISON