ACTION IN WRITING Sample Group Dated: The undersigned, being an officer of Sample Group (the “Company”), does hereby consent to the following actions: RESOLUTION WHEREAS, Company is a corporation/LLC/etc. duly formed and validly existing under the laws of the State of Incorporation; and WHEREAS, the Company sponsors a health benefit plan for the benefit of eligible employees (the “Plan”); and WHEREAS, the assets of the Plan are held in the Sample Group Health Benefits Trust (the “Trust”); and WHEREAS, the Company may appoint one or more individuals or entities as trustee(s) of the Trust; and WHEREAS, the Company now desires to appoint the individuals or entities attached hereto as Exhibit A (the “Trustees”), as trustees of the Trust, effective as of the date such individuals or entities consent to such appointment; and WHEREAS, under Article V of the Trust, the Company reserves the right to amend or terminate the Trust, in whole or in part; and WHEREAS, Company recognizes that Univest Bank & Trust Co is relying on these resolutions in connection with opening one or more bank accounts for the Trust to be able to conduct its financial and banking transactions. RESOLVED, that effective as of such date, the Trustees are appointed as trustees of the Trust; and RESOLVED, that any officer of the Company is hereby authorized to amend or terminate the Trust, in whole or in part, at any time in accordance with Article V of the Trust. Sample Group By: Title: Date:
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