MIAMI LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED, INC.

Contacts

Phone	+1 786-362-7500
Fax	3058541759

Authorized person

Name	VIRGINIA JACKO
Role	PRESIDENT & CEO
Phone	3058564176

Taxonomy

Taxonomy Code	225100000X - Physical Therapist
Is Primary	No
Taxonomy Code	225X00000X - Occupational Therapist
Is Primary	No
Taxonomy Code	235Z00000X - Speech-Language Pathologist
Is Primary	No
Taxonomy Code	251V00000X - Voluntary or Charitable Agency
Is Primary	Yes
Taxonomy Code	252Y00000X - Early Intervention Provider Agency
Is Primary	No

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	624310
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130

Signature of

Role	Plan administrator
Date	2019-09-05
Name of individual signing	VIRGINIA JACKO
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	624100
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130

Signature of

Role	Plan administrator
Date	2016-10-13
Name of individual signing	VIRGINIA JACKO
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	624310
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130

Signature of

Role	Plan administrator
Date	2014-09-26
Name of individual signing	VIRGINIA JACKO
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	624310
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130

Signature of

Role	Plan administrator
Date	2013-09-11
Name of individual signing	VIRGINIA JACKO
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	812990
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130

Plan administrator’s name and address

Administrator’s EIN	590637847
Plan administrator’s name	MIAMI LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED, INC.
Plan administrator’s address	601 SOUTHWEST 8TH AVENUE, MIAMI, FL, 33130
Administrator’s telephone number	3058562288

Signature of

Role	Plan administrator
Date	2012-07-27
Name of individual signing	VIRGINIA JACKO
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	812990
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SW 8TH AVENUE, MIAMI, FL, 331303209

Plan administrator’s name and address

Administrator’s EIN	590637847
Plan administrator’s name	MIAMI LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED, INC.
Plan administrator’s address	601 SW 8TH AVENUE, MIAMI, FL, 331303209
Administrator’s telephone number	3058562288

Signature of

Role	Plan administrator
Date	2011-09-23
Name of individual signing	VIRGINIA A. JACKO
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	812990
Sponsor’s telephone number	3058562288
Plan sponsor’s address	601 SW 8TH AVENUE, MIAMI, FL, 331303209

Plan administrator’s name and address

Administrator’s EIN	590637847
Plan administrator’s name	MIAMI LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED, INC.
Plan administrator’s address	601 SW 8TH AVENUE, MIAMI, FL, 331303209
Administrator’s telephone number	3058562288

Signature of

Role	Plan administrator
Date	2010-10-06
Name of individual signing	VIRGINIA A. JACKO
Valid signature	Filed with authorized/valid electronic signature