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VantageCare Retirement Health Savings Plan <br />Implementation Data Form — Page 3 <br />ICMAC <br />Plan Contacts (Continued) <br />aarnwgRai .errzeaS,,.,hy (Complete item #18. If item #14-17 and 19 are left blank, the Primary Contact in #4 will receive mailings.) <br />Trustee Contact <br />Information <br />18. PT10 (200) <br />(210) <br />(215) <br />(310) <br />(305) <br />(320) <br />(401) <br />(420) <br />Trustee Name: Francisco Gutierrez <br />Trustee Title: Finance Director <br />Trustee: City of Santa Ana <br />Trustee Address: 20 Civic Center Plaza, M-17 <br />Street <br />City Santa Ana (325)State CA <br />Y/N (402) <br />Telephone: ( 714) 647-5420 (421) Fax: <br />(330)Zip 92702 <br />Y/N <br />( 714) 647-5414 <br />Billing (Fees) Contact <br />Information <br />19. PT06 (200) <br />(210) <br />(420) <br />Contact Name: n/a <br />Contact Title: <br />Telephone; ( ) _. (421) Fax: <br />( ) <br />Comments: (Alternate <br />Addresses for #14-19) <br />Internal Use Only <br />641 <br />912 608 <br />074 <br />ICMA Retirement Corporation • P.O. Box 96220 • Washingtan, DC 20090-6220 • Toll Free 1-800 669-7400 <br />