Laserfiche WebLink
PROXY <br /> The undersigned hereby appoints the Board of Directors of Health Care Service Corporation, a Mutual Legal Reserve <br /> Company, or any successor thereof("HCSC"), with full power of substitution, and such persons as the Board of Directors <br /> may designate by resolution, as the undersigned's proxy to act on behalf of the undersigned at all meetings of members <br /> of HCSC (and at all meetings of members of any successor of HCSC) and any adjournments thereof, with full power to <br /> vote on behalf of the undersigned on all matters that may come before any such meeting and any adjournment thereof. <br /> The annual meeting of members shall be held each year in the corporate headquarters on the last Tuesday of October at <br /> 12:30 p.m. Special meetings of members may be called pursuant to notice mailed to the member not less than thirty (30) <br /> nor more than sixty (60) days prior to such meetings. This proxy shall remain in effect until revoked in writing by the <br /> undersigned at least twenty (20)days prior to any meeting of members or by attending and voting in person at any annual <br /> or special meeting of members. <br /> From time to time, HCSC pays indemnification or advances expenses to directors, officers, employees or agents <br /> consistent with HCSC's bylaws then in force and as otherwise required by applicable law. <br /> P22346, By: <br /> P22347, <br /> Group No.: P22348, <br /> P22349, <br /> PE4337 111111 66SOn <br /> Print Signer's Name H <br /> C. 11ci.�zc CY <br /> Signature and Title <br /> Group Name: City of Decatur <br /> Address: #1 Gary K. Anderson Plaza <br /> City: Decatur State: IL ZIP: 62523 <br /> Dated thisr day of (� YY1 <br /> C.l.� Proprietary and Confidential Information of Claim Administrator <br /> Not for use or disclosure outside Claim Administrator,Employer,their respective affiliated companies and third party representatives,except <br /> with written permission of Claim Administrator. <br /> HCSC IL GEN ASO BPA(Rev.08/17) A Division of Health Care Service Corporation,a Mutual Legal Reserve Company, 9 <br /> an Independent Licensee of the Blue Cross and Blue Shield Association <br />