Laserfiche WebLink
PROXY <br /> The undersigned hereby appoints the Board of Directors of Health Care Service Corporation, a Mutual Legal Reserve Company, <br /> or any successor thereof("HCSC"),with full power of substitution,and such persons as the Board of Directors may designate by <br /> resolution, as the undersigned's proxy to act on behalf of the undersigned at all meetings of inembers of HCSC (and at all <br /> meetings of inembers of any successor of HCSC) and any adjournments thereof, with full power to vote on behalf of the <br /> undersigned on all matters that may come before any such meeting and any adjournment thereof. The annual meeting of <br /> members shall be held each year in the corporate headquarters on the last Tuesday of October at 12:30 p.m. Special meetings <br /> of inembers may be called pursuant to notice mailed to the member not less than thirty (30) nor more than sixty (60) days prior <br /> to such meetings. This proxy shall remain in effect until revoked in writing by the undersigned at least twenty (20) days prior to <br /> any meeting of inembers or by attending and voting in person at any annual or special meeting of inembers. <br /> P22346 By: <br /> P22347 <br /> Group No.: p22348 <br /> P22349 �`Q-�SOv� <br /> Print Si er's N e ere <br /> y � C ,� ��c.����tt.� <br /> Signature and Title <br /> Group Name: City of DeCatur <br /> Address: #1 Gary K. Anderson Plaza <br /> City: Decatur State: IL Zip Code: 62563- <br /> 1196 <br /> Dated this day of <br /> Month Year <br /> HCSC IL GEN ASO BPA(Rev. 5.15) page 12 <br />