HAROLD A. KADISH, D.M.D., P.C.

File	View Page
Three-digit plan number (PN)	004
Effective date of plan	1983-04-01
Business code	621210
Sponsor’s telephone number	8608750791
Plan sponsor’s address	30 EAST OFFICE PARK ROUTE 30, VERNON, CT, 06066

Plan administrator’s name and address

Administrator’s EIN	060986103
Plan administrator’s name	HAROLD A. KADISH, D.M.D.,P.C.
Plan administrator’s address	30 EAST OFFICE PARK ROUTE 30, VERNON, CT, 06066
Administrator’s telephone number	8608750791

Signature of

Role	Plan administrator
Date	2011-07-29
Name of individual signing	HAROLD KADISH
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2011-07-29
Name of individual signing	HAROLD KADISH
Valid signature	Filed with authorized/valid electronic signature