HARRY H. MARK, M.D., P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1984-01-01
Business code	621111
Sponsor’s telephone number	2032342212
Plan sponsor’s address	16 BROADWAY, NORTH HAVEN, CT, 06473

Plan administrator’s name and address

Administrator’s EIN	061064191
Plan administrator’s name	HARRY H. MARK, M.D., P.C.
Plan administrator’s address	16 BROADWAY, NORTH HAVEN, CT, 06473
Administrator’s telephone number	2032342212

Signature of

Role	Plan administrator
Date	2010-08-25
Name of individual signing	HARRY MARK
Valid signature	Filed with authorized/valid electronic signature