CENTRAL CONNECTICUT GASTROENTEROLOGY, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Signature of

Role	Plan administrator
Date	2015-07-17
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Signature of

Role	Plan administrator
Date	2015-09-03
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Signature of

Role	Plan administrator
Date	2014-09-25
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2014-09-25
Name of individual signing	JEFFREY BREITER,M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Signature of

Role	Plan administrator
Date	2013-10-06
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Plan administrator’s name and address

Administrator’s EIN	061564532
Plan administrator’s name	CENTRAL CONNECTICUT GASTROENTEROLOGY, LLC
Plan administrator’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074
Administrator’s telephone number	8606444442

Signature of

Role	Plan administrator
Date	2012-05-10
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606444442
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Plan administrator’s name and address

Administrator’s EIN	061564532
Plan administrator’s name	CENTRAL CONNECTICUT GASTROENTEROLOGY, LLC
Plan administrator’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074
Administrator’s telephone number	8606444442

Signature of

Role	Plan administrator
Date	2011-10-03
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1983-01-01
Business code	621111
Sponsor’s telephone number	8606466383
Plan sponsor’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074

Plan administrator’s name and address

Administrator’s EIN	061564532
Plan administrator’s name	CENTRAL CONNECTICUT GASTROENTEROLOGY, LLC
Plan administrator’s address	2400 TAMARACK AVENUE, SUITE 101, SOUTH WINDSOR, CT, 06074
Administrator’s telephone number	8606466383

Signature of

Role	Plan administrator
Date	2010-10-06
Name of individual signing	JEFFREY BREITER, M.D.
Valid signature	Filed with authorized/valid electronic signature