OLD LYME DENTAL ASSOCIATES, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8604347378
Plan sponsor’s address	19 HALLS ROAD, SUITE 218, OLD LYME, CT, 06371

Plan administrator’s name and address

Administrator’s EIN	262431951
Plan administrator’s name	OLD LYME DENTAL ASSOCIATES, LLC
Plan administrator’s address	19 HALLS ROAD, SUITE 218, OLD LYME, CT, 06371
Administrator’s telephone number	8604347378

Signature of

Role	Plan administrator
Date	2010-09-10
Name of individual signing	STEVEN GOODWIN
Valid signature	Filed with authorized/valid electronic signature