FAIRFIELD COUNTY ORTHODONTICS, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST RD STE 211, FAIRFIELD, CT, 068246024

Signature of

Role	Plan administrator
Date	2024-09-26
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-09-26
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature

Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST RD STE 211, FAIRFIELD, CT, 068246024

Signature of

Role	Plan administrator
Date	2024-10-04
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-10-04
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 211, FAIRFIELD, CT, 06824

Signature of

Role	Plan administrator
Date	2024-10-03
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-10-03
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST RD STE 211, FAIRFIELD, CT, 068246024

Signature of

Role	Plan administrator
Date	2024-10-04
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-10-04
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 211, FAIRFIELD, CT, 06824

Signature of

Role	Plan administrator
Date	2023-07-14
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2023-07-14
Name of individual signing	FERNANDA MARCHI
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 211, FAIRFIELD, CT, 06824

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 221, FAIRFIELD, CT, 06824

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 221, FAIRFIELD, CT, 06824

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2032926644
Plan sponsor’s address	1275 POST ROAD, SUITE 221, FAIRFIELD, CT, 06824