IRA POLLACK, M.D., P.C.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2016-05-25
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2016-07-05
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2015-09-09
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2015-09-09
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2015-06-23
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2014-06-24
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2014-06-02
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2013-08-06
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Signature of

Role	Plan administrator
Date	2013-06-28
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8607495881
Plan sponsor’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082

Plan administrator’s name and address

Administrator’s EIN	752324447
Plan administrator’s name	IRA POLLACK, M.D., P.C.
Plan administrator’s address	1699 KING STREET SUITE 208, ENFIELD, CT, 06082
Administrator’s telephone number	8607495881

Signature of

Role	Plan administrator
Date	2012-07-30
Name of individual signing	IRA POLLACK
Valid signature	Filed with authorized/valid electronic signature