TOOTH FAIRY PEDIATRIC DENTISTRY LLC

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Three-digit plan number (PN)	001
Effective date of plan	2016-04-01
Business code	621210
Sponsor’s telephone number	9149070895
Plan sponsor’s address	360 MAIN STREET, RIDGEFIELD, CT, 06877

Signature of

Role	Plan administrator
Date	2024-05-02
Name of individual signing	TERESA LEE
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-05-02
Name of individual signing	TERESA LEE
Valid signature	Filed with authorized/valid electronic signature

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Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	9149070895
Plan sponsor’s address	360 MAIN STREET, RIDGEFIELD, CT, 06877

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Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	35 COPPS HILL ROAD, #6, RIDGEFIELD, CT, 06877

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	35 COPPS HILL ROAD, #6, RIDGEFIELD, CT, 06877

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	35 COPPS HILL ROAD, #6, RIDGEFIELD, CT, 06877

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-04-01
Business code	621210
Sponsor’s telephone number	9149070895
Plan sponsor’s address	360 MAIN STREET, RIDGEFIELD, CT, 06877

Signature of

Role	Plan administrator
Date	2023-10-05
Name of individual signing	MELISSA GRANT
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2023-10-05
Name of individual signing	MELISSA GRANT
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-04-01
Business code	621210
Sponsor’s telephone number	9149070895
Plan sponsor’s address	360 MAIN STREET, RIDGEFIELD, CT, 06877

Signature of

Role	Plan administrator
Date	2022-10-12
Name of individual signing	MELISSA GRANT
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	35 COPPS HILL ROAD, #6, RIDGEFIELD, CT, 06877

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-04-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	360 MAIN STREET, RIDGEFIELD, CT, 06877

Signature of

Role	Plan administrator
Date	2021-10-15
Name of individual signing	SUHO LEE
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2021-10-15
Name of individual signing	SUHO LEE
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	2034032525
Plan sponsor’s address	35 COPPS HILL ROAD, #6, RIDGEFIELD, CT, 06877