JASON GLAZER D.M.D., P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2024-04-01
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2023-05-16
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2022-03-15
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2021-02-19
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2020-05-14
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 303, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2019-07-16
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 3B, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2018-05-24
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 3B, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2017-03-23
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2017-03-23
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 3B, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2016-05-13
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621210
Sponsor’s telephone number	8603493368
Plan sponsor’s address	16 MAIN STREET, STE 3B, DURHAM, CT, 06422

Signature of

Role	Plan administrator
Date	2015-05-21
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2015-05-21
Name of individual signing	JASON GLAZER
Valid signature	Filed with authorized/valid electronic signature