NEWBURGH INTERNAL MEDICINE, P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1971-07-01
Business code	621111
Sponsor’s telephone number	8455341505
Plan sponsor’s mailing address	21 LAUREL AVENUE, SUITE 260, CORNWALL, NY, 12518
Plan sponsor’s address	21 LAUREL AVENUE, SUITE 260, CORNWALL, NY, 12518

Plan administrator’s name and address

Administrator’s EIN	141688118
Plan administrator’s name	NEWBURGH INTERNAL MEDICINE, P.C.
Plan administrator’s address	21 LAUREL AVENUE, SUITE 260, CORNWALL, NY, 12518
Administrator’s telephone number	8455341505

Number of participants as of the end of the plan year

Active participants	2
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	0
Number of participants with account balances as of the end of the plan year	2
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	0

Signature of

Role	Plan administrator
Date	2010-06-16
Name of individual signing	LUDWIG BACH
Valid signature	Filed with authorized/valid electronic signature