COMMUNITY CARE ORGANIZATION, INC.

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Three-digit plan number (PN)	521
Effective date of plan	2014-05-01
Business code	622000
Sponsor’s telephone number	7186307000
Plan sponsor’s mailing address	246 55TH STREET AA-4, BROOKLYN, NY, 11220
Plan sponsor’s address	246 55TH STREET AA-4, BROOKLYN, NY, 11220

Number of participants as of the end of the plan year

Active participants	320
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

Signature of

Role	Plan administrator
Date	2016-10-18
Name of individual signing	FRANK FRANZI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2016-10-18
Name of individual signing	FRANK FRANZI
Valid signature	Filed with authorized/valid electronic signature