SUSQUEHANNA EYE CARE, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621320
Sponsor’s telephone number	6077981987
Plan sponsor’s address	400 PLAZA DR STE 12, VESTAL, NY, 13850

Plan administrator’s name and address

Administrator’s EIN	331005840
Plan administrator’s name	SUSQUEHANNA EYE CARE PLLC
Plan administrator’s address	400 PLAZA DR STE 12, VESTAL, NY, 13850
Administrator’s telephone number	6077981987

Signature of

Role	Plan administrator
Date	2012-11-06
Name of individual signing	ANDREW SACCO
Role	Employer/plan sponsor
Date	2012-11-06
Name of individual signing	ANDREW SACCO

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621320
Sponsor’s telephone number	6077981987
Plan sponsor’s mailing address	3209 VESTAL PARKWAY EAST, SUITE C, VESTAL, NY, 13850
Plan sponsor’s address	3209 VESTAL PARKWAY EAST, SUITE C, VESTAL, NY, 13850

Plan administrator’s name and address

Administrator’s EIN	331005840
Plan administrator’s name	SUSQUEHANNA EYE CARE PLLC
Plan administrator’s address	3209 VESTAL PARKWAY EAST, SUITE C, VESTAL, NY, 13850
Administrator’s telephone number	6077981987

Number of participants as of the end of the plan year

Active participants	13
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	10
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	0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	6

Signature of

Role	Plan administrator
Date	2010-10-25
Name of individual signing	ANDREW SACCO
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621320
Sponsor’s telephone number	6077981987
Plan sponsor’s address	400 PLAZA DRIVE STE 12, VESTAL, NY, 13850

Plan administrator’s name and address

Administrator’s EIN	331005840
Plan administrator’s name	SUSQUEHANNA EYE CARE PLLC
Plan administrator’s address	400 PLAZA DRIVE STE 12, VESTAL, NY, 13850
Administrator’s telephone number	6077981987

Signature of

Role	Plan administrator
Date	2010-07-30
Name of individual signing	ANDREW SACCO