ADIRONDACK MEDICAL SUPPLY COMPANY, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2004-01-01
Business code	541990
Sponsor’s telephone number	5185812540
Plan sponsor’s address	1490 SARATOGA RD ROUTE 50, BALLSTON SPA, NY, 12020

Signature of

Role	Plan administrator
Date	2017-08-01
Name of individual signing	AMY MCGARITY

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2004-01-01
Business code	541990
Sponsor’s telephone number	5185812540
Plan sponsor’s mailing address	1490 SARATOGA ROAD, ROUTE 50, BALLSTON SPA, NY, 12020
Plan sponsor’s address	1490 SARATOGA ROAD, ROUTE 50, BALLSTON SPA, NY, 12020

Plan administrator’s name and address

Administrator’s EIN	141873789
Plan administrator’s name	ADIRONDACK MEDICAL SUPPLY
Plan administrator’s address	1490 SARATOGA ROAD, ROUTE 50, BALLSTON SPA, NY, 12020
Administrator’s telephone number	5185812540

Number of participants as of the end of the plan year

Active participants	4
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	4
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	2010-09-13
Name of individual signing	AMY SAAR
Valid signature	Filed with authorized/valid electronic signature