WALDORF DERMATOLOGY & LASER ASSOCIATES, P.C.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1971-09-01
Business code	621111
Sponsor’s telephone number	8456237077
Plan sponsor’s mailing address	57 N MIDDLETOWN RD, NANUET, NY, 109542312
Plan sponsor’s address	57 N MIDDLETOWN RD, NANUET, NY, 109542312

Number of participants as of the end of the plan year

Active participants	0
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	0
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	2017-12-14
Name of individual signing	HEIDI WALDORF
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1971-09-01
Business code	621111
Sponsor’s telephone number	8456237077
Plan sponsor’s mailing address	57 NORTH MIDDLETOWN ROAD, NANUET, NY, 10954
Plan sponsor’s address	57 NORTH MIDDLETOWN ROAD, NANUET, NY, 10954

Plan administrator’s name and address

Administrator’s EIN	132685281
Plan administrator’s name	WALDORF DERMATOLOGY & LASER ASSOCIATES, P.C.,
Plan administrator’s address	57 NORTH MIDDLETOWN ROAD, NANUET, NY, 10954

Number of participants as of the end of the plan year

Active participants	15
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	1
Number of participants with account balances as of the end of the plan year	17
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	2010-06-04
Name of individual signing	DONALD S. WALDORF
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2010-06-04
Name of individual signing	DONALD S. WALDORF
Valid signature	Filed with authorized/valid electronic signature
Role	DFE
Date	2010-06-04
Name of individual signing	DONALD S. WALDORF
Valid signature	Filed with authorized/valid electronic signature