JOHN W. LEPORE DDS, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621210
Sponsor’s telephone number	5853812200
Plan sponsor’s address	815 AYRAULT ROAD, FAIRPORT, NY, 14450

Signature of

Role	Plan administrator
Date	2024-07-29
Name of individual signing	JOHN LEPORE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621210
Sponsor’s telephone number	5853812200
Plan sponsor’s DBA name	JOHN W LEPORE, DDS, PLLC
Plan sponsor’s mailing address	815 AYRAULT RD, FAIRPORT, NY, 14450
Plan sponsor’s address	815 AYRAULT RD, FAIRPORT, NY, 14450

Plan administrator’s name and address

Administrator’s EIN	208413243
Plan administrator’s name	JOHN W LEPORE, DDS, PLLC
Plan administrator’s address	815 AYRAULT RD, FAIRPORT, NY, 14450
Administrator’s telephone number	5853812200

Number of participants as of the end of the plan year

Active participants	6
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	2
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	8
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	1

Signature of

Role	Plan administrator
Date	2010-12-01
Name of individual signing	MARY JO HARTMAN
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2001-01-01
Business code	621210
Sponsor’s telephone number	5853812200
Plan sponsor’s mailing address	815 AYRAULT RD, FAIRPORT, NY, 14450
Plan sponsor’s address	815 AYRAULT RD, FAIRPORT, NY, 14450

Plan administrator’s name and address

Administrator’s EIN	208143243
Plan administrator’s name	JOHN W LEPORE, DDS, PLLC
Plan administrator’s address	815 AYRAULT RD, FAIRPORT, NY, 14450
Administrator’s telephone number	5853812200

Number of participants as of the end of the plan year

Active participants	7
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	0
Number of participants with account balances as of the end of the plan year	8
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	2010-12-01
Name of individual signing	MARY JO HARTMAN
Valid signature	Filed with authorized/valid electronic signature