CARRIAGE HOUSE MEDICAL MANAGEMENT, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2010-05-01
Business code	111100
Sponsor’s telephone number	3157370183
Plan sponsor’s mailing address	3985 ONEIDA STREET SUITE 101, NEW HARTFORD, NY, 13413
Plan sponsor’s address	3985 ONEIDA STREET SUITE 101, NEW HARTFORD, NY, 13413

Plan administrator’s name and address

Administrator’s EIN	260675662
Plan administrator’s name	CARRIAGE HOUSE MEDICAL MANAGEMENT, INC
Plan administrator’s address	3985 ONEIDA STREET SUITE 101, NEW HARTFORD, NY, 13413
Administrator’s telephone number	3157370183

Number of participants as of the end of the plan year

Active participants	5
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	5
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	2011-10-12
Name of individual signing	JOHN LULEY
Valid signature	Filed with authorized/valid electronic signature