COMMUNITY HOSPITALIST, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-01-01
Business code	621111
Sponsor’s telephone number	8453427615
Plan sponsor’s address	P.O. BOX 2209, MIDDLETOWN, NY, 10940

Plan administrator’s name and address

Administrator’s EIN	262661793
Plan administrator’s name	COMMUNITY HOSPITALIST, PLLC
Plan administrator’s address	P.O. BOX 2209, MIDDLETOWN, NY, 10940
Administrator’s telephone number	8453427615

Signature of

Role	Plan administrator
Date	2010-09-28
Name of individual signing	DIANE PINE
Role	Employer/plan sponsor
Date	2010-09-28
Name of individual signing	DIANE PINE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2009-01-01
Business code	621111
Sponsor’s telephone number	8453427615
Plan sponsor’s mailing address	PO BOX 2209, MIDDLETOWN, NY, 10940
Plan sponsor’s address	160 EAST MAIN STREET, PORT JERVIS, NY, 12771

Plan administrator’s name and address

Administrator’s EIN	262661793
Plan administrator’s name	COMMUNITY HOSPITALIST
Plan administrator’s address	PO BOX 2209, MIDDLETOWN, NY, 10940
Administrator’s telephone number	8453427615

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	2010-03-03
Name of individual signing	LISA DE SENA