CYNTHIA TSEN, DDS, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188980900
Plan sponsor’s address	85-27 BROADWAY, ELMHURST, NY, 11373

Signature of

Role	Plan administrator
Date	2024-05-08
Name of individual signing	CYNTHIA TSEN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188980900
Plan sponsor’s address	85-27 BROADWAY, ELMHURST, NY, 11373

Signature of

Role	Plan administrator
Date	2023-05-11
Name of individual signing	CYNTHIA TSEN

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188980900
Plan sponsor’s address	85-27 BROADWAY, ELMHURST, NY, 11373

Signature of

Role	Plan administrator
Date	2022-05-23
Name of individual signing	CYNTHIA TSEN