IRA KAMP D.D.S., PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	6072724331
Plan sponsor’s address	1025 N. TIOGA STREET, ITHACA, NY, 14850

Signature of

Role	Plan administrator
Date	2019-06-18
Name of individual signing	IRA KAMP

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	6072724331
Plan sponsor’s address	1025 N. TIOGA STREET, ITHACA, NY, 14850

Signature of

Role	Plan administrator
Date	2018-06-22
Name of individual signing	IRA KAMP

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	6072724331
Plan sponsor’s address	1025 N. TIOGA STREET, ITHACA, NY, 14850

Signature of

Role	Plan administrator
Date	2017-06-13
Name of individual signing	IRA KAMP

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	6072724331
Plan sponsor’s address	1025 N. TIOGA STREET, ITHACA, NY, 14850

Signature of

Role	Plan administrator
Date	2016-07-01
Name of individual signing	IRA KAMP

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	6072724331
Plan sponsor’s mailing address	1025 N TIOGA STREET, ITHACA, NY, 14850
Plan sponsor’s address	1025 N TIOGA STREET, ITHACA, NY, 14850

Plan administrator’s name and address

Administrator’s EIN	263985542
Plan administrator’s name	IRA KAMP D.D.S.
Plan administrator’s address	1025 N TIOGA STREET, ITHACA, NY, 14850
Administrator’s telephone number	6072724331

Number of participants as of the end of the plan year

Active participants	8
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	11
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	20
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	2011-01-05
Name of individual signing	IRA KAMP
Valid signature	Filed with authorized/valid electronic signature