BROWNSTONE PEDIATRIC DENTISTRY, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	119 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2024-10-09
Name of individual signing	CORMAC MACDERMOTT
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	119 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2023-09-06
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	119 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2022-10-05
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	120 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2021-07-14
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	120 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2020-09-24
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	120 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2019-10-01
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	120 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2018-08-29
Name of individual signing	CORMAC MACDERMOTT

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2015-01-01
Business code	621210
Sponsor’s telephone number	7188552855
Plan sponsor’s address	120 MONTAGUE STREET, BROOKLYN, NY, 11201

Signature of

Role	Plan administrator
Date	2017-06-12
Name of individual signing	CORMAC MACDERMOTT