EAST VILLAGE DENTAL P.C.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	2122657724
Plan sponsor’s mailing address	8A EAST 63RD STREET, NEW YORK, NY, 10065
Plan sponsor’s address	8A EAST 63RD STREET, NEW YORK, NY, 10065

Number of participants as of the end of the plan year

Active participants	18
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	6
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	24
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	0

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	2122657724
Plan sponsor’s mailing address	8A EAST 63RD STREET, NEW YORK, NY, 10065
Plan sponsor’s address	8A EAST 63RD STREET, NEW YORK, NY, 10065

Number of participants as of the end of the plan year

Active participants	11
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	6
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	17
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2

Signature of

Role	Plan administrator
Date	2013-04-26
Name of individual signing	LANA ROZENBERG
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2013-04-26
Name of individual signing	LANA ROZENBERG
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	2122657724
Plan sponsor’s mailing address	8A EAST 63RD STREET, NEW YORK, NY, 10065
Plan sponsor’s address	8A EAST 63RD STREET, NEW YORK, NY, 10065

Plan administrator’s name and address

Administrator’s EIN	113405463
Plan administrator’s name	LANA ROZENBERG
Plan administrator’s address	8A EAST 63RD STREET, NEW YORK, NY, 10065
Administrator’s telephone number	2122657724

Number of participants as of the end of the plan year

Active participants	11
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	4
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	15
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2

Signature of

Role	Plan administrator
Date	2012-07-27
Name of individual signing	LANA ROZENBERG
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2012-07-27
Name of individual signing	LANA ROZENBERG
Valid signature	Filed with authorized/valid electronic signature