ALCOHOL AND DRUG DEPENDENCY SERVICES, INC.

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Three-digit plan number (PN)	001
Effective date of plan	1976-01-01
Business code	621399
Sponsor’s telephone number	7168542997
Plan sponsor’s mailing address	291 ELM STREET, BUFFALO, NY, 14203
Plan sponsor’s address	291 ELM STREET, BUFFALO, NY, 14203

Plan administrator’s name and address

Administrator’s EIN	161078102
Plan administrator’s name	ALCOHOL AND DRUG DEPENDENCY SERVICES, INC.
Plan administrator’s address	291 ELM STREET, BUFFALO, NY, 14203
Administrator’s telephone number	7168542997

Number of participants as of the end of the plan year

Active participants	161
Retired or separated participants receiving benefits	3
Other retired or separated participants entitled to future benefits	58
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	188
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	2013-10-15
Name of individual signing	WILLIAM BURGIN
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2013-10-15
Name of individual signing	WILLIAM BURGIN
Valid signature	Filed with authorized/valid electronic signature