PITTSFORD ORAL FACIAL & IMPLANT SURGERY, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2023-10-06
Name of individual signing	DONALD PITCHER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2022-10-11
Name of individual signing	DONALD PITCHER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2021-10-07
Name of individual signing	DONALD PITCHER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2020-10-13
Name of individual signing	DONALD PITCHER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2019-10-08
Name of individual signing	DONALD PITCHER

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	5855869063
Plan sponsor’s address	30 OFFICE PARK WAY, PITTSFORD, NY, 14534

Signature of

Role	Plan administrator
Date	2018-10-04
Name of individual signing	DONALD PITCHER