CARL D. BENDER, D.D.S., P.C.

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Three-digit plan number (PN)	001
Effective date of plan	1984-09-01
Business code	621210
Sponsor’s telephone number	2035741725
Plan sponsor’s mailing address	714 CHASE PARKWAY, WATERBURY, CT, 06708
Plan sponsor’s address	714 CHASE PARKWAY, WATERBURY, CT, 06708

Plan administrator’s name and address

Administrator’s EIN	060967628
Plan administrator’s name	CARL D. BENDER, D.D.S., P.C.
Plan administrator’s address	714 CHASE PARKWAY, WATERBURY, CT, 06708
Administrator’s telephone number	2035741725

Number of participants as of the end of the plan year

Active participants	0
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	0
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	0
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	2011-03-14
Name of individual signing	CARL BENDER, D.D.S.
Valid signature	Filed with authorized/valid electronic signature

Three-digit plan number (PN)	001
Effective date of plan	1984-09-01
Business code	621210
Sponsor’s telephone number	2035741725
Plan sponsor’s mailing address	714 CHASE PARKWAY, WATERBURY, CT, 06708
Plan sponsor’s address	714 CHASE PARKWAY, WATERBURY, CT, 06708

Plan administrator’s name and address

Administrator’s EIN	060967628
Plan administrator’s name	CARL D. BENDER, D.D.S., P.C.
Plan administrator’s address	714 CHASE PARKWAY, WATERBURY, CT, 06708
Administrator’s telephone number	2035741725

Number of participants as of the end of the plan year

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