RIVER VALLEY DENTAL PLLC

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Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	6065644371
Plan sponsor’s address	507 MARKET PLACE DR., MAYSVILLE, KY, 41056

Signature of

Role	Plan administrator
Date	2021-10-02
Name of individual signing	WILLIAM THOMPSON
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	6065644371
Plan sponsor’s address	399 W. MAPLE LEAF BLVD., MAYSVILLE, KY, 41056

Signature of

Role	Plan administrator
Date	2020-05-11
Name of individual signing	WILLIAM THOMPSON
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	6065644371
Plan sponsor’s address	399 W. MAPLE LEAF BLVD., MAYSVILLE, KY, 41056

Signature of

Role	Plan administrator
Date	2019-05-01
Name of individual signing	WILLIAM THOMPSON
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-01-01
Business code	621210
Sponsor’s telephone number	6065644371
Plan sponsor’s address	399 W. MAPLE LEAF BLVD., MAYSVILLE, KY, 41056

Signature of

Role	Plan administrator
Date	2018-05-14
Name of individual signing	DR. WILLIAM THOMPSON
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2018-05-14
Name of individual signing	DR. WILLAIM THOMPSON
Valid signature	Filed with authorized/valid electronic signature