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1523007rddDoc 21241Filed 12/16/15 Entered 12/16/15 09:22:48 Exhibit A Pg 1 of 60 CONFIDENTIALSTORE NO: 0022971 110 Shangri-La DR. LEXINGTON PARK, MD and STORE NO: 0022885 344 HOSPITAL DR. GLEN BURNIE,

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Doc 2124-1 is a form used for reporting financial information to regulatory authorities.

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