401k Plan data: MEDSTAR LABORATORY, INC. 401(K) PLAN plan

MEDSTAR LABORATORY, INC. 401(K) PLAN 401k Plan overview

Plan Name	MEDSTAR LABORATORY, INC. 401(K) PLAN
Plan identification number	001

MEDSTAR LABORATORY, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MEDSTAR LABORATORY, INC. has sponsored the creation of one or more 401k plans.

Company Name: MEDSTAR LABORATORY, INC.

Employer identification number (EIN): 364215081

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDSTAR LABORATORY, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2018-01-01
001 2017-01-01 RAJ PATEL 2018-10-05 RAJ PATEL 2018-10-05
001 2016-01-01 RAJ PATEL 2017-10-12 RAJ PATEL 2017-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2018-01-01
001	2017-01-01	RAJ PATEL	2018-10-05	RAJ PATEL	2018-10-05
001	2016-01-01	RAJ PATEL	2017-10-12	RAJ PATEL	2017-10-12

Plan Statistics for MEDSTAR LABORATORY, INC. 401(K) PLAN

401k plan membership statisitcs for MEDSTAR LABORATORY, INC. 401(K) PLAN

Measure Date Value
2020: MEDSTAR LABORATORY, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 91
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 14
Total of all active and inactive participants 2020-01-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 105
Number of participants with account balances 2020-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: MEDSTAR LABORATORY, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 99
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 12
Total of all active and inactive participants 2019-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 111
Number of participants with account balances 2019-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: MEDSTAR LABORATORY, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 97
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 10
Total of all active and inactive participants 2018-01-01 107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 107
Number of participants with account balances 2018-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2020: MEDSTAR LABORATORY, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	91
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	14
Total of all active and inactive participants	2020-01-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	105
Number of participants with account balances	2020-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: MEDSTAR LABORATORY, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	99
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	12
Total of all active and inactive participants	2019-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	111
Number of participants with account balances	2019-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: MEDSTAR LABORATORY, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	97
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	10
Total of all active and inactive participants	2018-01-01	107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	107
Number of participants with account balances	2018-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on MEDSTAR LABORATORY, INC. 401(K) PLAN

Measure	Date	Value
2021 : MEDSTAR LABORATORY, INC. 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$383,956
Total of all expenses incurred	2021-12-31	$65,579
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$43,229
Value of total corrective distributions	2021-12-31	$7,274
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$220,337
Value of total assets at end of year	2021-12-31	$1,240,333
Value of total assets at beginning of year	2021-12-31	$921,956
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$15,076
Total interest from all sources	2021-12-31	$275
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	No
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$131,893
Participant contributions at end of year	2021-12-31	$8,747
Participant contributions at beginning of year	2021-12-31	$3,975
Participant contributions at end of year	2021-12-31	$14,423
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$318,377
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,240,333
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$921,956
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$15,076
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,128,719
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$857,567
Interest on participant loans	2021-12-31	$275
Net investment gain/loss from pooled separate accounts	2021-12-31	$163,344
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$88,444
Employer contributions (assets) at end of year	2021-12-31	$88,444
Employer contributions (assets) at beginning of year	2021-12-31	$60,414
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$43,229
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
2020 : MEDSTAR LABORATORY, INC. 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$277,764
Total of all expenses incurred	2020-12-31	$40,227
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$29,407
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$165,632
Value of total assets at end of year	2020-12-31	$921,956
Value of total assets at beginning of year	2020-12-31	$684,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,820
Total interest from all sources	2020-12-31	$239
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	No
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$105,218
Participant contributions at end of year	2020-12-31	$3,975
Participant contributions at beginning of year	2020-12-31	$5,701
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$237,537
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$921,956
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$684,419
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$10,820
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$857,567
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$615,053
Interest on participant loans	2020-12-31	$239
Net investment gain/loss from pooled separate accounts	2020-12-31	$111,893
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$60,414
Employer contributions (assets) at end of year	2020-12-31	$60,414
Employer contributions (assets) at beginning of year	2020-12-31	$63,665
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$29,407
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
2019 : MEDSTAR LABORATORY, INC. 401(K) PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$281,314
Total of all expenses incurred	2019-12-31	$20,394
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$11,309
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$175,635
Value of total assets at end of year	2019-12-31	$684,419
Value of total assets at beginning of year	2019-12-31	$423,499
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$9,085
Total interest from all sources	2019-12-31	$241
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$104,772
Participant contributions at end of year	2019-12-31	$5,701
Participant contributions at beginning of year	2019-12-31	$5,588
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$7,198
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$260,920
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$684,419
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$423,499
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$9,085
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$615,053
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$357,406
Interest on participant loans	2019-12-31	$241
Net investment gain/loss from pooled separate accounts	2019-12-31	$105,438
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$63,665
Employer contributions (assets) at end of year	2019-12-31	$63,665
Employer contributions (assets) at beginning of year	2019-12-31	$60,505
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$11,309
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
2018 : MEDSTAR LABORATORY, INC. 401(K) PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$133,802
Total of all expenses incurred	2018-12-31	$117,814
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$2,096
Value of total corrective distributions	2018-12-31	$109,154
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$156,180
Value of total assets at end of year	2018-12-31	$423,499
Value of total assets at beginning of year	2018-12-31	$407,511
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,564
Total interest from all sources	2018-12-31	$180
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	No
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$95,832
Participant contributions at end of year	2018-12-31	$5,588
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$15,988
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$423,499
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$407,511
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$6,564
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$357,406
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$348,831
Interest on participant loans	2018-12-31	$180
Net investment gain/loss from pooled separate accounts	2018-12-31	$-22,558
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$60,348
Employer contributions (assets) at end of year	2018-12-31	$60,505
Employer contributions (assets) at beginning of year	2018-12-31	$58,680
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$2,096
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	OSTROW REISIN BERK & ABRAMS LTD.
Accountancy firm EIN	2018-12-31	362938874

Form 5500 Responses for MEDSTAR LABORATORY, INC. 401(K) PLAN

2020: MEDSTAR LABORATORY, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MEDSTAR LABORATORY, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MEDSTAR LABORATORY, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

62652

Policy instance

Insurance contract or identification number	62652
Number of Individuals Covered	50
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,999
Total amount of fees paid to insurance company	USD $578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,999
Insurance broker organization code?	3
Amount paid for insurance broker fees	578
Additional information about fees paid to insurance broker	TPA FEES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

62652

Policy instance

Insurance contract or identification number	62652
Number of Individuals Covered	48
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,524
Total amount of fees paid to insurance company	USD $507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,524
Insurance broker organization code?	3
Amount paid for insurance broker fees	507
Additional information about fees paid to insurance broker	TPA FEES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

62652

Policy instance

Insurance contract or identification number	62652
Number of Individuals Covered	48
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,361
Total amount of fees paid to insurance company	USD $340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

62652

Policy instance

Insurance contract or identification number	62652
Number of Individuals Covered	43
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,825
Total amount of fees paid to insurance company	USD $264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,825
Insurance broker organization code?	3
Amount paid for insurance broker fees	264
Additional information about fees paid to insurance broker	TPA FEES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

62652

Policy instance

Insurance contract or identification number	62652
Number of Individuals Covered	39
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,098
Total amount of fees paid to insurance company	USD $159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,098
Insurance broker organization code?	3
Amount paid for insurance broker fees	159
Additional information about fees paid to insurance broker	TPA FEES

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Company Name:	MEDSTAR LABORATORY, INC.
Employer identification number (EIN):	364215081
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories