401k Plan data: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN plan

NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 401k Plan overview

Plan Name	NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN
Plan identification number	002

NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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

NORTHSTAR ORTHODONTICS, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTHSTAR ORTHODONTICS, INC.

Employer identification number (EIN): 411689877

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 CONRAD KELLY 2023-09-20 CONRAD KELLY 2023-09-20
002 2021-01-01 CONRAD KELLY 2022-06-23 CONRAD KELLY 2022-06-23
002 2020-01-01 CONRAD KELLY 2021-07-28
002 2019-01-01 CONRAD KELLY 2020-07-28
002 2018-01-01 CYNTHIA KELLY 2019-07-30 CYNTHIS KELLY 2019-07-30
002 2017-01-01 CINDY BECKER 2018-06-22
002 2016-01-01 CINDY KELLY 2017-07-27
002 2015-01-01 CYNTHIA KELLY 2016-06-22
002 2014-01-01 CYNTHIA KELLY
002 2013-01-01 CYNTHIA KELLY
002 2012-01-01 CYNTHIA KELLY
002 2011-01-01 CYNTHIA KELLY 2012-09-12 CYNTHIA KELLY 2012-09-12
002 2010-01-01 CYNTHIA KELLY 2011-08-25 CYNTHIA KELLY 2011-08-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	CONRAD KELLY	2023-09-20	CONRAD KELLY	2023-09-20
002	2021-01-01	CONRAD KELLY	2022-06-23	CONRAD KELLY	2022-06-23
002	2020-01-01	CONRAD KELLY	2021-07-28
002	2019-01-01	CONRAD KELLY	2020-07-28
002	2018-01-01	CYNTHIA KELLY	2019-07-30	CYNTHIS KELLY	2019-07-30
002	2017-01-01	CINDY BECKER	2018-06-22
002	2016-01-01	CINDY KELLY	2017-07-27
002	2015-01-01	CYNTHIA KELLY	2016-06-22
002	2014-01-01	CYNTHIA KELLY
002	2013-01-01	CYNTHIA KELLY
002	2012-01-01	CYNTHIA KELLY
002	2011-01-01	CYNTHIA KELLY	2012-09-12	CYNTHIA KELLY	2012-09-12
002	2010-01-01	CYNTHIA KELLY	2011-08-25	CYNTHIA KELLY	2011-08-25

Plan Statistics for NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN

401k plan membership statisitcs for NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN

Measure Date Value
2014: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 76
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 53
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 27
Total of all active and inactive participants 2014-01-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 80
Number of participants with account balances 2014-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 14
2013: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 75
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 53
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 25
Total of all active and inactive participants 2013-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 78
Number of participants with account balances 2013-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 13
2012: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 61
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 17
Total of all active and inactive participants 2012-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 78
Number of participants with account balances 2012-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 14

Measure	Date	Value
2014: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	53
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	27
Total of all active and inactive participants	2014-01-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	80
Number of participants with account balances	2014-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	14
2013: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	75
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	53
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	25
Total of all active and inactive participants	2013-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	78
Number of participants with account balances	2013-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	13
2012: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	61
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	17
Total of all active and inactive participants	2012-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	78
Number of participants with account balances	2012-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	14

Financial Data on NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN

Measure	Date	Value
2014 : NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$299,334
Expenses. Total of all expenses incurred	2014-12-31	$115,262
Benefits paid (including direct rollovers)	2014-12-31	$114,987
Total plan assets at end of year	2014-12-31	$3,219,642
Total plan assets at beginning of year	2014-12-31	$3,035,570
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$84,378
Expenses. Other expenses not covered elsewhere	2014-12-31	$275
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$178,205
Net income (gross income less expenses)	2014-12-31	$184,072
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,219,642
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,035,570
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$36,751
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$749,700
Expenses. Total of all expenses incurred	2013-12-31	$268,743
Benefits paid (including direct rollovers)	2013-12-31	$268,293
Total plan assets at end of year	2013-12-31	$3,035,570
Total plan assets at beginning of year	2013-12-31	$2,554,613
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$89,716
Expenses. Other expenses not covered elsewhere	2013-12-31	$450
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$619,153
Net income (gross income less expenses)	2013-12-31	$480,957
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,035,570
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,554,613
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$40,831
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$438,694
Expenses. Total of all expenses incurred	2012-12-31	$129,773
Benefits paid (including direct rollovers)	2012-12-31	$129,423
Total plan assets at end of year	2012-12-31	$2,554,613
Total plan assets at beginning of year	2012-12-31	$2,245,692
Value of fidelity bond covering the plan	2012-12-31	$200,000
Total contributions received or receivable from participants	2012-12-31	$102,888
Expenses. Other expenses not covered elsewhere	2012-12-31	$350
Contributions received from other sources (not participants or employers)	2012-12-31	$1,288
Other income received	2012-12-31	$334,518
Net income (gross income less expenses)	2012-12-31	$308,921
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,554,613
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,245,692
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0

Form 5500 Responses for NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN

2014: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: NORTHSTAR ORTHODONTICS, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-830576

Policy instance

Insurance contract or identification number	GA-830576
Number of Individuals Covered	76
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,124
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,124
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO L P.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-830576

Policy instance

Insurance contract or identification number	GA-830576
Number of Individuals Covered	72
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,485
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,485
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-830576

Policy instance

Insurance contract or identification number	GA-830576
Number of Individuals Covered	61
Insurance policy start date	2012-03-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $25,009
Total amount of fees paid to insurance company	USD $1,328
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,009
Insurance broker organization code?	3
Amount paid for insurance broker fees	1328
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

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Company Name:	NORTHSTAR ORTHODONTICS, INC.
Employer identification number (EIN):	411689877
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories