401k Plan data: NHS NORTHSTAR ERISA WRAP PLAN plan

NHS NORTHSTAR ERISA WRAP PLAN 401k Plan overview

Plan Name	NHS NORTHSTAR ERISA WRAP PLAN
Plan identification number	502

NHS NORTHSTAR ERISA WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: NHS NORTHSTAR, INC.

Employer identification number (EIN): 411942787

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NHS NORTHSTAR ERISA WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01

Plan Statistics for NHS NORTHSTAR ERISA WRAP PLAN

401k plan membership statisitcs for NHS NORTHSTAR ERISA WRAP PLAN

Measure Date Value
2022: NHS NORTHSTAR ERISA WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 229
Number of retired or separated participants receiving benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 230

Measure	Date	Value
2022: NHS NORTHSTAR ERISA WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	229
Number of retired or separated participants receiving benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	230

Form 5500 Responses for NHS NORTHSTAR ERISA WRAP PLAN

2022: NHS NORTHSTAR ERISA WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

168372

Policy instance

Insurance contract or identification number	168372
Number of Individuals Covered	156
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,351
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,351
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

50008541001

Policy instance

Insurance contract or identification number	50008541001
Number of Individuals Covered	90
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $575
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $575
Insurance broker organization code?	3

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

145916

Policy instance

Insurance contract or identification number	145916
Number of Individuals Covered	96
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $28,215
Total amount of fees paid to insurance company	USD $397
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $940,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,215
Amount paid for insurance broker fees	397
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE
Insurance broker organization code?	3

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Company Name:	NHS NORTHSTAR, INC.
Employer identification number (EIN):	411942787
NAIC Classification:	624100
NAIC Description:	Individual and Family Services