401k Plan data: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN plan

3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN
Plan identification number	001

3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

3 STAR HEALTHCARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: 3 STAR HEALTHCARE, INC.

Employer identification number (EIN): 270401215

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-06-01 JAMES MICHAEL VARNELL
001 2012-06-01 JAMES MICHAEL VARNELL
001 2011-06-01 JAMES MICHAEL VARNELL
001 2009-06-19 JAMES VARNELL

Plan id#	Filing Submission Date	Name of Administrator
001	2013-06-01	JAMES MICHAEL VARNELL
001	2012-06-01	JAMES MICHAEL VARNELL
001	2011-06-01	JAMES MICHAEL VARNELL
001	2009-06-19	JAMES VARNELL

Plan Statistics for 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN

Measure Date Value
2013: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 2
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 2
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-06-01 0
Total participants 2013-06-01 2
Number of participants with account balances 2013-06-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-06-01 0
2012: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 2
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-06-01 0
Total participants 2012-06-01 2
Number of participants with account balances 2012-06-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-06-01 0
2011: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 16
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 20
Number of retired or separated participants receiving benefits 2011-06-01 0
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-06-01 0
Total participants 2011-06-01 20
Number of participants with account balances 2011-06-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-06-01 0
2009: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-19 2
Total number of active participants reported on line 7a of the Form 5500 2009-06-19 2
Total of all active and inactive participants 2009-06-19 2
Total participants 2009-06-19 2
Number of participants with account balances 2009-06-19 2

Measure	Date	Value
2013: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	2
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	2
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-06-01	0
Total participants	2013-06-01	2
Number of participants with account balances	2013-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-06-01	0
2012: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	2
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-06-01	0
Total participants	2012-06-01	2
Number of participants with account balances	2012-06-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-06-01	0
2011: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	16
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	20
Number of retired or separated participants receiving benefits	2011-06-01	0
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-06-01	0
Total participants	2011-06-01	20
Number of participants with account balances	2011-06-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-06-01	0
2009: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-19	2
Total number of active participants reported on line 7a of the Form 5500	2009-06-19	2
Total of all active and inactive participants	2009-06-19	2
Total participants	2009-06-19	2
Number of participants with account balances	2009-06-19	2

Financial Data on 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN

Measure	Date	Value
2014 : 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-05-31	$-2,998
Expenses. Total of all expenses incurred	2014-05-31	$0
Benefits paid (including direct rollovers)	2014-05-31	$0
Total plan assets at end of year	2014-05-31	$0
Total plan assets at beginning of year	2014-05-31	$2,998
Total contributions received or receivable from participants	2014-05-31	$0
Contributions received from other sources (not participants or employers)	2014-05-31	$0
Other income received	2014-05-31	$-2,998
Net income (gross income less expenses)	2014-05-31	$-2,998
Net plan assets at end of year (total assets less liabilities)	2014-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-05-31	$2,998
Assets. Value of employer securities	2014-05-31	$0
Total contributions received or receivable from employer(s)	2014-05-31	$0
Value of certain deemed distributions of participant loans	2014-05-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-05-31	$0
2013 : 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-05-31	$1,999
Expenses. Total of all expenses incurred	2013-05-31	$0
Benefits paid (including direct rollovers)	2013-05-31	$0
Total plan assets at end of year	2013-05-31	$2,998
Total plan assets at beginning of year	2013-05-31	$999
Total contributions received or receivable from participants	2013-05-31	$0
Contributions received from other sources (not participants or employers)	2013-05-31	$0
Other income received	2013-05-31	$1,999
Net income (gross income less expenses)	2013-05-31	$1,999
Net plan assets at end of year (total assets less liabilities)	2013-05-31	$2,998
Net plan assets at beginning of year (total assets less liabilities)	2013-05-31	$999
Assets. Value of employer securities	2013-05-31	$2,998
Total contributions received or receivable from employer(s)	2013-05-31	$0
Value of certain deemed distributions of participant loans	2013-05-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-05-31	$0
2012 : 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-05-31	$999
Expenses. Total of all expenses incurred	2012-05-31	$0
Benefits paid (including direct rollovers)	2012-05-31	$0
Total plan assets at end of year	2012-05-31	$999
Total plan assets at beginning of year	2012-05-31	$0
Value of fidelity bond covering the plan	2012-05-31	$1,000,000
Total contributions received or receivable from participants	2012-05-31	$0
Contributions received from other sources (not participants or employers)	2012-05-31	$19,000
Other income received	2012-05-31	$-18,001
Net income (gross income less expenses)	2012-05-31	$999
Net plan assets at end of year (total assets less liabilities)	2012-05-31	$999
Net plan assets at beginning of year (total assets less liabilities)	2012-05-31	$0
Assets. Value of employer securities	2012-05-31	$999
Total contributions received or receivable from employer(s)	2012-05-31	$0
Value of certain deemed distributions of participant loans	2012-05-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-05-31	$0
2011 : 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-05-31	$-355,001
Expenses. Total of all expenses incurred	2011-05-31	$0
Benefits paid (including direct rollovers)	2011-05-31	$0
Total plan assets at end of year	2011-05-31	$0
Total plan assets at beginning of year	2011-05-31	$355,001
Value of fidelity bond covering the plan	2011-05-31	$1,000,000
Total contributions received or receivable from participants	2011-05-31	$0
Contributions received from other sources (not participants or employers)	2011-05-31	$0
Other income received	2011-05-31	$-355,001
Net income (gross income less expenses)	2011-05-31	$-355,001
Net plan assets at end of year (total assets less liabilities)	2011-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2011-05-31	$355,001
Total contributions received or receivable from employer(s)	2011-05-31	$0
Value of certain deemed distributions of participant loans	2011-05-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-05-31	$0

Form 5500 Responses for 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN

2013: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Trust	Yes
2013-06-01	Plan benefit arrangement - Trust	Yes
2012: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Trust	Yes
2012-06-01	Plan benefit arrangement - Trust	Yes
2011: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Trust	Yes
2011-06-01	Plan benefit arrangement - Trust	Yes
2009: 3 STAR HEALTHCARE, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-06-19	Type of plan entity	Single employer plan
2009-06-19	First time form 5500 has been submitted	Yes
2009-06-19	Submission has been amended	No
2009-06-19	This submission is the final filing	No
2009-06-19	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-06-19	Plan is a collectively bargained plan	No
2009-06-19	Plan funding arrangement – Trust	Yes
2009-06-19	Plan benefit arrangement - Trust	Yes

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Company Name:	3 STAR HEALTHCARE, INC.
Employer identification number (EIN):	270401215
NAIC Classification:	621210
NAIC Description:	Offices of Dentists