401k Plan data: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST plan

NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 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 EMERGENCY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTHSTAR EMERGENCY SERVICES, INC.

Employer identification number (EIN): 201783317

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2013-01-01 NORTHSTAR EMERGENCY SERVICES I
001 2012-01-01 NORTHSTAR EMERGENCY SERVICES I
001 2011-01-01 KARLA NAZARENO 2012-07-23
001 2010-01-01 KARLA NAZARENO 2011-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2019-01-01
001	2013-01-01	NORTHSTAR EMERGENCY SERVICES I
001	2012-01-01	NORTHSTAR EMERGENCY SERVICES I
001	2011-01-01	KARLA NAZARENO	2012-07-23
001	2010-01-01	KARLA NAZARENO	2011-10-14

Plan Statistics for NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2019: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 249
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 219
Number of retired or separated participants receiving benefits 2019-01-01 39
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 258
Number of participants with account balances 2019-01-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 17
2013: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 158
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 155
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 3
Total of all active and inactive participants 2012-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 158
Number of participants with account balances 2012-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2019: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	249
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	219
Number of retired or separated participants receiving benefits	2019-01-01	39
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	258
Number of participants with account balances	2019-01-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	17
2013: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	158
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	155
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	3
Total of all active and inactive participants	2012-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	158
Number of participants with account balances	2012-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2019 : NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$443,835
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$965
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$921
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$420,740
Value of total assets at end of year	2019-12-31	$442,870
Value of total assets at beginning of year	2019-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$44
Total interest from all sources	2019-12-31	$5
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
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	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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	$339,912
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$12,577
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
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
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$442,870
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$442,870
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$0
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
Value of interest in pooled separate accounts at end of year	2019-12-31	$374,614
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$5
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$23,090
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	$68,251
Employer contributions (assets) at end of year	2019-12-31	$68,251
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$921
Contract administrator fees	2019-12-31	$44
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MOSS ADAMS, LLP
Accountancy firm EIN	2019-12-31	910189318
2013 : NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-05-08	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-05-08	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-05-08	$0
Total income from all sources (including contributions)	2013-05-08	$-251,241
Total loss/gain on sale of assets	2013-05-08	$0
Total of all expenses incurred	2013-05-08	$63,677
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-05-08	$36,250
Expenses. Certain deemed distributions of participant loans	2013-05-08	$0
Value of total corrective distributions	2013-05-08	$25,238
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-05-08	$31,537
Value of total assets at end of year	2013-05-08	$0
Value of total assets at beginning of year	2013-05-08	$314,918
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-05-08	$2,189
Total interest from all sources	2013-05-08	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-05-08	$433
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-05-08	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-05-08	$0
Total dividends received from registered investment company shares (eg mutual funds)	2013-05-08	$433
Assets. Real estate other than employer real property at end of year	2013-05-08	$0
Assets. Real estate other than employer real property at beginning of year	2013-05-08	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2013-05-08	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2013-05-08	$0
Was this plan covered by a fidelity bond	2013-05-08	No
If this is an individual account plan, was there a blackout period	2013-05-08	No
Were there any nonexempt tranactions with any party-in-interest	2013-05-08	No
Contributions received from participants	2013-05-08	$27,263
Participant contributions at end of year	2013-05-08	$0
Participant contributions at beginning of year	2013-05-08	$0
Participant contributions at end of year	2013-05-08	$0
Participant contributions at beginning of year	2013-05-08	$0
Assets. Other investments not covered elsewhere at end of year	2013-05-08	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-05-08	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-05-08	$4,274
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-05-08	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-05-08	$0
Assets. Loans (other than to participants) at end of year	2013-05-08	$0
Assets. Loans (other than to participants) at beginning of year	2013-05-08	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-05-08	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-05-08	$0
Administrative expenses (other) incurred	2013-05-08	$2,189
Liabilities. Value of operating payables at end of year	2013-05-08	$0
Liabilities. Value of operating payables at beginning of year	2013-05-08	$0
Total non interest bearing cash at end of year	2013-05-08	$0
Total non interest bearing cash at beginning of year	2013-05-08	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-05-08	No
Value of net income/loss	2013-05-08	$-314,918
Value of net assets at end of year (total assets less liabilities)	2013-05-08	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-05-08	$314,918
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-05-08	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-05-08	No
Were any leases to which the plan was party in default or uncollectible	2013-05-08	No
Assets. partnership/joint venture interests at end of year	2013-05-08	$0
Assets. partnership/joint venture interests at beginning of year	2013-05-08	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-05-08	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-05-08	$126,571
Interest on participant loans	2013-05-08	$0
Value of interest in master investment trust accounts at end of year	2013-05-08	$0
Value of interest in master investment trust accounts at beginning of year	2013-05-08	$0
Value of interest in common/collective trusts at end of year	2013-05-08	$0
Value of interest in common/collective trusts at beginning of year	2013-05-08	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-05-08	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-05-08	$188,347
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-05-08	$188,347
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-05-08	$0
Assets. Value of investments in 103.12 investment entities at end of year	2013-05-08	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-05-08	$0
Asset value of US Government securities at end of year	2013-05-08	$0
Asset value of US Government securities at beginning of year	2013-05-08	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-05-08	$-283,211
Net investment gain/loss from pooled separate accounts	2013-05-08	$0
Net investment gain or loss from common/collective trusts	2013-05-08	$0
Net gain/loss from 103.12 investment entities	2013-05-08	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-05-08	No
Was there a failure to transmit to the plan any participant contributions	2013-05-08	No
Has the plan failed to provide any benefit when due under the plan	2013-05-08	No
Assets. Invements in employer securities at beginning of year	2013-05-08	$0
Assets. Value of employer real property at end of year	2013-05-08	$0
Assets. Value of employer real property at beginning of year	2013-05-08	$0
Contributions received in cash from employer	2013-05-08	$0
Employer contributions (assets) at end of year	2013-05-08	$0
Employer contributions (assets) at beginning of year	2013-05-08	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-05-08	$36,250
Asset. Corporate debt instrument preferred debt at end of year	2013-05-08	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-05-08	$0
Asset. Corporate debt instrument debt (other) at end of year	2013-05-08	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-05-08	$0
Contract administrator fees	2013-05-08	$0
Assets. Corporate common stocks other than exployer securities at end of year	2013-05-08	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-05-08	$0
Liabilities. Value of benefit claims payable at end of year	2013-05-08	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-05-08	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2013-05-08	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-05-08	$0
Did the plan have assets held for investment	2013-05-08	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	2013-05-08	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-05-08	No
Liabilities. Value of acquisition indebtedness at end of year	2013-05-08	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-05-08	$0
Opinion of an independent qualified public accountant for this plan	2013-05-08	Unqualified
2012 : NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$64,827
Expenses. Total of all expenses incurred	2012-12-31	$364
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$314,918
Total plan assets at beginning of year	2012-12-31	$250,455
Value of fidelity bond covering the plan	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$57,053
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$29,262
Other income received	2012-12-31	$-21,488
Net income (gross income less expenses)	2012-12-31	$64,463
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$314,918
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$250,455
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
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$364

Form 5500 Responses for NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST

2019: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
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
2013: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 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	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NORTHSTAR EMERGENCY SERVICES I 401(K) PROFIT SHARING PLAN & TRUST 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81C482

Policy instance

Insurance contract or identification number	81C482
Number of Individuals Covered	229
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,036
Are there contracts with allocated funds for individual policies?	0
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?	No
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
Amount paid for insurance broker fees	1036
Additional information about fees paid to insurance broker	TPA PARTNERSHIP PROGRAM
Insurance broker organization code?	5

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Company Name:	NORTHSTAR EMERGENCY SERVICES, INC.
Employer identification number (EIN):	201783317
NAIC Classification:	621900