401k Plan data: DOLLAR DRUG 401K SAVINGS PLAN plan

DOLLAR DRUG 401K SAVINGS PLAN 401k Plan overview

Plan Name	DOLLAR DRUG 401K SAVINGS PLAN
Plan identification number	001

DOLLAR DRUG 401K SAVINGS 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

JGS PHARMACIES INC has sponsored the creation of one or more 401k plans.

Company Name: JGS PHARMACIES INC

Employer identification number (EIN): 020544166

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOLLAR DRUG 401K SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JO ANNE CLEEVES 2023-05-16
001 2021-01-01 JO ANNE CLEEVES 2022-07-19
001 2021-01-01 JO ANNE CLEEVES 2022-07-20
001 2020-01-01 JO ANNE CLEEVES 2021-03-16
001 2020-01-01 JO ANNE CLEEVES 2021-03-09
001 2019-01-01 JO ANNE CLEEVES 2020-03-12
001 2018-01-01 JO ANNE CLEEVES 2019-03-11
001 2017-01-01 ADMIN@DOLLARDRUG.COM 2018-07-02
001 2016-01-01 JO ANNE CLEEVES 2017-07-13
001 2015-01-01 JO ANNE CLEEVES 2016-07-13
001 2014-01-01 JO ANNE CLEEVES 2015-09-02
001 2013-01-01 JO ANNE CLEEVES
001 2012-01-01 JO ANNE CLEEVES
001 2011-01-01 JO ANNE CLEEVES
001 2009-01-01 STEVE SMITH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	JO ANNE CLEEVES	2023-05-16
001	2021-01-01	JO ANNE CLEEVES	2022-07-19
001	2021-01-01	JO ANNE CLEEVES	2022-07-20
001	2020-01-01	JO ANNE CLEEVES	2021-03-16
001	2020-01-01	JO ANNE CLEEVES	2021-03-09
001	2019-01-01	JO ANNE CLEEVES	2020-03-12
001	2018-01-01	JO ANNE CLEEVES	2019-03-11
001	2017-01-01	ADMIN@DOLLARDRUG.COM	2018-07-02
001	2016-01-01	JO ANNE CLEEVES	2017-07-13
001	2015-01-01	JO ANNE CLEEVES	2016-07-13
001	2014-01-01	JO ANNE CLEEVES	2015-09-02
001	2013-01-01	JO ANNE CLEEVES
001	2012-01-01	JO ANNE CLEEVES
001	2011-01-01	JO ANNE CLEEVES
001	2009-01-01	STEVE SMITH

Plan Statistics for DOLLAR DRUG 401K SAVINGS PLAN

401k plan membership statisitcs for DOLLAR DRUG 401K SAVINGS PLAN

Measure Date Value
2013: DOLLAR DRUG 401K SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 22
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 3
Total of all active and inactive participants 2013-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 25
Number of participants with account balances 2013-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: DOLLAR DRUG 401K SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 22
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 2
Total of all active and inactive participants 2012-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 24
Number of participants with account balances 2012-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: DOLLAR DRUG 401K SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 23
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 23
Number of participants with account balances 2011-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: DOLLAR DRUG 401K SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 17
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 5
Total of all active and inactive participants 2009-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 22
Number of participants with account balances 2009-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: DOLLAR DRUG 401K SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	22
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	3
Total of all active and inactive participants	2013-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	25
Number of participants with account balances	2013-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: DOLLAR DRUG 401K SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	22
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	2
Total of all active and inactive participants	2012-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	24
Number of participants with account balances	2012-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: DOLLAR DRUG 401K SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	23
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	23
Number of participants with account balances	2011-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: DOLLAR DRUG 401K SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	17
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	5
Total of all active and inactive participants	2009-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	22
Number of participants with account balances	2009-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DOLLAR DRUG 401K SAVINGS PLAN

Measure	Date	Value
2013 : DOLLAR DRUG 401K SAVINGS PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$278,561
Expenses. Total of all expenses incurred	2013-12-31	$130
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$1,118,919
Total plan assets at beginning of year	2013-12-31	$840,488
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$68,699
Expenses. Other expenses not covered elsewhere	2013-12-31	$130
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$170,040
Net income (gross income less expenses)	2013-12-31	$278,431
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,118,919
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$840,488
Assets. Value of participant loans	2013-12-31	$47,660
Total contributions received or receivable from employer(s)	2013-12-31	$39,822
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
2012 : DOLLAR DRUG 401K SAVINGS PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$196,283
Expenses. Total of all expenses incurred	2012-12-31	$54,854
Benefits paid (including direct rollovers)	2012-12-31	$54,748
Total plan assets at end of year	2012-12-31	$840,488
Total plan assets at beginning of year	2012-12-31	$699,059
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$69,881
Expenses. Other expenses not covered elsewhere	2012-12-31	$106
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$86,859
Net income (gross income less expenses)	2012-12-31	$141,429
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$840,488
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$699,059
Assets. Value of participant loans	2012-12-31	$29,387
Total contributions received or receivable from employer(s)	2012-12-31	$39,543
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
2011 : DOLLAR DRUG 401K SAVINGS PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$91,831
Expenses. Total of all expenses incurred	2011-12-31	$46,897
Benefits paid (including direct rollovers)	2011-12-31	$46,761
Total plan assets at end of year	2011-12-31	$699,059
Total plan assets at beginning of year	2011-12-31	$654,125
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$75,399
Expenses. Other expenses not covered elsewhere	2011-12-31	$136
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-22,218
Net income (gross income less expenses)	2011-12-31	$44,934
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$699,059
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$654,125
Assets. Value of participant loans	2011-12-31	$20,531
Total contributions received or receivable from employer(s)	2011-12-31	$38,650
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : DOLLAR DRUG 401K SAVINGS PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$172,299
Expenses. Total of all expenses incurred	2010-12-31	$4,972
Benefits paid (including direct rollovers)	2010-12-31	$4,860
Total plan assets at end of year	2010-12-31	$654,125
Total plan assets at beginning of year	2010-12-31	$486,798
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$76,986
Expenses. Other expenses not covered elsewhere	2010-12-31	$112
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$60,505
Net income (gross income less expenses)	2010-12-31	$167,327
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$654,125
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$486,798
Assets. Value of participant loans	2010-12-31	$5,080
Total contributions received or receivable from employer(s)	2010-12-31	$34,808
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : DOLLAR DRUG 401K SAVINGS PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for DOLLAR DRUG 401K SAVINGS PLAN

2013: DOLLAR DRUG 401K SAVINGS 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: DOLLAR DRUG 401K SAVINGS 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
2011: DOLLAR DRUG 401K SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: DOLLAR DRUG 401K SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	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-800886

Policy instance

Insurance contract or identification number	GA-800886
Number of Individuals Covered	20
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,357
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 $4,357
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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

Policy contract number

GA-800886

Policy instance

Insurance contract or identification number	GA-800886
Number of Individuals Covered	22
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,657
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 $3,657
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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

Policy contract number

GA-800886

Policy instance

Insurance contract or identification number	GA-800886
Number of Individuals Covered	18
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,372
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

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

Policy contract number

GA-800886

Policy instance

Insurance contract or identification number	GA-800886
Number of Individuals Covered	19
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,664
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 $2,664
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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Company Name:	JGS PHARMACIES INC
Employer identification number (EIN):	020544166
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores