401k Plan data: SULLIVAN'S PHARMACY 401(K) PLAN plan

SULLIVAN'S PHARMACY 401(K) PLAN 401k Plan overview

Plan Name	SULLIVAN'S PHARMACY 401(K) PLAN
Plan identification number	002

SULLIVAN'S PHARMACY 401(K) 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

SULLIVANS PHARMACY has sponsored the creation of one or more 401k plans.

Company Name: SULLIVANS PHARMACY

Employer identification number (EIN): 042581398

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SULLIVAN'S PHARMACY 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
002 2021-01-01
002 2020-01-01
002 2020-01-01
002 2019-01-01 GREGORY LAHAM 2020-10-14
002 2018-01-01 GREGORY LAHAM 2019-10-15
002 2018-01-01 GREGORY LAHAM 2022-10-07
002 2017-01-01 GREGORY LAHAM 2018-10-04
002 2016-01-01 GREGORY LAHAM 2017-10-10
002 2015-01-01 GREGORY LAHAM 2016-10-06
002 2014-01-01 GREGORY LAHAM 2015-10-14
002 2013-01-01 GREGORY LAHAM 2014-09-19
002 2012-01-01 GREGORY LAHAM 2013-10-07
002 2011-01-01 GREGORY LAHAM 2012-10-13
002 2010-01-01 GREGORY LAHAM 2012-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2020-01-01
002	2019-01-01	GREGORY LAHAM	2020-10-14
002	2018-01-01	GREGORY LAHAM	2019-10-15
002	2018-01-01	GREGORY LAHAM	2022-10-07
002	2017-01-01	GREGORY LAHAM	2018-10-04
002	2016-01-01	GREGORY LAHAM	2017-10-10
002	2015-01-01	GREGORY LAHAM	2016-10-06
002	2014-01-01	GREGORY LAHAM	2015-10-14
002	2013-01-01	GREGORY LAHAM	2014-09-19
002	2012-01-01	GREGORY LAHAM	2013-10-07
002	2011-01-01	GREGORY LAHAM	2012-10-13
002	2010-01-01	GREGORY LAHAM	2012-10-13

Plan Statistics for SULLIVAN'S PHARMACY 401(K) PLAN

401k plan membership statisitcs for SULLIVAN'S PHARMACY 401(K) PLAN

Measure Date Value
2022: SULLIVAN'S PHARMACY 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 87
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 25
Total of all active and inactive participants 2022-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 112
Number of participants with account balances 2022-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: SULLIVAN'S PHARMACY 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 82
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 24
Total of all active and inactive participants 2021-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 106
Number of participants with account balances 2021-01-01 81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: SULLIVAN'S PHARMACY 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 91
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 23
Total of all active and inactive participants 2020-01-01 114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 114
Number of participants with account balances 2020-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 8

Measure	Date	Value
2022: SULLIVAN'S PHARMACY 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	87
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	25
Total of all active and inactive participants	2022-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	112
Number of participants with account balances	2022-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: SULLIVAN'S PHARMACY 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	82
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	24
Total of all active and inactive participants	2021-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	106
Number of participants with account balances	2021-01-01	81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: SULLIVAN'S PHARMACY 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	91
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	23
Total of all active and inactive participants	2020-01-01	114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	114
Number of participants with account balances	2020-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	8

Financial Data on SULLIVAN'S PHARMACY 401(K) PLAN

Measure	Date	Value
2022 : SULLIVAN'S PHARMACY 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-1,671,931
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,042,193
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$2,005,058
Expenses. Certain deemed distributions of participant loans	2022-12-31	$7,341
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$523,999
Value of total assets at end of year	2022-12-31	$10,339,617
Value of total assets at beginning of year	2022-12-31	$14,053,741
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$29,794
Total interest from all sources	2022-12-31	$16,767
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$567,100
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$567,100
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$351,155
Participant contributions at end of year	2022-12-31	$172,766
Participant contributions at beginning of year	2022-12-31	$209,512
Administrative expenses (other) incurred	2022-12-31	$29,794
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-3,714,124
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$10,339,617
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$14,053,741
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,718,960
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$13,465,081
Interest on participant loans	2022-12-31	$11,153
Interest earned on other investments	2022-12-31	$5,614
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$447,891
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$379,148
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,779,797
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$172,844
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$2,005,058
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Disclaimer
Accountancy firm name	2022-12-31	G.T. REILLY & COMPANY
Accountancy firm EIN	2022-12-31	042513210
2021 : SULLIVAN'S PHARMACY 401(K) PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-12-31	$3,701
Total unrealized appreciation/depreciation of assets	2021-12-31	$3,701
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$2,870,884
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,050,547
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,005,383
Expenses. Certain deemed distributions of participant loans	2021-12-31	$8,966
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$564,711
Value of total assets at end of year	2021-12-31	$14,053,741
Value of total assets at beginning of year	2021-12-31	$14,233,404
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$36,198
Total interest from all sources	2021-12-31	$14,394
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$760,804
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$760,804
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$378,882
Participant contributions at end of year	2021-12-31	$209,512
Participant contributions at beginning of year	2021-12-31	$303,760
Administrative expenses (other) incurred	2021-12-31	$36,198
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-179,663
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$14,053,741
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$14,233,404
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$13,465,081
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$13,571,126
Interest on participant loans	2021-12-31	$14,394
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$379,148
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$358,518
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,527,274
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$185,829
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,005,383
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	G.T. REILLY & COMPANY
Accountancy firm EIN	2021-12-31	042513210
2020 : SULLIVAN'S PHARMACY 401(K) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$2,645
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$2,755,374
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$814,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$780,304
Expenses. Certain deemed distributions of participant loans	2020-12-31	$5,173
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$600,136
Value of total assets at end of year	2020-12-31	$14,109,505
Value of total assets at beginning of year	2020-12-31	$12,168,166
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$28,558
Total interest from all sources	2020-12-31	$22,486
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$430,626
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$430,626
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$402,101
Participant contributions at end of year	2020-12-31	$303,760
Participant contributions at beginning of year	2020-12-31	$293,961
Administrative expenses (other) incurred	2020-12-31	$28,558
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,941,339
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$14,109,505
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$12,168,166
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$13,571,126
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$11,737,681
Interest on participant loans	2020-12-31	$20,602
Interest earned on other investments	2020-12-31	$1,884
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$234,619
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$136,524
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,702,126
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$198,035
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$780,304
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	G.T. REILLY & COMPANY
Accountancy firm EIN	2020-12-31	042513210

Form 5500 Responses for SULLIVAN'S PHARMACY 401(K) PLAN

2022: SULLIVAN'S PHARMACY 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: SULLIVAN'S PHARMACY 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: SULLIVAN'S PHARMACY 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

370492-01

Policy instance

Insurance contract or identification number	370492-01
Number of Individuals Covered	73
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

370492-01

Policy instance

Insurance contract or identification number	370492-01
Number of Individuals Covered	12
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

370492-01

Policy instance

Insurance contract or identification number	370492-01
Number of Individuals Covered	84
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

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Company Name:	SULLIVANS PHARMACY
Employer identification number (EIN):	042581398
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores