401k Plan data: PAYLESS DRUG STORES, INC. 401(K) PLAN plan

PAYLESS DRUG STORES, INC. 401(K) PLAN 401k Plan overview

Plan Name	PAYLESS DRUG STORES, INC. 401(K) PLAN
Plan identification number	001

PAYLESS DRUG STORES, INC. 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

CARE RX LLC has sponsored the creation of one or more 401k plans.

Company Name: CARE RX LLC

Employer identification number (EIN): 463528542

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAYLESS DRUG STORES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-01-01 DAVE EVANS 2020-09-14
001 2018-01-01 ANDREW KLEFFNER 2019-10-11
001 2017-01-01
001 2016-01-01
001 2015-01-01 ANDREW KLEFFNER

Plan Statistics for PAYLESS DRUG STORES, INC. 401(K) PLAN

401k plan membership statisitcs for PAYLESS DRUG STORES, INC. 401(K) PLAN

Measure Date Value
2019: PAYLESS DRUG STORES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 549
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 2
Total of all active and inactive participants 2019-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 2
Number of participants with account balances 2019-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: PAYLESS DRUG STORES, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 544
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 432
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 111
Total of all active and inactive participants 2018-01-01 544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 544
Number of participants with account balances 2018-01-01 421
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 43
2017: PAYLESS DRUG STORES, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 562
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 450
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 84
Total of all active and inactive participants 2017-01-01 534
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 534
Number of participants with account balances 2017-01-01 361
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 28
2016: PAYLESS DRUG STORES, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 336
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 478
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 70
Total of all active and inactive participants 2016-01-01 549
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 549
Number of participants with account balances 2016-01-01 314
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 18
2015: PAYLESS DRUG STORES, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 293
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 279
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 50
Total of all active and inactive participants 2015-01-01 330
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 330
Number of participants with account balances 2015-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 7

Measure	Date	Value
2019: PAYLESS DRUG STORES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	549
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	2
Total of all active and inactive participants	2019-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	2
Number of participants with account balances	2019-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: PAYLESS DRUG STORES, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	544
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	432
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	111
Total of all active and inactive participants	2018-01-01	544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	544
Number of participants with account balances	2018-01-01	421
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	43
2017: PAYLESS DRUG STORES, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	562
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	450
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	84
Total of all active and inactive participants	2017-01-01	534
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	534
Number of participants with account balances	2017-01-01	361
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	28
2016: PAYLESS DRUG STORES, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	336
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	478
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	70
Total of all active and inactive participants	2016-01-01	549
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	549
Number of participants with account balances	2016-01-01	314
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	18
2015: PAYLESS DRUG STORES, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	293
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	279
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	50
Total of all active and inactive participants	2015-01-01	330
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	330
Number of participants with account balances	2015-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	7

Financial Data on PAYLESS DRUG STORES, INC. 401(K) PLAN

Measure	Date	Value
2019 : PAYLESS DRUG STORES, INC. 401(K) PLAN 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	$2,990,572
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$14,813,212
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$14,573,809
Value of total corrective distributions	2019-12-31	$89,902
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$902,781
Value of total assets at end of year	2019-12-31	$6,707
Value of total assets at beginning of year	2019-12-31	$11,829,347
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$149,501
Total interest from all sources	2019-12-31	$17,767
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
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$788,329
Participant contributions at beginning of year	2019-12-31	$126,110
Participant contributions at beginning of year	2019-12-31	$3,173
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$4,652
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
Value of net income/loss	2019-12-31	$-11,822,640
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$6,707
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$11,829,347
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 registered invesment companies (eg mutual funds) at end of year	2019-12-31	$6,399
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$11,181,041
Interest on participant loans	2019-12-31	$3,265
Interest earned on other investments	2019-12-31	$14,502
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$308
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$518,405
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,070,024
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	Yes
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	$109,800
Employer contributions (assets) at beginning of year	2019-12-31	$618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$14,573,809
Contract administrator fees	2019-12-31	$149,501
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	KBF CPAS LLP
Accountancy firm EIN	2019-12-31	821030164
2018 : PAYLESS DRUG STORES, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$1,205,754
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$455,567
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$302,221
Value of total corrective distributions	2018-12-31	$38,750
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,960,641
Value of total assets at end of year	2018-12-31	$11,829,347
Value of total assets at beginning of year	2018-12-31	$11,079,160
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$114,596
Total interest from all sources	2018-12-31	$17,630
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$560,579
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$560,579
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,424,090
Participant contributions at end of year	2018-12-31	$126,110
Participant contributions at beginning of year	2018-12-31	$125,500
Participant contributions at end of year	2018-12-31	$3,173
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$299,590
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$750,187
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$11,829,347
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$11,079,160
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$11,181,041
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$10,480,407
Interest on participant loans	2018-12-31	$5,032
Interest earned on other investments	2018-12-31	$12,598
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$518,405
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$473,253
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,333,096
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$236,961
Employer contributions (assets) at end of year	2018-12-31	$618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$302,221
Contract administrator fees	2018-12-31	$114,596
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	KBF CPAS LLP
Accountancy firm EIN	2018-12-31	821030164
2017 : PAYLESS DRUG STORES, INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$3,247,247
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$3,015,322
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,251,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,146,111
Value of total corrective distributions	2017-12-31	$19,272
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,577,524
Value of total assets at end of year	2017-12-31	$11,079,160
Value of total assets at beginning of year	2017-12-31	$6,067,952
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$85,978
Total interest from all sources	2017-12-31	$12,909
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$370,687
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$370,687
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$1,360,738
Participant contributions at end of year	2017-12-31	$125,500
Participant contributions at beginning of year	2017-12-31	$76,298
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$7,526
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$1,428
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,763,961
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$11,079,160
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$6,067,952
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$10,480,407
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$5,714,300
Interest on participant loans	2017-12-31	$3,286
Interest earned on other investments	2017-12-31	$9,623
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$473,253
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$275,926
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,054,202
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$209,260
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,146,111
Contract administrator fees	2017-12-31	$85,978
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	KBF CPAS LLP
Accountancy firm EIN	2017-12-31	821030164
2016 : PAYLESS DRUG STORES, INC. 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$1,423,536
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$851,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$794,495
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$900,043
Value of total assets at end of year	2016-12-31	$6,067,952
Value of total assets at beginning of year	2016-12-31	$5,495,523
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$56,612
Total interest from all sources	2016-12-31	$9,534
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$236,805
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$236,805
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$721,074
Participant contributions at end of year	2016-12-31	$76,298
Participant contributions at beginning of year	2016-12-31	$108,953
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$90,190
Total non interest bearing cash at end of year	2016-12-31	$1,428
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$572,429
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,067,952
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$5,495,523
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$5,714,300
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$5,059,432
Interest on participant loans	2016-12-31	$3,068
Interest earned on other investments	2016-12-31	$6,521
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$327,138
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$327,138
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$-55
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$275,926
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$277,154
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$88,779
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$794,495
Contract administrator fees	2016-12-31	$56,612
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	KIECKHAFER SCHIFFER & COMPANY LLP
Accountancy firm EIN	2016-12-31	330688321
2015 : PAYLESS DRUG STORES, INC. 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$13,656
Total income from all sources (including contributions)	2015-12-31	$648,488
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,254,336
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,166,821
Value of total corrective distributions	2015-12-31	$41,327
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$676,782
Value of total assets at end of year	2015-12-31	$5,495,523
Value of total assets at beginning of year	2015-12-31	$6,115,027
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$46,188
Total interest from all sources	2015-12-31	$3,903
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$292,852
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$292,852
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$615,125
Participant contributions at end of year	2015-12-31	$108,953
Participant contributions at beginning of year	2015-12-31	$123,299
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$1,963
Liabilities. Value of operating payables at beginning of year	2015-12-31	$13,656
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-605,848
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$5,495,523
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$6,101,371
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$5,059,432
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$5,991,728
Interest on participant loans	2015-12-31	$3,672
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$327,138
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$231
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-325,049
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$59,694
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,166,821
Contract administrator fees	2015-12-31	$46,188
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	KIECKHAFER SCHIFFER & COMPANY LLP
Accountancy firm EIN	2015-12-31	330688321

Form 5500 Responses for PAYLESS DRUG STORES, INC. 401(K) PLAN

2019: PAYLESS DRUG STORES, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
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
2018: PAYLESS DRUG STORES, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PAYLESS DRUG STORES, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: PAYLESS DRUG STORES, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PAYLESS DRUG STORES, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

807536

Policy instance

Insurance contract or identification number	807536
Number of Individuals Covered	3
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 $0
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

807536

Policy instance

Insurance contract or identification number	807536
Number of Individuals Covered	544
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

807536

Policy instance

Insurance contract or identification number	807536
Number of Individuals Covered	534
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CARE RX LLC
Employer identification number (EIN):	463528542
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2020-01-01
001	2019-01-01	DAVE EVANS	2020-09-14
001	2018-01-01	ANDREW KLEFFNER	2019-10-11
001	2017-01-01
001	2016-01-01
001	2015-01-01	ANDREW KLEFFNER