401k Plan data: LUCKY HEALTH GROUP, INC. 401(K) PLAN plan

LUCKY HEALTH GROUP, INC. 401(K) PLAN 401k Plan overview

Plan Name	LUCKY HEALTH GROUP, INC. 401(K) PLAN
Plan identification number	001

LUCKY HEALTH GROUP, 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

LUCKY HEALTH GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: LUCKY HEALTH GROUP, INC.

Employer identification number (EIN): 843102345

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUCKY HEALTH GROUP, 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

Plan Statistics for LUCKY HEALTH GROUP, INC. 401(K) PLAN

401k plan membership statisitcs for LUCKY HEALTH GROUP, INC. 401(K) PLAN

Measure Date Value
2020: LUCKY HEALTH GROUP, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
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 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: LUCKY HEALTH GROUP, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 133
Number of retired or separated participants receiving benefits 2019-01-01 9
Number of other retired or separated participants entitled to future benefits 2019-01-01 29
Total of all active and inactive participants 2019-01-01 171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 171
Number of participants with account balances 2019-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 21

Measure	Date	Value
2020: LUCKY HEALTH GROUP, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
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	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: LUCKY HEALTH GROUP, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	133
Number of retired or separated participants receiving benefits	2019-01-01	9
Number of other retired or separated participants entitled to future benefits	2019-01-01	29
Total of all active and inactive participants	2019-01-01	171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	171
Number of participants with account balances	2019-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	21

Financial Data on LUCKY HEALTH GROUP, INC. 401(K) PLAN

Measure	Date	Value
2020 : LUCKY HEALTH GROUP, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total transfer of assets from this plan	2020-06-30	$836,983
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$141,569
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$14,739
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$6,983
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$154,402
Value of total assets at end of year	2020-06-30	$0
Value of total assets at beginning of year	2020-06-30	$710,153
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$7,756
Total interest from all sources	2020-06-30	$34
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$699
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$699
Administrative expenses professional fees incurred	2020-06-30	$7,756
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$129,092
Assets. Loans (other than to participants) at end of year	2020-06-30	$0
Assets. Loans (other than to participants) at beginning of year	2020-06-30	$1,334
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$126,830
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$710,153
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$143,503
Interest on participant loans	2020-06-30	$34
Value of interest in common/collective trusts at end of year	2020-06-30	$0
Value of interest in common/collective trusts at beginning of year	2020-06-30	$556,682
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-06-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-06-30	$1,101
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-06-30	$1,101
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$7,533
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$-13,566
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	Yes
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$25,310
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$6,983
Did the plan have assets held for investment	2020-06-30	No
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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	MAYER HOFFMAN MCCANN PC
Accountancy firm EIN	2020-06-30	431947695
2019 : LUCKY HEALTH GROUP, 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	$591,723
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$335,885
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$326,588
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$473,856
Value of total assets at end of year	2019-12-31	$710,153
Value of total assets at beginning of year	2019-12-31	$454,315
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$9,297
Total interest from all sources	2019-12-31	$0
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
Administrative expenses professional fees incurred	2019-12-31	$9,297
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$334,635
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$79,142
Assets. Loans (other than to participants) at end of year	2019-12-31	$1,334
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$255,838
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$710,153
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$454,315
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	$143,503
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$16,427
Value of interest in common/collective trusts at end of year	2019-12-31	$556,682
Value of interest in common/collective trusts at beginning of year	2019-12-31	$437,888
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$1,101
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$7,533
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$117,867
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	$60,079
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$326,588
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	RSM US LLP
Accountancy firm EIN	2019-12-31	420714325

Form 5500 Responses for LUCKY HEALTH GROUP, INC. 401(K) PLAN

2020: LUCKY HEALTH GROUP, INC. 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	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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
2019: LUCKY HEALTH GROUP, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single 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

Insurance Providers Used on plan

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

Policy contract number

505079-01

Policy instance

Insurance contract or identification number	505079-01
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-06-30
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

505079-01

Policy instance

Insurance contract or identification number	505079-01
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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:	LUCKY HEALTH GROUP, INC.
Employer identification number (EIN):	843102345
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores