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FORM 5500 DATA

Tiffany Care Centers, Inc. 401k Plan

Overview

Plan Information

  • Plan Year09/01/2017 — 08/31/2018
  • Date of Plan09/01/1995
  • Net Assets as of 08/31/2018 $2,688,730
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program? No
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit Arrangement Trust

Participant Information as of 08/31/2018

  • Active (Eligible) Participants412
  • Retired or separated participants receiving benefits41
  • Other retired or separated participants entitled to future benefits32
  • Subtotal485
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits2
  • Total487
  • Total number of participants as of 09/01/2017500
  • Number of participants with account balances197
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested9

Expenses

  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • AddressP.O. Box 308
  • CityMound City
  • StateMO
  • Zip64470-0308
  • Telephone(816) 442-3128
  • EIN43-1090886
  • Industry Code623000

Audit Information

  • Audit StatusAudited
  • AuditorEmerick & Company
  • Auditor EIN43-1855764
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2G 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.
2J 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.
2K 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 contributions 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.
3D 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.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? Yes $87,112
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $275,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? No
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? No

Financials

Income and Expense Statement

Income $440,271
Contributions $225,702
Cash Contributions $225,702
Cash from Employers $80,441
Cash from Participants $145,174
Others (including rollovers) $87
Noncash Contributions $0
Total Earnings on Investments $214,569
Total Interest $6,557
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $6,557
Interest from Other Investments $0
Total Dividends $0
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $208,012
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $0
Other Income $0
Expenses $562,622
Total Benefit Payments $547,427
Directly to participants or beneficiaries, including direct rollovers $547,427
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $3,298
Certain deemed distributions of participant loans $6,325
Interest expense $0
Total Administrative Expenses $5,572
Professional Fees $5,572
Contract Administrator Fees $0
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $-122,351
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

08/31/2018 08/31/2017 Change YOY
Total Assets $2,688,730 $2,811,081 -4.35%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $0 $0 0.0%
Employer Contributions $0 $0 0.0%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $1,836 $5,573 -67.06%
Interest-bearing cash $1,836 $5,573 -67.06%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $141,733 $128,938 9.92%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $2,545,161 $2,676,570 -4.91%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $0 $0 0.0%
Value of funds held in insurance co. general account $0 $0 0.0%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $2,688,730 $2,811,081 -4.35%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Cbiz Benefits & Insurance Serv

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
John Hancock Recordkeeping and information management (computing, tabulating, data processing, etc.) Recordkeeper $2,276 $0 $2,276
Total $2,276 $0 $2,276

Indirect Compensation

There are no service providers with indirect compensation listed for this plan.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
Jh Thru 2030 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $431,812
Jh Thru 2035 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $352,638
Jh Thru 2015 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $298,971
Jh Thru 2040 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $250,069
Jh Thru 2025 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $241,424
Jh Thru 2020 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $224,213
Jh Thru 2050 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $223,987
Jh Thru 2045 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $195,730
Jh Thru 2010 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $53,464
Jh 500 Index Fund John Hancock USA DFE: Pooled Separate Account $31,602
T Rowe Price Blue Chip Grwth Fund John Hancock USA DFE: Pooled Separate Account $29,766
Jh Disciplined Value Mid Cap Fund John Hancock USA DFE: Pooled Separate Account $29,271
Jh Thru 2055 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $28,246
Washington Mutual Investors John Hancock USA DFE: Pooled Separate Account $24,151
Jh Thru 2060 Active Strategy Fund John Hancock USA DFE: Pooled Separate Account $20,615
John Hancock Stable Value Fund John Hancock USA DFE: Pooled Separate Account $19,584
American Funds American Bal Fund John Hancock USA DFE: Pooled Separate Account $19,424
Jh Small Cap Index Fund John Hancock USA DFE: Pooled Separate Account $16,115
Jh Mid Cap Index Fund John Hancock USA DFE: Pooled Separate Account $15,966
Vanguard Small Cap Value Index John Hancock USA DFE: Pooled Separate Account $10,146
Invesco Small Cap Growth Fund John Hancock USA DFE: Pooled Separate Account $9,280
American Funds New World Fund John Hancock USA DFE: Pooled Separate Account $7,335
American Century Heritage Fund John Hancock USA DFE: Pooled Separate Account $6,888
Fidelity Advisor Total Bond Fund John Hancock USA DFE: Pooled Separate Account $1,669
American Funds Us Govt Sec Fund John Hancock USA DFE: Pooled Separate Account $1,377
Dodge & Cox Internatl Stock Fund John Hancock USA DFE: Pooled Separate Account $731
Mutual Glbl Disc John Hancock USA DFE: Pooled Separate Account $687
Total $2,545,161

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
John Hancock Life Insurance Company 172
EIN 01-0233346
Industry Code 65838
Contract Number 113851
Contract Year 09/01/2017 — 08/31/2018
Value in General Account at Year End $1,836
Value in Separate Accounts at Year End $2,545,161
Insurance Fees and Commissions $9,754
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Cbiz Financial Solutions, Inc. 6050 Oak Tree Blvd South Cleveland, OH 44131 Agent or Broker other than Insurance $5,589 $0
Benefit Plans, Inc. 16924 Frances Street Omaha, NE 68130 Third Party Administrator $0 $4,165 FEES PAID
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Unspecified
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0