401k Plan data: 3.1 PHILLIP LIM LLC BENEFITS PROGRAM plan

3.1 PHILLIP LIM LLC BENEFITS PROGRAM 401k Plan overview

Plan Name	3.1 PHILLIP LIM LLC BENEFITS PROGRAM
Plan identification number	501

3.1 PHILLIP LIM LLC BENEFITS PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

3.1 PHILLIP LIM LLC has sponsored the creation of one or more 401k plans.

Company Name: 3.1 PHILLIP LIM LLC

Employer identification number (EIN): 201826764

NAIC Classification: 315990
NAIC Description: Apparel Accessories and Other Apparel Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 3.1 PHILLIP LIM LLC BENEFITS PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for 3.1 PHILLIP LIM LLC BENEFITS PROGRAM

401k plan membership statisitcs for 3.1 PHILLIP LIM LLC BENEFITS PROGRAM

Measure Date Value
2017: 3.1 PHILLIP LIM LLC BENEFITS PROGRAM 2017 401k membership
Total participants, beginning-of-year 2017-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 94
Number of retired or separated participants receiving benefits 2017-01-01 4
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 98

Measure	Date	Value
2017: 3.1 PHILLIP LIM LLC BENEFITS PROGRAM 2017 401k membership
Total participants, beginning-of-year	2017-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	94
Number of retired or separated participants receiving benefits	2017-01-01	4
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	98

Form 5500 Responses for 3.1 PHILLIP LIM LLC BENEFITS PROGRAM

2017: 3.1 PHILLIP LIM LLC BENEFITS PROGRAM 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

485254

Policy instance

Insurance contract or identification number	485254
Number of Individuals Covered	74
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $2,613
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,613
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES, LLC

FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )

Policy contract number

99339871001

Policy instance

Insurance contract or identification number	99339871001
Number of Individuals Covered	43
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $252
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $252
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

HW1103

Policy instance

Insurance contract or identification number	HW1103
Number of Individuals Covered	106
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $34,148
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $855,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,148
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00902192

Policy instance

Insurance contract or identification number	00902192
Number of Individuals Covered	7
Insurance policy start date	2017-06-01
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	3.1 PHILLIP LIM LLC
Employer identification number (EIN):	201826764
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing