401k Plan data: MONCLER USA BENEFIT PLAN plan

MONCLER USA BENEFIT PLAN 401k Plan overview

Plan Name	MONCLER USA BENEFIT PLAN
Plan identification number	501

MONCLER USA BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

MONCLER RETAIL, LLC has sponsored the creation of one or more 401k plans.

Company Name: MONCLER RETAIL, LLC

Employer identification number (EIN): 472946188

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MONCLER USA BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-03-01
501 2016-03-01
501 2015-03-01 ARA CHO

Plan Statistics for MONCLER USA BENEFIT PLAN

401k plan membership statisitcs for MONCLER USA BENEFIT PLAN

Measure Date Value
2017: MONCLER USA BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-03-01 104
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 146
Number of retired or separated participants receiving benefits 2017-03-01 0
Number of other retired or separated participants entitled to future benefits 2017-03-01 0
Total of all active and inactive participants 2017-03-01 146
2016: MONCLER USA BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-03-01 86
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 103
Number of retired or separated participants receiving benefits 2016-03-01 1
Number of other retired or separated participants entitled to future benefits 2016-03-01 0
Total of all active and inactive participants 2016-03-01 104
2015: MONCLER USA BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 103
Number of retired or separated participants receiving benefits 2015-03-01 1
Number of other retired or separated participants entitled to future benefits 2015-03-01 0
Total of all active and inactive participants 2015-03-01 104

Measure	Date	Value
2017: MONCLER USA BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-03-01	104
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	146
Number of retired or separated participants receiving benefits	2017-03-01	0
Number of other retired or separated participants entitled to future benefits	2017-03-01	0
Total of all active and inactive participants	2017-03-01	146
2016: MONCLER USA BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-03-01	86
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	103
Number of retired or separated participants receiving benefits	2016-03-01	1
Number of other retired or separated participants entitled to future benefits	2016-03-01	0
Total of all active and inactive participants	2016-03-01	104
2015: MONCLER USA BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	103
Number of retired or separated participants receiving benefits	2015-03-01	1
Number of other retired or separated participants entitled to future benefits	2015-03-01	0
Total of all active and inactive participants	2015-03-01	104

Form 5500 Responses for MONCLER USA BENEFIT PLAN

2017: MONCLER USA BENEFIT PLAN 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MONCLER USA BENEFIT PLAN 2016 form 5500 responses
2016-03-01	Type of plan entity	Mulitple employer plan
2016-03-01	Submission has been amended	No
2016-03-01	This submission is the final filing	No
2016-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-03-01	Plan is a collectively bargained plan	No
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MONCLER USA BENEFIT PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Mulitple employer plan
2015-03-01	First time form 5500 has been submitted	Yes
2015-03-01	Submission has been amended	No
2015-03-01	This submission is the final filing	No
2015-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-03-01	Plan is a collectively bargained plan	No
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

824332

Policy instance

Insurance contract or identification number	824332
Number of Individuals Covered	146
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $2,266
Total amount of fees paid to insurance company	USD $1,464
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,620
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker name	MY BENEFIT ADVISOR

UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 )

Policy contract number

1619

Policy instance

Insurance contract or identification number	1619
Number of Individuals Covered	20
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
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

627197

Policy instance

Insurance contract or identification number	627197
Number of Individuals Covered	136
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $21,599
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,058
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	EMERSON REID, LLC

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

Policy contract number

MU8408

Policy instance

Insurance contract or identification number	MU8408
Number of Individuals Covered	138
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $32,931
Total amount of fees paid to insurance company	USD $18,592
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $837,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,058
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker name	MY BENEFIT ADVISOR, LLC

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

Policy contract number

MU8408

Policy instance

Insurance contract or identification number	MU8408
Number of Individuals Covered	119
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $27,769
Total amount of fees paid to insurance company	USD $14,854
Are there contracts with allocated funds for individual policies?	No
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $650,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,769
Insurance broker organization code?	3
Amount paid for insurance broker fees	14854
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker name	EMERSON REID AND COMANY, INC.

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Company Name:	MONCLER RETAIL, LLC
Employer identification number (EIN):	472946188
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing