401k Plan data: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN plan

DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 401k Plan overview

Plan Name	DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN
Plan identification number	502

DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Other welfare benefit cover

401k Sponsoring company profile

DENIM NORTH AMERICA, LLC has sponsored the creation of one or more 401k plans.

Company Name: DENIM NORTH AMERICA, LLC

Employer identification number (EIN): 010673289

NAIC Classification: 313000
NAIC Description: Textile Mills

Additional information about DENIM NORTH AMERICA, LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 120383

More information about DENIM NORTH AMERICA, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 LEE LOSTE-BROWN LEE LOSTE-BROWN 2018-07-25
502 2016-01-01 LEE LOSTE-BROWN LEE LOSTE-BROWN 2017-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2017-01-01	LEE LOSTE-BROWN		LEE LOSTE-BROWN	2018-07-25
502	2016-01-01	LEE LOSTE-BROWN		LEE LOSTE-BROWN	2017-07-25

Plan Statistics for DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN

401k plan membership statisitcs for DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN

Measure Date Value
2017: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 167
Total of all active and inactive participants 2017-01-01 167
Total participants 2017-01-01 167
2016: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 169
Total of all active and inactive participants 2016-01-01 169
Total participants 2016-01-01 169

Measure	Date	Value
2017: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	167
Total of all active and inactive participants	2017-01-01	167
Total participants	2017-01-01	167
2016: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	169
Total of all active and inactive participants	2016-01-01	169
Total participants	2016-01-01	169

Form 5500 Responses for DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN

2017: DENIM NORTH AMERICA, LLC LIFE AND AD&D 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 benefit arrangement – Insurance	Yes
2016: DENIM NORTH AMERICA, LLC LIFE AND AD&D PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

06357

Policy instance

Insurance contract or identification number	06357
Number of Individuals Covered	167
Insurance policy start date	2017-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,311
Total amount of fees paid to insurance company	USD $67
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $135,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	67
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $10,132
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

Potentially related plans

DENIM NORTH AMERICA LLC STD [EIN = 010637289]

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Company Name:	DENIM NORTH AMERICA, LLC
Employer identification number (EIN):	010673289
NAIC Classification:	313000
NAIC Description:	Textile Mills

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	120383