401k Plan data: LACALLE GROUP EMPLOYEE BENEFITS PLAN plan

LACALLE GROUP EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	LACALLE GROUP EMPLOYEE BENEFITS PLAN
Plan identification number	501

LACALLE GROUP EMPLOYEE BENEFITS 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

LACALLE GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: LACALLE GROUP, LLC

Employer identification number (EIN): 272950709

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Additional information about LACALLE GROUP, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2010-06-25

Company Identification Number: 0801286821

Legal Registered Office Address: 12333 SOWDEN RD STE B79931

HOUSTON
United States of America (USA)
77080

More information about LACALLE GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LACALLE GROUP EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 JAMARA RODRIGUEZ 2023-03-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	JAMARA RODRIGUEZ	2023-03-08

Plan Statistics for LACALLE GROUP EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for LACALLE GROUP EMPLOYEE BENEFITS PLAN

Measure Date Value
2021: LACALLE GROUP EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 144
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 144
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 144

Measure	Date	Value
2021: LACALLE GROUP EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	144
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	144
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	144

Form 5500 Responses for LACALLE GROUP EMPLOYEE BENEFITS PLAN

2021: LACALLE GROUP EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

09N8137

Policy instance

Insurance contract or identification number	09N8137
Number of Individuals Covered	229
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $44,170
Total amount of fees paid to insurance company	USD $0
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	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 $1,290,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,170
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

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

Policy contract number

00467999

Policy instance

Insurance contract or identification number	00467999
Number of Individuals Covered	144
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $23,200
Total amount of fees paid to insurance company	USD $9,145
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D,ACCIDENT, CRITICAL ILLNESS
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 $209,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,200
Amount paid for insurance broker fees	9145
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

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Company Name:	LACALLE GROUP, LLC
Employer identification number (EIN):	272950709
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2010-06-25
Company Identification Number:	0801286821
Legal Registered Office Address:	12333 SOWDEN RD STE B79931 HOUSTON United States of America (USA) 77080