401k Plan data: PG GROUP EMPLOYEE BENEFITS PLAN plan

PG GROUP EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	PG GROUP EMPLOYEE BENEFITS PLAN
Plan identification number	501

PG GROUP EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: PG GROUP, LLC

Employer identification number (EIN): 824354380

NAIC Classification: 541600

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01 MICAH SIEGAL 2022-07-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-01-01	MICAH SIEGAL	2022-07-05

Plan Statistics for PG GROUP EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for PG GROUP EMPLOYEE BENEFITS PLAN

Measure Date Value
2021: PG GROUP EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 346
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 346
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2021: PG GROUP EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	346
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	346
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for PG GROUP EMPLOYEE BENEFITS PLAN

2021: PG GROUP EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VEAB100237

Policy instance

Insurance contract or identification number	VEAB100237
Number of Individuals Covered	307
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,979
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $48,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,979
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	PG GROUP, LLC
Employer identification number (EIN):	824354380
NAIC Classification:	541600