401k Plan data: OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN plan

OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN
Plan identification number	601

OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover 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

OAKLAND CITY UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name: OAKLAND CITY UNIVERSITY

Employer identification number (EIN): 350869063

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
601 2021-01-01 TODD A. WAHL 2022-06-07
601 2021-01-01 TODD A. WAHL 2023-03-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
601	2021-01-01	TODD A. WAHL	2022-06-07
601	2021-01-01	TODD A. WAHL	2023-03-20

Plan Statistics for OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN

Measure Date Value
2021: OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 174
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 2021-01-01 174
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2021: OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	174
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	174
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for OAKLAND CITY UNIVERSITY EMPLOYEE BENEFITS PLAN

2021: OAKLAND CITY UNIVERSITY 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	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30014028

Policy instance

Insurance contract or identification number	30014028
Number of Individuals Covered	95
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $849
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $849
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

647975

Policy instance

Insurance contract or identification number	647975
Number of Individuals Covered	174
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00613206

Policy instance

Insurance contract or identification number	G00613206
Number of Individuals Covered	174
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,895
Total amount of fees paid to insurance company	USD $2,712
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $67,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,895
Amount paid for insurance broker fees	2712
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	OAKLAND CITY UNIVERSITY
Employer identification number (EIN):	350869063
NAIC Classification:	611000