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| Plan Name | OSCAR ELLA WILF CAMPUS EMPLOYEE BENEFITS LIFE AD&D/LTD/STD |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | THE OSCAR AND ELLA WILF CAMPUS FOR SENIOR LIVING |
| Employer identification number (EIN): | 521624834 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2021-01-01 | KRISTI SAVELL | 2022-04-12 | ||
| 502 | 2020-01-01 | KRISTI SAVELL | 2021-07-08 | ||
| 502 | 2020-01-01 | KRISTI SAVELL | 2022-04-12 |
| Measure | Date | Value |
|---|---|---|
| 2021: OSCAR ELLA WILF CAMPUS EMPLOYEE BENEFITS LIFE AD&D/LTD/STD 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| 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 | 0 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: OSCAR ELLA WILF CAMPUS EMPLOYEE BENEFITS LIFE AD&D/LTD/STD 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 104 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 104 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2021: OSCAR ELLA WILF CAMPUS EMPLOYEE BENEFITS LIFE AD&D/LTD/STD 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: OSCAR ELLA WILF CAMPUS EMPLOYEE BENEFITS LIFE AD&D/LTD/STD 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLUG0BB4G | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLUG0B9VT | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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