401k Plan data: OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN plan

OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN 401k Plan overview

Plan Name	OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN
Plan identification number	510

OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

OBERLIN COLLEGE has sponsored the creation of one or more 401k plans.

Company Name: OBERLIN COLLEGE

Employer identification number (EIN): 340714363

NAIC Classification: 611000

Additional information about OBERLIN COLLEGE

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1834-02-28

Company Identification Number: 395019

Legal Registered Office Address: -
-
-
United States of America (USA)
-

More information about OBERLIN COLLEGE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2023-01-01

Plan Statistics for OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN

401k plan membership statisitcs for OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN

Measure Date Value
2023: OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 357
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 357
Total of all active and inactive participants 2023-01-01 357
Total participants 2023-01-01 357

Measure	Date	Value
2023: OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	357
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	357
Total of all active and inactive participants	2023-01-01	357
Total participants	2023-01-01	357

Form 5500 Responses for OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN

2023: OBERLIN COLLEGE GROUP MEDICARE ADVANTAG PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

590467

Policy instance

Insurance contract or identification number	590467
Number of Individuals Covered	357
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $491,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

K40016003

Policy instance

Insurance contract or identification number	K40016003
Number of Individuals Covered	357
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
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	No
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 $980,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	OBERLIN COLLEGE
Employer identification number (EIN):	340714363
NAIC Classification:	611000

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1834-02-28
Company Identification Number:	395019
Legal Registered Office Address:	- - - United States of America (USA) -