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MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 401k Plan overview

Plan NameMENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN
Plan identification number 501

MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MENTAL HEALTH CLINIC OF PASSAIC, has sponsored the creation of one or more 401k plans.

Company Name:MENTAL HEALTH CLINIC OF PASSAIC,
Employer identification number (EIN):221829500
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-02-01SYBIL SCHREIBER
5012014-02-01SYBIL SCHREIBER
5012013-02-01SYBIL SCHREIBER
5012012-02-01SYBIL SCHREIBER
5012011-02-01SYBIL SCHREIBER
5012010-02-01SYBIL SCHREIBER

Plan Statistics for MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN

401k plan membership statisitcs for MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN

Measure Date Value
2015: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-010
Total of all active and inactive participants2015-02-010
Total participants2015-02-010
2014: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-0173
Total number of active participants reported on line 7a of the Form 55002014-02-0173
Total of all active and inactive participants2014-02-0173
Total participants2014-02-010
2013: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-0173
Total number of active participants reported on line 7a of the Form 55002013-02-0173
Total of all active and inactive participants2013-02-0173
Total participants2013-02-010
2012: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01167
Total number of active participants reported on line 7a of the Form 55002012-02-01167
Total of all active and inactive participants2012-02-01167
Total participants2012-02-010
2011: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01184
Total number of active participants reported on line 7a of the Form 55002011-02-01167
Total of all active and inactive participants2011-02-01167
Total participants2011-02-01167
2010: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01195
Total number of active participants reported on line 7a of the Form 55002010-02-01184
Total of all active and inactive participants2010-02-01184
Total participants2010-02-01184

Form 5500 Responses for MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN

2015: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – General assets of the sponsorYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2014: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – General assets of the sponsorYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – General assets of the sponsorYes
2013: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – General assets of the sponsorYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – General assets of the sponsorYes
2012: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – General assets of the sponsorYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – General assets of the sponsorYes
2011: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – General assets of the sponsorYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – General assets of the sponsorYes
2010: MENTAL HEALTH CLINIC OF PASSAIC, INC HEALTH AND LIFE INSURANCE PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan funding arrangement – General assets of the sponsorYes
2010-02-01Plan benefit arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Number of Individuals Covered51
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $19,756
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,045
Insurance broker nameWILLIS OF NEW JERSEY, INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50008678
Policy instance 2
Insurance contract or identification number50008678
Number of Individuals Covered72
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $533
Total amount of fees paid to insurance companyUSD $249
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $533
Amount paid for insurance broker fees249
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameHORIZON INSURANCE COMPANY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50008678
Policy instance 2
Insurance contract or identification number50008678
Number of Individuals Covered73
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $605
Total amount of fees paid to insurance companyUSD $283
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $605
Amount paid for insurance broker fees283
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameHORIZON INSURANCE COMPANY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Number of Individuals Covered60
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $23,214
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $521,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,214
Insurance broker nameWILLIS OF NEW JERSEY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Number of Individuals Covered66
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $46,836
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $483,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,418
Insurance broker nameWILLIS INS SVCS OF CA INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50008678
Policy instance 2
Insurance contract or identification number50008678
Number of Individuals Covered73
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $576
Total amount of fees paid to insurance companyUSD $269
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $576
Amount paid for insurance broker fees269
Additional information about fees paid to insurance brokerBROKER
Insurance broker nameHORIZON INSURANCE COMPANY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameWILLIS OF NEW JERSEY INC
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
Policy contract numberUS399975
Policy instance 2
Insurance contract or identification numberUS399975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameWILLIS OF NEW JERSEY, INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Number of Individuals Covered91
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $491
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
Policy contract numberUS399975
Policy instance 2
Insurance contract or identification numberUS399975
Number of Individuals Covered167
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $19,516
Welfare Benefit Premiums Paid to CarrierUSD $515,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number480650
Policy instance 1
Insurance contract or identification number480650
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $579
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
Policy contract numberUS399975
Policy instance 2
Insurance contract or identification numberUS399975
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $25,877
Welfare Benefit Premiums Paid to CarrierUSD $523,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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