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| Plan Name | SANITAS OF NEW JERSEY, LLC EMPLOYEE WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SANITAS OF NEW JERSEY, LLC |
| Employer identification number (EIN): | 822815748 |
| NAIC Classification: | 621112 |
| NAIC Description: | Offices of Physicians, Mental Health Specialists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-01-01 | ||||
| 501 | 2021-01-01 | MONICA AGUILERA |
| Measure | Date | Value |
|---|---|---|
| 2021: SANITAS OF NEW JERSEY, LLC EMPLOYEE WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 78 |
| Total of all active and inactive participants | 2021-01-01 | 78 |
| 2021: SANITAS OF NEW JERSEY, LLC EMPLOYEE WELFARE 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 | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | G166213 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD129810 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL159099 |
| Policy instance | 8 |
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) | |
| Policy contract number | 8034D |
| Policy instance | 7 |
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) | |
| Policy contract number | 8034D |
| Policy instance | 6 |
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) | |
| Policy contract number | 8034D |
| Policy instance | 5 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VG188526 |
| Policy instance | 4 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E5429790 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR209495 |
| Policy instance | 2 |
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) | |
| Policy contract number | 8034D |
| Policy instance | 10 |
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