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TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 401k Plan overview

Plan NameTOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY
Plan identification number 501

TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

TOWER LABORATORIES has sponsored the creation of one or more 401k plans.

Company Name:TOWER LABORATORIES
Employer identification number (EIN):061009478
NAIC Classification:325410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-05-01SARAH SCOTT2024-01-30
5012021-05-01
5012020-05-01
5012019-05-01
5012018-05-01
5012017-05-01CATHERINE CORMIER CATHERINE CORMIER2018-10-05
5012016-05-01CATHERINE CORMIER CATHERINE CORMIER2017-11-13
5012015-05-01CATHERINE CORMIER CATHERINE CORMIER2016-11-22
5012014-05-01CATHERINE CORMIER CATHERINE CORMIER2015-11-25
5012014-05-01CATHERINE CORMIER CATHERINE CORMIER2016-11-22
5012013-05-01CATHERINE CORMIER CATHERINE CORMIER2014-11-25
5012012-05-01CATHERINE CORMIER
5012011-05-01CATHERINE CORMIER
5012010-05-01CATHERINE CORMIER
5012009-05-01CATHERINE CORMIER

Plan Statistics for TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY

401k plan membership statisitcs for TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY

Measure Date Value
2022: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2022 401k membership
Total participants, beginning-of-year2022-05-01227
Total number of active participants reported on line 7a of the Form 55002022-05-01189
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01189
2021: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year2021-05-01213
Total number of active participants reported on line 7a of the Form 55002021-05-01227
Total of all active and inactive participants2021-05-01227
Total participants2021-05-01227
2020: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year2020-05-01189
Total number of active participants reported on line 7a of the Form 55002020-05-01213
Total of all active and inactive participants2020-05-01213
Total participants2020-05-01213
2019: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year2019-05-01185
Total number of active participants reported on line 7a of the Form 55002019-05-01189
Total of all active and inactive participants2019-05-01189
Total participants2019-05-01189
2018: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year2018-05-01170
Total number of active participants reported on line 7a of the Form 55002018-05-01185
Total of all active and inactive participants2018-05-01185
Total participants2018-05-01185
2017: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year2017-05-01179
Total number of active participants reported on line 7a of the Form 55002017-05-01170
Total of all active and inactive participants2017-05-01170
Total participants2017-05-01170
2016: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year2016-05-01199
Total number of active participants reported on line 7a of the Form 55002016-05-01179
Total of all active and inactive participants2016-05-01179
Total participants2016-05-01179
2015: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year2015-05-01195
Total number of active participants reported on line 7a of the Form 55002015-05-01199
Total of all active and inactive participants2015-05-01199
Total participants2015-05-01199
2014: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year2014-05-01176
Total number of active participants reported on line 7a of the Form 55002014-05-01195
Total of all active and inactive participants2014-05-01195
Total participants2014-05-01195
2013: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year2013-05-01145
Total number of active participants reported on line 7a of the Form 55002013-05-01176
Total of all active and inactive participants2013-05-01176
Total participants2013-05-01176
2012: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-05-01136
Total number of active participants reported on line 7a of the Form 55002012-05-01145
Total of all active and inactive participants2012-05-01145
Total participants2012-05-01145
2011: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-05-01128
Total number of active participants reported on line 7a of the Form 55002011-05-01136
Total of all active and inactive participants2011-05-01136
Total participants2011-05-01136
2010: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year2010-05-01127
Total number of active participants reported on line 7a of the Form 55002010-05-01128
Number of retired or separated participants receiving benefits2010-05-010
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-01128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-05-010
Total participants2010-05-01128
Number of participants with account balances2010-05-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-05-010
2009: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-05-01127
Total number of active participants reported on line 7a of the Form 55002009-05-01127
Total of all active and inactive participants2009-05-01127
Total participants2009-05-01127

Form 5500 Responses for TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY

2022: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingNo
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – InsuranceYes
2021: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01First time form 5500 has been submittedYes
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01First time form 5500 has been submittedYes
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedYes
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01First time form 5500 has been submittedYes
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01First time form 5500 has been submittedYes
2010-05-01Submission has been amendedYes
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: TOWER LABORATORIES LTD. GROUP SHORT TERM DISABILITY 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01First time form 5500 has been submittedYes
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BJHK
Policy instance 1
Insurance contract or identification numberG000BJHK
Number of Individuals Covered292
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $5,026
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $91,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,026
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BJHK
Policy instance 1
Insurance contract or identification numberG000BJHK
Number of Individuals Covered227
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $4,173
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $56,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,173
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BJHK
Policy instance 1
Insurance contract or identification numberG000BJHK
Number of Individuals Covered213
Insurance policy start date2020-05-01
Insurance policy end date2021-05-01
Total amount of commissions paid to insurance brokerUSD $4,150
Total amount of fees paid to insurance companyUSD $1,603
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $56,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,150
Amount paid for insurance broker fees1603
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BJHK
Policy instance 1
Insurance contract or identification numberG000BJHK
Number of Individuals Covered189
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $4,037
Total amount of fees paid to insurance companyUSD $701
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $51,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,037
Amount paid for insurance broker fees701
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered185
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $4,399
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $42,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,300
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered170
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $5,114
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $42,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,114
Insurance broker organization code?3
Insurance broker nameTZEDAKAH HOUSE, LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered199
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $3,294
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $36,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,294
Insurance broker organization code?3
Insurance broker nameTZEDAKAH HOUSE LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered195
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $819
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $34,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,164
Insurance broker organization code?3
Insurance broker nameTZEDAKAH HOUSE LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered176
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $2,897
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $28,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,897
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTZEDAKAH HOUSE LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered145
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $2,551
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,551
Insurance broker organization code?3
Insurance broker nameTZEDAKAH HOUSE LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered136
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $2,365
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00003623
Policy instance 1
Insurance contract or identification numberAL00003623
Number of Individuals Covered128
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $2,304
Total amount of fees paid to insurance companyUSD $718
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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