TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN 401k Plan overview
| Plan Name | TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN Benefits
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits | - Health (other than dental or vision)
- Life insurance
- Dental
- Vision
- Temporary disability (accident and sickness)
- Long-term disability cover
- Death benefits (include travel accident but not life insurance)
- Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
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401k Sponsoring company profile
TETRAPHASE PHARMACEUTICALS, INC. has sponsored the creation of one or more 401k plans.
Additional information about TETRAPHASE PHARMACEUTICALS, INC.
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 4186628 |
More information about TETRAPHASE PHARMACEUTICALS, INC.
Form 5500 Filing Information
Submission information for form 5500 for 401k plan TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 501 | 2018-11-01 | MARIA STAHL | 2020-03-04 | | |
Plan Statistics for TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN
401k plan membership statisitcs for TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2018: TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 88 |
| Number of retired or separated participants receiving benefits | 2018-11-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2018-11-01 | 0 |
| Total of all active and inactive participants | 2018-11-01 | 97 |
| Number of employers contributing to the scheme | 2018-11-01 | 0 |
Form 5500 Responses for TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN
| 2018: TETRAPHASE PHARMACEUTICALS, INC. HEALTH AND WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | First time form 5500 has been submitted | Yes |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
Insurance Providers Used on plan
| DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
| Policy contract number | 10766 |
| Policy instance | 2 |
| Insurance contract or identification number | 10766 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $6,844 | | Total amount of fees paid to insurance company | USD $52 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $174,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,844 | | Amount paid for insurance broker fees | 52 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8026848 |
| Policy instance | 1 |
| Insurance contract or identification number | 8026848 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $49,497 | | Total amount of fees paid to insurance company | USD $8,160 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,335,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $49,497 | | Amount paid for insurance broker fees | 8160 | | Additional information about fees paid to insurance broker | OTHER COMMISSION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30060923 |
| Policy instance | 3 |
| Insurance contract or identification number | 30060923 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $915 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $915 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 430640 |
| Policy instance | 4 |
| Insurance contract or identification number | 430640 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $12,429 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $135,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,429 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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