401k Plan data: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN plan

ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 401k Plan overview

Plan Name	ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN
Plan identification number	003

ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ANTHEM VENTURE MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: ANTHEM VENTURE MANAGEMENT, LLC

Employer identification number (EIN): 954888451

NAIC Classification: 523900

Additional information about ANTHEM VENTURE MANAGEMENT, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3412804

More information about ANTHEM VENTURE MANAGEMENT, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01 WILLIAM WOODWARD 2018-05-29
003 2016-01-01 WILLIAM WOODWARD
003 2015-01-01 WILLIAM WOODWARD
003 2014-01-01 WILLIAM WOODWARD
003 2013-01-01 WILLIAM WOODWARD 2015-09-08
003 2012-01-01 WILLIAM WOODWARD 2013-10-01
003 2011-01-01 WILLIAM WOODWARD 2012-10-15
003 2010-01-01 WILLIAM WOODWARD 2011-10-14 WILLIAM WOODWARD 2011-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2017-01-01	WILLIAM WOODWARD	2018-05-29
003	2016-01-01	WILLIAM WOODWARD
003	2015-01-01	WILLIAM WOODWARD
003	2014-01-01	WILLIAM WOODWARD
003	2013-01-01	WILLIAM WOODWARD	2015-09-08
003	2012-01-01	WILLIAM WOODWARD	2013-10-01
003	2011-01-01	WILLIAM WOODWARD	2012-10-15
003	2010-01-01	WILLIAM WOODWARD	2011-10-14	WILLIAM WOODWARD	2011-10-14

Plan Statistics for ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN

401k plan membership statisitcs for ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN

Measure Date Value
2017: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2017 401k membership
Market value of plan assets 2017-12-31 3,800,413
Acturial value of plan assets 2017-12-31 3,800,413
Funding target for retired participants and beneficiaries receiving payment 2017-12-31 0
Number of terminated vested participants 2017-12-31 1
Fundng target for terminated vested participants 2017-12-31 892,468
Active participant vested funding target 2017-12-31 2,713,343
Number of active participants 2017-12-31 2
Total funding liabilities for active participants 2017-12-31 2,713,343
Total participant count 2017-12-31 3
Total funding target for all participants 2017-12-31 3,605,811
Balance at beginning of prior year after applicable adjustments 2017-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2017-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2017-12-31 0
Prefunding balanced used to offset prior years funding requirement 2017-12-31 0
Amount remaining of carryover balance 2017-12-31 0
Amount remaining of prefunding balance 2017-12-31 0
Present value of excess contributions 2017-12-31 38,451
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2017-12-31 38,451
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2017-12-31 0
Reductions in caryover balances due to elections or deemed elections 2017-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2017-12-31 0
Balance of carryovers at beginning of current year 2017-12-31 0
Balance of prefunding at beginning of current year 2017-12-31 0
Total employer contributions 2017-12-31 0
Total employee contributions 2017-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2017-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2017-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2017-12-31 0
Unpaid minimum required contributions for all prior years 2017-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2017-12-31 0
Remaining amount of unpaid minimum required contributions 2017-12-31 0
Minimum required contributions for current year target normal cost 2017-12-31 0
Net shortfall amortization installment of oustanding balance 2017-12-31 0
Waiver amortization installment 2017-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2017-12-31 0
Additional cash requirement 2017-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2017-12-31 0
Unpaid minimum required contributions for current year 2017-12-31 0
Unpaid minimum required contributions for all years 2017-12-31 0
2016: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2016 401k membership
Market value of plan assets 2016-12-31 2,920,571
Acturial value of plan assets 2016-12-31 2,920,571
Funding target for retired participants and beneficiaries receiving payment 2016-12-31 0
Number of terminated vested participants 2016-12-31 0
Fundng target for terminated vested participants 2016-12-31 0
Active participant vested funding target 2016-12-31 2,774,272
Number of active participants 2016-12-31 3
Total funding liabilities for active participants 2016-12-31 2,774,272
Total participant count 2016-12-31 3
Total funding target for all participants 2016-12-31 2,774,272
Balance at beginning of prior year after applicable adjustments 2016-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2016-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2016-12-31 0
Prefunding balanced used to offset prior years funding requirement 2016-12-31 0
Amount remaining of carryover balance 2016-12-31 0
Amount remaining of prefunding balance 2016-12-31 0
Present value of excess contributions 2016-12-31 30,949
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2016-12-31 30,949
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2016-12-31 0
Reductions in caryover balances due to elections or deemed elections 2016-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2016-12-31 0
Balance of carryovers at beginning of current year 2016-12-31 0
Balance of prefunding at beginning of current year 2016-12-31 0
Total employer contributions 2016-12-31 200,000
Total employee contributions 2016-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2016-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2016-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2016-12-31 200,050
Unpaid minimum required contributions for all prior years 2016-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2016-12-31 0
Remaining amount of unpaid minimum required contributions 2016-12-31 0
Minimum required contributions for current year target normal cost 2016-12-31 307,898
Net shortfall amortization installment of oustanding balance 2016-12-31 0
Waiver amortization installment 2016-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2016-12-31 161,599
Additional cash requirement 2016-12-31 161,599
Contributions allocatedtoward minimum required contributions for current year 2016-12-31 200,050
Unpaid minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for all years 2016-12-31 0
Total participants, beginning-of-year 2016-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2017: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2017 401k membership
Market value of plan assets	2017-12-31	3,800,413
Acturial value of plan assets	2017-12-31	3,800,413
Funding target for retired participants and beneficiaries receiving payment	2017-12-31	0
Number of terminated vested participants	2017-12-31	1
Fundng target for terminated vested participants	2017-12-31	892,468
Active participant vested funding target	2017-12-31	2,713,343
Number of active participants	2017-12-31	2
Total funding liabilities for active participants	2017-12-31	2,713,343
Total participant count	2017-12-31	3
Total funding target for all participants	2017-12-31	3,605,811
Balance at beginning of prior year after applicable adjustments	2017-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2017-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2017-12-31	0
Prefunding balanced used to offset prior years funding requirement	2017-12-31	0
Amount remaining of carryover balance	2017-12-31	0
Amount remaining of prefunding balance	2017-12-31	0
Present value of excess contributions	2017-12-31	38,451
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2017-12-31	38,451
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2017-12-31	0
Reductions in caryover balances due to elections or deemed elections	2017-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2017-12-31	0
Balance of carryovers at beginning of current year	2017-12-31	0
Balance of prefunding at beginning of current year	2017-12-31	0
Total employer contributions	2017-12-31	0
Total employee contributions	2017-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2017-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2017-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2017-12-31	0
Unpaid minimum required contributions for all prior years	2017-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2017-12-31	0
Remaining amount of unpaid minimum required contributions	2017-12-31	0
Minimum required contributions for current year target normal cost	2017-12-31	0
Net shortfall amortization installment of oustanding balance	2017-12-31	0
Waiver amortization installment	2017-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2017-12-31	0
Additional cash requirement	2017-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2017-12-31	0
Unpaid minimum required contributions for current year	2017-12-31	0
Unpaid minimum required contributions for all years	2017-12-31	0
2016: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2016 401k membership
Market value of plan assets	2016-12-31	2,920,571
Acturial value of plan assets	2016-12-31	2,920,571
Funding target for retired participants and beneficiaries receiving payment	2016-12-31	0
Number of terminated vested participants	2016-12-31	0
Fundng target for terminated vested participants	2016-12-31	0
Active participant vested funding target	2016-12-31	2,774,272
Number of active participants	2016-12-31	3
Total funding liabilities for active participants	2016-12-31	2,774,272
Total participant count	2016-12-31	3
Total funding target for all participants	2016-12-31	2,774,272
Balance at beginning of prior year after applicable adjustments	2016-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2016-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2016-12-31	0
Prefunding balanced used to offset prior years funding requirement	2016-12-31	0
Amount remaining of carryover balance	2016-12-31	0
Amount remaining of prefunding balance	2016-12-31	0
Present value of excess contributions	2016-12-31	30,949
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2016-12-31	30,949
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2016-12-31	0
Reductions in caryover balances due to elections or deemed elections	2016-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2016-12-31	0
Balance of carryovers at beginning of current year	2016-12-31	0
Balance of prefunding at beginning of current year	2016-12-31	0
Total employer contributions	2016-12-31	200,000
Total employee contributions	2016-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2016-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2016-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2016-12-31	200,050
Unpaid minimum required contributions for all prior years	2016-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2016-12-31	0
Remaining amount of unpaid minimum required contributions	2016-12-31	0
Minimum required contributions for current year target normal cost	2016-12-31	307,898
Net shortfall amortization installment of oustanding balance	2016-12-31	0
Waiver amortization installment	2016-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2016-12-31	161,599
Additional cash requirement	2016-12-31	161,599
Contributions allocatedtoward minimum required contributions for current year	2016-12-31	200,050
Unpaid minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for all years	2016-12-31	0
Total participants, beginning-of-year	2016-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN

Measure	Date	Value
2016 : ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$482,879
Expenses. Total of all expenses incurred	2016-12-31	$264
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$3,120,621
Total plan assets at beginning of year	2016-12-31	$2,638,006
Value of fidelity bond covering the plan	2016-12-31	$472,000
Total contributions received or receivable from participants	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$282,879
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$482,615
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$3,120,621
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,638,006
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$230,690
Total contributions received or receivable from employer(s)	2016-12-31	$200,000
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$264
2015 : ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-889,343
Expenses. Total of all expenses incurred	2015-12-31	$21,383
Benefits paid (including direct rollovers)	2015-12-31	$21,251
Total plan assets at end of year	2015-12-31	$2,638,006
Total plan assets at beginning of year	2015-12-31	$3,548,732
Value of fidelity bond covering the plan	2015-12-31	$407,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-1,089,343
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-910,726
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,638,006
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$3,548,732
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$176,214
Total contributions received or receivable from employer(s)	2015-12-31	$200,000
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$132
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$1,760,173
Expenses. Total of all expenses incurred	2014-12-31	$2,279,478
Benefits paid (including direct rollovers)	2014-12-31	$2,231,623
Total plan assets at end of year	2014-12-31	$3,548,732
Total plan assets at beginning of year	2014-12-31	$4,068,037
Value of fidelity bond covering the plan	2014-12-31	$407,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$47,855
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$1,530,670
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$-519,305
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,548,732
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,068,037
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$397,868
Total contributions received or receivable from employer(s)	2014-12-31	$229,503
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0

Form 5500 Responses for ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN

2016: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ANTHEM VENTURE MANAGEMENT, LLC DEFINED BENEFIT PENSION PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GENWORTH LIFE AND ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65536 )

Policy contract number

H082075

Policy instance

Insurance contract or identification number	H082075
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $3,688
Are there contracts with allocated funds for individual policies?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1
Amount paid for insurance broker fees	3688
Additional information about fees paid to insurance broker	FEE
Insurance broker organization code?	3
Insurance broker name	TSOLAG KARGODORIAN

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

TFA-19646

Policy instance

Insurance contract or identification number	TFA-19646
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $42,993
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,395
Insurance broker organization code?	3
Insurance broker name	ANDREW SENI

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

G227695.01.0001

Policy instance

Insurance contract or identification number	G227695.01.0001
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $41,443
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,443
Insurance broker organization code?	3
Insurance broker name	CRUMP LIFE INSURANCE SERVICES

GENWORTH LIFE AND ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65536 )

Policy contract number

H082075

Policy instance

Insurance contract or identification number	H082075
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,950
Are there contracts with allocated funds for individual policies?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2950
Additional information about fees paid to insurance broker	FEE
Insurance broker organization code?	3
Insurance broker name	TSOLAG KARGODORIAN

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Company Name:	ANTHEM VENTURE MANAGEMENT, LLC
Employer identification number (EIN):	954888451
NAIC Classification:	523900

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3412804