COBURN SUPPLY COMPANY, INC. has sponsored the creation of one or more 401k plans.
Additional information about COBURN SUPPLY COMPANY, INC.
| Measure | Date | Value |
|---|
| 2022: HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 967 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 1,000 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 1,007 |
| Number of employers contributing to the scheme | 2022-02-01 | 0 |
| 2021: HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 974 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 958 |
| Number of retired or separated participants receiving benefits | 2021-02-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
| Total of all active and inactive participants | 2021-02-01 | 967 |
| Number of employers contributing to the scheme | 2021-02-01 | 0 |
| 2020: HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 913 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 960 |
| Number of retired or separated participants receiving benefits | 2020-02-01 | 14 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 974 |
| Number of employers contributing to the scheme | 2020-02-01 | 0 |
| 2019: HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 910 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 903 |
| Number of retired or separated participants receiving benefits | 2019-02-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
| Total of all active and inactive participants | 2019-02-01 | 913 |
| Number of employers contributing to the scheme | 2019-02-01 | 0 |
| 2018: HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 1,419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 897 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 13 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
| Total of all active and inactive participants | 2018-02-01 | 910 |
| Number of employers contributing to the scheme | 2018-02-01 | 0 |
| 2017: HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 1,406 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 1,419 |
| Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
| Total of all active and inactive participants | 2017-02-01 | 1,419 |
| 2016: HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 1,451 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 1,406 |
| Number of retired or separated participants receiving benefits | 2016-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
| Total of all active and inactive participants | 2016-02-01 | 1,406 |
| 2015: HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 1,534 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 1,451 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
| Total of all active and inactive participants | 2015-02-01 | 1,451 |
| 2014: HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 1,360 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 1,534 |
| Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
| Total of all active and inactive participants | 2014-02-01 | 1,534 |
| 2013: HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 1,424 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 1,360 |
| Total of all active and inactive participants | 2013-02-01 | 1,360 |
| 2012: HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 1,425 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 1,424 |
| Total of all active and inactive participants | 2012-02-01 | 1,424 |
| 2011: HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 1,287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 1,425 |
| Total of all active and inactive participants | 2011-02-01 | 1,425 |
| 2010: HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 1,251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 1,287 |
| Total of all active and inactive participants | 2010-02-01 | 1,287 |
| 2009: HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 1,228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 1,251 |
| Total of all active and inactive participants | 2009-02-01 | 1,251 |
| 2022: HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | Yes |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Submission has been amended | Yes |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F023751 |
| Policy instance | 2 |
| Insurance contract or identification number | F023751 | | Number of Individuals Covered | 984 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $36,333 | | Total amount of fees paid to insurance company | USD $9,750 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $364,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,333 | | Amount paid for insurance broker fees | 9750 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5956592 |
| Policy instance | 1 |
| Insurance contract or identification number | 5956592 | | Number of Individuals Covered | 1258 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $53,716 | | Total amount of fees paid to insurance company | USD $9,132 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $505,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,716 | | Amount paid for insurance broker fees | 87 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F023751 |
| Policy instance | 2 |
| Insurance contract or identification number | F023751 | | Number of Individuals Covered | 909 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $34,972 | | Total amount of fees paid to insurance company | USD $9,750 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $349,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,972 | | Amount paid for insurance broker fees | 9750 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5956592 |
| Policy instance | 1 |
| Insurance contract or identification number | 5956592 | | Number of Individuals Covered | 1211 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $42,032 | | Total amount of fees paid to insurance company | USD $5,461 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $462,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,032 | | Amount paid for insurance broker fees | 71 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5956592 |
| Policy instance | 1 |
| Insurance contract or identification number | 5956592 | | Number of Individuals Covered | 1196 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $41,791 | | Total amount of fees paid to insurance company | USD $5,301 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $418,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,791 | | Amount paid for insurance broker fees | 52 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F023751 |
| Policy instance | 2 |
| Insurance contract or identification number | F023751 | | Number of Individuals Covered | 902 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $36,317 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $364,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,317 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5956592 |
| Policy instance | 1 |
| Insurance contract or identification number | 5956592 | | Number of Individuals Covered | 1174 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $37,651 | | Total amount of fees paid to insurance company | USD $4,802 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $411,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,651 | | Amount paid for insurance broker fees | 73 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F023751 |
| Policy instance | 2 |
| Insurance contract or identification number | F023751 | | Number of Individuals Covered | 944 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $34,929 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $347,728 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,929 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 4 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1107 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $32,542 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $328,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,542 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURAHCE AGENCY INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 840 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $38,705 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (A D & D) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,705 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 503 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $2,414 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,414 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1419 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $104,538 | | Total amount of fees paid to insurance company | USD $11,181 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $577,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $104,538 | | Amount paid for insurance broker fees | 11181 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 945 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $32,167 | | Total amount of fees paid to insurance company | USD $2,535 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (A D & D) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,167 | | Amount paid for insurance broker fees | 2535 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1451 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $111,321 | | Total amount of fees paid to insurance company | USD $19,693 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $637,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111,321 | | Amount paid for insurance broker fees | 19693 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 4 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1003 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $29,881 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $312,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,881 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURAHCE AGENCY INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 450 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $2,254 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,254 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 430 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $2,186 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,186 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 954 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $31,487 | | Total amount of fees paid to insurance company | USD $4,129 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (A D & D) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,487 | | Amount paid for insurance broker fees | 4129 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1534 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $109,484 | | Total amount of fees paid to insurance company | USD $10,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $838,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $109,484 | | Amount paid for insurance broker fees | 10000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FG1D0329 |
| Policy instance | 4 |
| Insurance contract or identification number | FG1D0329 | | Number of Individuals Covered | 943 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $30,433 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,433 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 425 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $2,102 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,102 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 632 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $21,538 | | Total amount of fees paid to insurance company | USD $239 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,538 | | Amount paid for insurance broker fees | 239 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1360 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $108,161 | | Total amount of fees paid to insurance company | USD $10,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $782,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108,161 | | Amount paid for insurance broker fees | 10000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 634 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $20,760 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,760 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1424 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $110,198 | | Total amount of fees paid to insurance company | USD $10,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $806,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $110,198 | | Amount paid for insurance broker fees | 10000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $2,141 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,141 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FG1D0329 |
| Policy instance | 4 |
| Insurance contract or identification number | FG1D0329 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $30,315 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,315 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FG1D0329 |
| Policy instance | 4 |
| Insurance contract or identification number | FG1D0329 | | Number of Individuals Covered | 875 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $27,417 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 408 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $1,967 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 624 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $19,740 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1425 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $104,969 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $801,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 31760 |
| Policy instance | 1 |
| Insurance contract or identification number | 31760 | | Number of Individuals Covered | 1287 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $99,855 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $604,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99,855 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC. |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 366971G |
| Policy instance | 2 |
| Insurance contract or identification number | 366971G | | Number of Individuals Covered | 606 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $18,968 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,968 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FG1D0329 |
| Policy instance | 4 |
| Insurance contract or identification number | FG1D0329 | | Number of Individuals Covered | 783 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $18,631 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,631 | | Insurance broker name | SHERLOCK INSURANCE AGENCY |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12291399 |
| Policy instance | 3 |
| Insurance contract or identification number | 12291399 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $1,955 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,955 | | Insurance broker organization code? | 3 | | Insurance broker name | SHERLOCK INSURANCE AGENCY, INC |
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