401k Plan data: GUARDIAN ALARM WELFARE BENEFIT PLAN plan

GUARDIAN ALARM WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	GUARDIAN ALARM WELFARE BENEFIT PLAN
Plan identification number	502

GUARDIAN ALARM WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GUARDIAN ALARM COMPANY OF MICHIGAN has sponsored the creation of one or more 401k plans.

Company Name: GUARDIAN ALARM COMPANY OF MICHIGAN

Employer identification number (EIN): 381906849

NAIC Classification: 561600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GUARDIAN ALARM WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-05-01 RICHARD PIERCE
502 2014-05-01 RICHARD PIERCE
502 2013-05-01 RICHARD PIERCE
502 2012-05-01 RICHARD PIERCE
502 2011-05-01 RICHARD PIERCE

Plan id#	Filing Submission Date	Name of Administrator
502	2015-05-01	RICHARD PIERCE
502	2014-05-01	RICHARD PIERCE
502	2013-05-01	RICHARD PIERCE
502	2012-05-01	RICHARD PIERCE
502	2011-05-01	RICHARD PIERCE

Plan Statistics for GUARDIAN ALARM WELFARE BENEFIT PLAN

401k plan membership statisitcs for GUARDIAN ALARM WELFARE BENEFIT PLAN

Measure Date Value
2015: GUARDIAN ALARM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-05-01 843
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 388
Number of retired or separated participants receiving benefits 2015-05-01 0
Number of other retired or separated participants entitled to future benefits 2015-05-01 0
Total of all active and inactive participants 2015-05-01 388
2014: GUARDIAN ALARM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 1,171
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 388
Number of retired or separated participants receiving benefits 2014-05-01 0
Number of other retired or separated participants entitled to future benefits 2014-05-01 0
Total of all active and inactive participants 2014-05-01 388
2013: GUARDIAN ALARM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 1,100
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 365
Number of retired or separated participants receiving benefits 2013-05-01 0
Number of other retired or separated participants entitled to future benefits 2013-05-01 0
Total of all active and inactive participants 2013-05-01 365
2012: GUARDIAN ALARM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-05-01 839
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 346
Number of retired or separated participants receiving benefits 2012-05-01 0
Number of other retired or separated participants entitled to future benefits 2012-05-01 0
Total of all active and inactive participants 2012-05-01 346
2011: GUARDIAN ALARM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-05-01 881
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 327
Number of retired or separated participants receiving benefits 2011-05-01 0
Number of other retired or separated participants entitled to future benefits 2011-05-01 0
Total of all active and inactive participants 2011-05-01 327

Measure	Date	Value
2015: GUARDIAN ALARM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-05-01	843
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	388
Number of retired or separated participants receiving benefits	2015-05-01	0
Number of other retired or separated participants entitled to future benefits	2015-05-01	0
Total of all active and inactive participants	2015-05-01	388
2014: GUARDIAN ALARM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	1,171
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	388
Number of retired or separated participants receiving benefits	2014-05-01	0
Number of other retired or separated participants entitled to future benefits	2014-05-01	0
Total of all active and inactive participants	2014-05-01	388
2013: GUARDIAN ALARM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	1,100
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	365
Number of retired or separated participants receiving benefits	2013-05-01	0
Number of other retired or separated participants entitled to future benefits	2013-05-01	0
Total of all active and inactive participants	2013-05-01	365
2012: GUARDIAN ALARM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-05-01	839
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	346
Number of retired or separated participants receiving benefits	2012-05-01	0
Number of other retired or separated participants entitled to future benefits	2012-05-01	0
Total of all active and inactive participants	2012-05-01	346
2011: GUARDIAN ALARM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-05-01	881
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	327
Number of retired or separated participants receiving benefits	2011-05-01	0
Number of other retired or separated participants entitled to future benefits	2011-05-01	0
Total of all active and inactive participants	2011-05-01	327

Form 5500 Responses for GUARDIAN ALARM WELFARE BENEFIT PLAN

2015: GUARDIAN ALARM WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2015-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GUARDIAN ALARM WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GUARDIAN ALARM WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GUARDIAN ALARM WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2012-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GUARDIAN ALARM WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	132
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $5,695
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,221
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN INC

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

840344

Policy instance

Insurance contract or identification number	840344
Number of Individuals Covered	51
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $19,300
Total amount of fees paid to insurance company	USD $5,644
Welfare Benefit Premiums Paid to Carrier	USD $561,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,790
Amount paid for insurance broker fees	5644
Insurance broker organization code?	3
Insurance broker name	JAY SCHREIBMAN

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

18887-000

Policy instance

Insurance contract or identification number	18887-000
Number of Individuals Covered	40
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $34,771
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $706,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,771
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

EMPLOYEE HEALTH INSURANCE MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 0 )

Policy contract number

50001008-01

Policy instance

Insurance contract or identification number	50001008-01
Number of Individuals Covered	369
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $4,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,257
Insurance broker organization code?	3
Insurance broker name	FRANK MAYER

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0004

Policy instance

Insurance contract or identification number	00105073/0004
Number of Individuals Covered	255
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Welfare Benefit Premiums Paid to Carrier	USD $1,287,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0007

Policy instance

Insurance contract or identification number	00105073/0007
Number of Individuals Covered	172
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Welfare Benefit Premiums Paid to Carrier	USD $662,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9718438

Policy instance

Insurance contract or identification number	9718438
Number of Individuals Covered	763
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $1,764
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,606
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN INC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

8077

Policy instance

Insurance contract or identification number	8077
Number of Individuals Covered	196
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $1,270
Dental 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 $962
Insurance broker organization code?	3
Insurance broker name	LSG INSURANCE PARTNERS

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

9628

Policy instance

Insurance contract or identification number	9628
Number of Individuals Covered	670
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $7,702
Dental 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 $5,850
Insurance broker organization code?	3
Insurance broker name	LSG INSURANCE PARTNERS

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	207
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $10,651
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,741
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN INC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	501
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $4,424
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $34,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,041
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN INC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0011

Policy instance

Insurance contract or identification number	00105073/0011
Number of Individuals Covered	8
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $581
Welfare Benefit Premiums Paid to Carrier	USD $34,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $581
Insurance broker organization code?	1
Insurance broker name

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0010

Policy instance

Insurance contract or identification number	00105073/0010
Number of Individuals Covered	51
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $3,048
Welfare Benefit Premiums Paid to Carrier	USD $198,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,048
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0009

Policy instance

Insurance contract or identification number	00105073/0009
Number of Individuals Covered	58
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Welfare Benefit Premiums Paid to Carrier	USD $285,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0007

Policy instance

Insurance contract or identification number	00105073/0007
Number of Individuals Covered	176
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Welfare Benefit Premiums Paid to Carrier	USD $559,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0010

Policy instance

Insurance contract or identification number	00105073/0010
Number of Individuals Covered	38
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,406
Welfare Benefit Premiums Paid to Carrier	USD $150,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,406
Insurance broker name

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0011

Policy instance

Insurance contract or identification number	00105073/0011
Number of Individuals Covered	10
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $574
Welfare Benefit Premiums Paid to Carrier	USD $35,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $574
Insurance broker organization code?	3
Insurance broker name

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9718438

Policy instance

Insurance contract or identification number	9718438
Number of Individuals Covered	760
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $1,741
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,741
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

9628

Policy instance

Insurance contract or identification number	9628
Number of Individuals Covered	665
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $6,996
Dental 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 $6,996
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

8077

Policy instance

Insurance contract or identification number	8077
Number of Individuals Covered	196
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $1,071
Dental 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 $1,071
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	464
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,696
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,696
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	200
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $10,178
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,178
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	122
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $5,089
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,089
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0004

Policy instance

Insurance contract or identification number	00105073/0004
Number of Individuals Covered	261
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Welfare Benefit Premiums Paid to Carrier	USD $1,077,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE HEALTH INSURANCE MANAGEMENT INC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

50001008-01

Policy instance

Insurance contract or identification number	50001008-01
Number of Individuals Covered	364
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $4,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,233
Insurance broker organization code?	3
Insurance broker name	FRANK MAYER

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

18887-000

Policy instance

Insurance contract or identification number	18887-000
Number of Individuals Covered	30
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $31,422
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $648,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,422
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

840344

Policy instance

Insurance contract or identification number	840344
Number of Individuals Covered	52
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $19,722
Welfare Benefit Premiums Paid to Carrier	USD $532,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,722
Insurance broker organization code?	3
Insurance broker name	NATIONAL UNITED BROKERS

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0004

Policy instance

Insurance contract or identification number	00105073/0004
Number of Individuals Covered	230
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Welfare Benefit Premiums Paid to Carrier	USD $936,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE HEALTH INSURANCE MANAGEMENT INC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

50001008-01

Policy instance

Insurance contract or identification number	50001008-01
Number of Individuals Covered	340
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $4,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,106
Insurance broker organization code?	3
Insurance broker name	FRANK MAYER

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0007

Policy instance

Insurance contract or identification number	00105073/0007
Number of Individuals Covered	151
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Welfare Benefit Premiums Paid to Carrier	USD $486,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	129
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $5,128
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,128
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0009

Policy instance

Insurance contract or identification number	00105073/0009
Number of Individuals Covered	44
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Welfare Benefit Premiums Paid to Carrier	USD $158,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0010

Policy instance

Insurance contract or identification number	00105073/0010
Number of Individuals Covered	50
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $4,132
Welfare Benefit Premiums Paid to Carrier	USD $195,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,132
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0011

Policy instance

Insurance contract or identification number	00105073/0011
Number of Individuals Covered	13
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,044
Welfare Benefit Premiums Paid to Carrier	USD $45,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,044
Insurance broker organization code?	3
Insurance broker name

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9718438

Policy instance

Insurance contract or identification number	9718438
Number of Individuals Covered	763
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,856
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,856
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	193
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

18887-000

Policy instance

Insurance contract or identification number	18887-000
Number of Individuals Covered	29
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $29,020
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $565,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,020
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	445
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $3,645
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,645
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

9628

Policy instance

Insurance contract or identification number	9628
Number of Individuals Covered	605
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $6,902
Dental 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 $6,902
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

8077

Policy instance

Insurance contract or identification number	8077
Number of Individuals Covered	242
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,397
Dental 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 $1,397
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

8077

Policy instance

Insurance contract or identification number	8077
Number of Individuals Covered	286
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $1,485
Dental 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 $1,485
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	202
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $9,785
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,785
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	132
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $4,711
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,711
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

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

Policy contract number

G000ALEF

Policy instance

Insurance contract or identification number	G000ALEF
Number of Individuals Covered	433
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $3,479
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,479
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

9628

Policy instance

Insurance contract or identification number	9628
Number of Individuals Covered	510
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $6,279
Dental 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 $6,279
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0011

Policy instance

Insurance contract or identification number	00105073/0011
Number of Individuals Covered	15
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Welfare Benefit Premiums Paid to Carrier	USD $52,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0010

Policy instance

Insurance contract or identification number	00105073/0010
Number of Individuals Covered	58
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Welfare Benefit Premiums Paid to Carrier	USD $186,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0009

Policy instance

Insurance contract or identification number	00105073/0009
Number of Individuals Covered	44
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Welfare Benefit Premiums Paid to Carrier	USD $173,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0007

Policy instance

Insurance contract or identification number	00105073/0007
Number of Individuals Covered	150
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Welfare Benefit Premiums Paid to Carrier	USD $430,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE HEALTH INSURANCE MANAGEMENT INC (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

50001008-01

Policy instance

Insurance contract or identification number	50001008-01
Number of Individuals Covered	329
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $3,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,680
Insurance broker organization code?	3
Insurance broker name	FRANK MAYER

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

18887-000

Policy instance

Insurance contract or identification number	18887-000
Number of Individuals Covered	22
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $24,402
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $507,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,402
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9718438

Policy instance

Insurance contract or identification number	9718438
Number of Individuals Covered	678
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $1,799
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,799
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

8077

Policy instance

Insurance contract or identification number	8077
Number of Individuals Covered	272
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,263
Dental 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 $1,263
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

9628

Policy instance

Insurance contract or identification number	9628
Number of Individuals Covered	495
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $5,126
Dental 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 $5,126
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9718438

Policy instance

Insurance contract or identification number	9718438
Number of Individuals Covered	647
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,619
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,619
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0007

Policy instance

Insurance contract or identification number	00105073/0007
Number of Individuals Covered	3
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Welfare Benefit Premiums Paid to Carrier	USD $18,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0004

Policy instance

Insurance contract or identification number	00105073/0004
Number of Individuals Covered	7
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Welfare Benefit Premiums Paid to Carrier	USD $31,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPLOYEE HEALTH INSURANCE MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 0 )

Policy contract number

50001008-01

Policy instance

Insurance contract or identification number	50001008-01
Number of Individuals Covered	324
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $3,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,423
Insurance broker organization code?	3
Insurance broker name	FRANK MAYER

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

18887-000

Policy instance

Insurance contract or identification number	18887-000
Number of Individuals Covered	25
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $22,306
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $520,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,306
Insurance broker organization code?	3
Insurance broker name	CORNERSTONE BENEFITS LLC

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00105073/0009

Policy instance

Insurance contract or identification number	00105073/0009
Number of Individuals Covered	1
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Welfare Benefit Premiums Paid to Carrier	USD $4,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GUARDIAN ALARM COMPANY OF MICHIGAN
Employer identification number (EIN):	381906849
NAIC Classification:	561600