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GUARDIAN ALARM WELFARE BENEFIT PLAN 401k Plan overview

Plan NameGUARDIAN ALARM WELFARE BENEFIT PLAN
Plan identification number 502

GUARDIAN ALARM WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare 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 SignedName of Company SponsorDate Sponsor Signed
5022015-05-01RICHARD PIERCE
5022014-05-01RICHARD PIERCE
5022013-05-01RICHARD PIERCE
5022012-05-01RICHARD PIERCE
5022011-05-01RICHARD 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-year2015-05-01843
Total number of active participants reported on line 7a of the Form 55002015-05-01388
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01388
2014: GUARDIAN ALARM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-011,171
Total number of active participants reported on line 7a of the Form 55002014-05-01388
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01388
2013: GUARDIAN ALARM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-011,100
Total number of active participants reported on line 7a of the Form 55002013-05-01365
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01365
2012: GUARDIAN ALARM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01839
Total number of active participants reported on line 7a of the Form 55002012-05-01346
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01346
2011: GUARDIAN ALARM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01881
Total number of active participants reported on line 7a of the Form 55002011-05-01327
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01327

Form 5500 Responses for GUARDIAN ALARM WELFARE BENEFIT PLAN

2015: GUARDIAN ALARM WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Plan funding arrangement – General assets of the sponsorYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – General assets of the sponsorYes
2014: GUARDIAN ALARM WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Plan funding arrangement – General assets of the sponsorYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – General assets of the sponsorYes
2013: GUARDIAN ALARM WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Plan funding arrangement – General assets of the sponsorYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – General assets of the sponsorYes
2012: GUARDIAN ALARM WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Plan funding arrangement – General assets of the sponsorYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – General assets of the sponsorYes
2011: GUARDIAN ALARM WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Plan funding arrangement – General assets of the sponsorYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 13
Insurance contract or identification numberG000ALEF
Number of Individuals Covered132
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $5,695
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,221
Insurance broker organization code?3
Insurance broker nameLUBIN SCHWARTZ & GOLDMAN INC
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number840344
Policy instance 14
Insurance contract or identification number840344
Number of Individuals Covered51
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $19,300
Total amount of fees paid to insurance companyUSD $5,644
Welfare Benefit Premiums Paid to CarrierUSD $561,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,790
Amount paid for insurance broker fees5644
Insurance broker organization code?3
Insurance broker nameJAY SCHREIBMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number18887-000
Policy instance 1
Insurance contract or identification number18887-000
Number of Individuals Covered40
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $34,771
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $706,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,771
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
EMPLOYEE HEALTH INSURANCE MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number50001008-01
Policy instance 2
Insurance contract or identification number50001008-01
Number of Individuals Covered369
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $4,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,257
Insurance broker organization code?3
Insurance broker nameFRANK MAYER
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0004
Policy instance 3
Insurance contract or identification number00105073/0004
Number of Individuals Covered255
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0007
Policy instance 4
Insurance contract or identification number00105073/0007
Number of Individuals Covered172
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number9718438
Policy instance 5
Insurance contract or identification number9718438
Number of Individuals Covered763
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,764
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,606
Insurance broker organization code?3
Insurance broker nameLUBIN SCHWARTZ & GOLDMAN INC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number8077
Policy instance 7
Insurance contract or identification number8077
Number of Individuals Covered196
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,270
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $962
Insurance broker organization code?3
Insurance broker nameLSG INSURANCE PARTNERS
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9628
Policy instance 6
Insurance contract or identification number9628
Number of Individuals Covered670
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $7,702
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,850
Insurance broker organization code?3
Insurance broker nameLSG INSURANCE PARTNERS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 12
Insurance contract or identification numberG000ALEF
Number of Individuals Covered207
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $10,651
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,741
Insurance broker organization code?3
Insurance broker nameLUBIN SCHWARTZ & GOLDMAN INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 11
Insurance contract or identification numberG000ALEF
Number of Individuals Covered501
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $4,424
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,041
Insurance broker organization code?3
Insurance broker nameLUBIN SCHWARTZ & GOLDMAN INC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0011
Policy instance 10
Insurance contract or identification number00105073/0011
Number of Individuals Covered8
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $581
Welfare Benefit Premiums Paid to CarrierUSD $34,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 number00105073/0010
Policy instance 9
Insurance contract or identification number00105073/0010
Number of Individuals Covered51
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $3,048
Welfare Benefit Premiums Paid to CarrierUSD $198,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,048
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0009
Policy instance 8
Insurance contract or identification number00105073/0009
Number of Individuals Covered58
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0007
Policy instance 3
Insurance contract or identification number00105073/0007
Number of Individuals Covered176
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0010
Policy instance 4
Insurance contract or identification number00105073/0010
Number of Individuals Covered38
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $3,406
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $3,406
Insurance broker name
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0011
Policy instance 5
Insurance contract or identification number00105073/0011
Number of Individuals Covered10
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $574
Welfare Benefit Premiums Paid to CarrierUSD $35,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $574
Insurance broker organization code?3
Insurance broker name
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9718438
Policy instance 6
Insurance contract or identification number9718438
Number of Individuals Covered760
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $1,741
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,741
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9628
Policy instance 7
Insurance contract or identification number9628
Number of Individuals Covered665
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $6,996
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,996
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number8077
Policy instance 8
Insurance contract or identification number8077
Number of Individuals Covered196
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $1,071
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,071
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 9
Insurance contract or identification numberG000ALEF
Number of Individuals Covered464
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $3,696
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,696
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 10
Insurance contract or identification numberG000ALEF
Number of Individuals Covered200
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $10,178
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,178
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 11
Insurance contract or identification numberG000ALEF
Number of Individuals Covered122
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $5,089
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,089
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0004
Policy instance 12
Insurance contract or identification number00105073/0004
Number of Individuals Covered261
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number50001008-01
Policy instance 2
Insurance contract or identification number50001008-01
Number of Individuals Covered364
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $4,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,233
Insurance broker organization code?3
Insurance broker nameFRANK MAYER
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number18887-000
Policy instance 1
Insurance contract or identification number18887-000
Number of Individuals Covered30
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $31,422
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $648,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,422
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number840344
Policy instance 13
Insurance contract or identification number840344
Number of Individuals Covered52
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $19,722
Welfare Benefit Premiums Paid to CarrierUSD $532,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,722
Insurance broker organization code?3
Insurance broker nameNATIONAL UNITED BROKERS
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0004
Policy instance 13
Insurance contract or identification number00105073/0004
Number of Individuals Covered230
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number50001008-01
Policy instance 2
Insurance contract or identification number50001008-01
Number of Individuals Covered340
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $4,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,106
Insurance broker organization code?3
Insurance broker nameFRANK MAYER
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0007
Policy instance 3
Insurance contract or identification number00105073/0007
Number of Individuals Covered151
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 numberG000ALEF
Policy instance 12
Insurance contract or identification numberG000ALEF
Number of Individuals Covered129
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $5,128
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,128
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0009
Policy instance 4
Insurance contract or identification number00105073/0009
Number of Individuals Covered44
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0010
Policy instance 5
Insurance contract or identification number00105073/0010
Number of Individuals Covered50
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $4,132
Welfare Benefit Premiums Paid to CarrierUSD $195,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,132
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0011
Policy instance 6
Insurance contract or identification number00105073/0011
Number of Individuals Covered13
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,044
Welfare Benefit Premiums Paid to CarrierUSD $45,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,044
Insurance broker organization code?3
Insurance broker name
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9718438
Policy instance 7
Insurance contract or identification number9718438
Number of Individuals Covered763
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,856
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,856
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 11
Insurance contract or identification numberG000ALEF
Number of Individuals Covered193
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 nameCORNERSTONE BENEFITS LLC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number18887-000
Policy instance 1
Insurance contract or identification number18887-000
Number of Individuals Covered29
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $29,020
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $565,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,020
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 10
Insurance contract or identification numberG000ALEF
Number of Individuals Covered445
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $3,645
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,645
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9628
Policy instance 8
Insurance contract or identification number9628
Number of Individuals Covered605
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $6,902
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,902
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number8077
Policy instance 9
Insurance contract or identification number8077
Number of Individuals Covered242
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,397
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,397
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number8077
Policy instance 9
Insurance contract or identification number8077
Number of Individuals Covered286
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $1,485
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,485
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 11
Insurance contract or identification numberG000ALEF
Number of Individuals Covered202
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $9,785
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,785
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 12
Insurance contract or identification numberG000ALEF
Number of Individuals Covered132
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $4,711
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,711
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ALEF
Policy instance 10
Insurance contract or identification numberG000ALEF
Number of Individuals Covered433
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $3,479
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,479
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9628
Policy instance 8
Insurance contract or identification number9628
Number of Individuals Covered510
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $6,279
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,279
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0011
Policy instance 6
Insurance contract or identification number00105073/0011
Number of Individuals Covered15
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0010
Policy instance 5
Insurance contract or identification number00105073/0010
Number of Individuals Covered58
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0009
Policy instance 4
Insurance contract or identification number00105073/0009
Number of Individuals Covered44
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0007
Policy instance 3
Insurance contract or identification number00105073/0007
Number of Individuals Covered150
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number50001008-01
Policy instance 2
Insurance contract or identification number50001008-01
Number of Individuals Covered329
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $3,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,680
Insurance broker organization code?3
Insurance broker nameFRANK MAYER
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number18887-000
Policy instance 1
Insurance contract or identification number18887-000
Number of Individuals Covered22
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $24,402
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $507,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,402
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9718438
Policy instance 7
Insurance contract or identification number9718438
Number of Individuals Covered678
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $1,799
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,799
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number8077
Policy instance 7
Insurance contract or identification number8077
Number of Individuals Covered272
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $1,263
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,263
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9628
Policy instance 6
Insurance contract or identification number9628
Number of Individuals Covered495
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $5,126
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,126
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9718438
Policy instance 5
Insurance contract or identification number9718438
Number of Individuals Covered647
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $1,619
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,619
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0007
Policy instance 4
Insurance contract or identification number00105073/0007
Number of Individuals Covered3
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number00105073/0004
Policy instance 3
Insurance contract or identification number00105073/0004
Number of Individuals Covered7
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Welfare Benefit Premiums Paid to CarrierUSD $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 number50001008-01
Policy instance 2
Insurance contract or identification number50001008-01
Number of Individuals Covered324
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $3,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,423
Insurance broker organization code?3
Insurance broker nameFRANK MAYER
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number18887-000
Policy instance 1
Insurance contract or identification number18887-000
Number of Individuals Covered25
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $22,306
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $520,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,306
Insurance broker organization code?3
Insurance broker nameCORNERSTONE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00105073/0009
Policy instance 8
Insurance contract or identification number00105073/0009
Number of Individuals Covered1
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Welfare Benefit Premiums Paid to CarrierUSD $4,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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