401k Plan data: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN plan

ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN
Plan identification number	501

ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover

401k Sponsoring company profile

ANDERSON COLUMBIA CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: ANDERSON COLUMBIA CO., INC.

Employer identification number (EIN): 592871935

NAIC Classification: 237310
NAIC Description: Highway, Street, and Bridge Construction

Additional information about ANDERSON COLUMBIA CO., INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1988-03-08

Company Identification Number: M71821

Legal Registered Office Address: 871 NW GUERDON ST

LAKE CITY

32055

More information about ANDERSON COLUMBIA CO., INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 MARK RESLER 2023-10-27 MARK RESLER 2023-10-27
501 2021-01-01 MARK RESLER 2022-10-17 MARK RESLER 2022-10-17
501 2020-01-01 MARK RESLER 2021-10-12 MARK RESLER 2021-10-12
501 2019-01-01 MARK RESLER 2020-10-14 MARK RESLER 2020-10-14
501 2018-01-01 MARK RESLER 2019-10-10 MARK RESLER 2019-10-10
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 MARK RESLER
501 2011-01-01 MARK C RESLER
501 2010-01-01 MARK RESLER
501 2009-01-01 JOHN GODBOLD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	MARK RESLER	2023-10-27	MARK RESLER	2023-10-27
501	2021-01-01	MARK RESLER	2022-10-17	MARK RESLER	2022-10-17
501	2020-01-01	MARK RESLER	2021-10-12	MARK RESLER	2021-10-12
501	2019-01-01	MARK RESLER	2020-10-14	MARK RESLER	2020-10-14
501	2018-01-01	MARK RESLER	2019-10-10	MARK RESLER	2019-10-10
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	MARK RESLER
501	2011-01-01	MARK C RESLER
501	2010-01-01	MARK RESLER
501	2009-01-01	JOHN GODBOLD

Plan Statistics for ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN

Measure Date Value
2022: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 988
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 880
Total of all active and inactive participants 2022-01-01 880
Total participants 2022-01-01 880
2021: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 927
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 988
Total of all active and inactive participants 2021-01-01 988
Total participants 2021-01-01 988
2020: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 975
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 927
Total of all active and inactive participants 2020-01-01 927
Total participants 2020-01-01 927
2019: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,022
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 975
Total of all active and inactive participants 2019-01-01 975
Total participants 2019-01-01 975
2018: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,076
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,022
Total of all active and inactive participants 2018-01-01 1,022
Total participants 2018-01-01 1,022
2017: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,098
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,076
Total of all active and inactive participants 2017-01-01 1,076
Total participants 2017-01-01 1,076
2016: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,128
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,098
Total of all active and inactive participants 2016-01-01 1,098
Total participants 2016-01-01 1,098
2015: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,084
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,128
Total of all active and inactive participants 2015-01-01 1,128
Total participants 2015-01-01 1,128
2014: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 815
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 815
Total of all active and inactive participants 2014-01-01 815
Total participants 2014-01-01 815
2013: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 741
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 815
Total of all active and inactive participants 2013-01-01 815
Total participants 2013-01-01 815
2012: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 775
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 741
Total of all active and inactive participants 2012-01-01 741
Total participants 2012-01-01 741
2011: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 980
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 775
Total of all active and inactive participants 2011-01-01 775
Total participants 2011-01-01 775
2010: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 558
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 980
Total of all active and inactive participants 2010-01-01 980
Total participants 2010-01-01 980
Number of employers contributing to the scheme 2010-01-01 5
2009: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 558
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 558
Total of all active and inactive participants 2009-01-01 558
Total participants 2009-01-01 558
Number of employers contributing to the scheme 2009-01-01 5

Measure	Date	Value
2022: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	988
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	880
Total of all active and inactive participants	2022-01-01	880
Total participants	2022-01-01	880
2021: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	927
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	988
Total of all active and inactive participants	2021-01-01	988
Total participants	2021-01-01	988
2020: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	975
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	927
Total of all active and inactive participants	2020-01-01	927
Total participants	2020-01-01	927
2019: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,022
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	975
Total of all active and inactive participants	2019-01-01	975
Total participants	2019-01-01	975
2018: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,076
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,022
Total of all active and inactive participants	2018-01-01	1,022
Total participants	2018-01-01	1,022
2017: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,098
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,076
Total of all active and inactive participants	2017-01-01	1,076
Total participants	2017-01-01	1,076
2016: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,128
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,098
Total of all active and inactive participants	2016-01-01	1,098
Total participants	2016-01-01	1,098
2015: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,084
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,128
Total of all active and inactive participants	2015-01-01	1,128
Total participants	2015-01-01	1,128
2014: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	815
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	815
Total of all active and inactive participants	2014-01-01	815
Total participants	2014-01-01	815
2013: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	741
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	815
Total of all active and inactive participants	2013-01-01	815
Total participants	2013-01-01	815
2012: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	775
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	741
Total of all active and inactive participants	2012-01-01	741
Total participants	2012-01-01	741
2011: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	980
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	775
Total of all active and inactive participants	2011-01-01	775
Total participants	2011-01-01	775
2010: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	558
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	980
Total of all active and inactive participants	2010-01-01	980
Total participants	2010-01-01	980
Number of employers contributing to the scheme	2010-01-01	5
2009: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	558
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	558
Total of all active and inactive participants	2009-01-01	558
Total participants	2009-01-01	558
Number of employers contributing to the scheme	2009-01-01	5

Form 5500 Responses for ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN

2022: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Multi-employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Multi-employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Multi-employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ANDERSON COLUMBIA CO INC AND AFFILIATES FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	880
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $83,192
Health 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 $83,192
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	1181
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $30,020
Dental Insurance Welfare Benefit	Yes
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 $30,020
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	385
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $33,066
Life 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 $5,292
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	520
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $69,717
Total amount of fees paid to insurance company	USD $1,694
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $553,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,405
Insurance broker organization code?	3
Amount paid for insurance broker fees	157

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	264
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,101
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,656
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	1187
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,591
Dental Insurance Welfare Benefit	Yes
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 $29,591
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	416
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $74,169
Total amount of fees paid to insurance company	USD $2,486
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $571,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,001
Amount paid for insurance broker fees	821
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	398
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,612
Life 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 $4,675
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	961
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $83,400
Health 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 $83,400
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	264
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $601
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $601
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	470
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $84,271
Total amount of fees paid to insurance company	USD $3,013
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $582,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,000
Amount paid for insurance broker fees	1526
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	432
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $33,185
Life 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 $5,031
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	1214
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $32,957
Dental Insurance Welfare Benefit	Yes
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 $32,957
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	927
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $91,808
Health 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 $91,808
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	268
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,674
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,134
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Total amount of commissions paid to insurance broker	USD $91,930
Total amount of fees paid to insurance company	USD $4,125
Health 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 $33,634
Amount paid for insurance broker fees	1227
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	405
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,907
Life 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 $27,907
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	564
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,590
Dental Insurance Welfare Benefit	Yes
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 $27,590
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	961
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $89,088
Health 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 $89,088

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	253
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,912
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,751
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	588
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $99,206
Total amount of fees paid to insurance company	USD $5,153
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $661,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,226
Amount paid for insurance broker fees	2139
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	446
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $33,960
Life 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 $4,735
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	591
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $35,279
Dental Insurance Welfare Benefit	Yes
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 $35,279
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	1002
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $152,671
Health 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 $97,352
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	268
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,885
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,885
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	635
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $34,032
Dental Insurance Welfare Benefit	Yes
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 $34,032
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-013409-000

Policy instance

Insurance contract or identification number	16-013409-000
Number of Individuals Covered	1133
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $56,112
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $474,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,470
Insurance broker organization code?	3
Insurance broker name	ARTHUR J GALLAGHER & CO

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	1076
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $105,320
Health 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 $105,320
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	296
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,705
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,705
Insurance broker organization code?	3
Insurance broker name	THOMAS A BOYD

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

160793

Policy instance

Insurance contract or identification number	160793
Number of Individuals Covered	489
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,079
Life 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 $4,767
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	624
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $134,102
Total amount of fees paid to insurance company	USD $3,838
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $682,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,940
Amount paid for insurance broker fees	676
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	MATTHEW CHERRY

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

EXRK

Policy instance

Insurance contract or identification number	EXRK
Number of Individuals Covered	1128
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $67,971
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $556,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,302
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	1137
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $104,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $104,872
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	669
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $29,216
Dental Insurance Welfare Benefit	Yes
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 $1,099
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	613
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $136,085
Total amount of fees paid to insurance company	USD $8,658
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $548,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,384
Amount paid for insurance broker fees	2020
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	BRADLEY L WATSON

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	295
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $19,062
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,062
Insurance broker organization code?	3
Insurance broker name	THOMAS BOYD

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	405
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $27,675
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $199,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,675
Insurance broker organization code?	3
Insurance broker name	BOYD THOMAS

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	1084
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $154,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $154,639
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWITT INC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	629
Total amount of commissions paid to insurance broker	USD $7,116
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,116
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

180L42 HIGH PLA

Policy instance

Insurance contract or identification number	180L42 HIGH PLA
Number of Individuals Covered	151
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $6,213
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6213
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

180L42 LOW PLAN

Policy instance

Insurance contract or identification number	180L42 LOW PLAN
Number of Individuals Covered	607
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $7,407
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $187,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7407
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	661
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $99,552
Total amount of fees paid to insurance company	USD $5,498
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $474,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,633
Amount paid for insurance broker fees	660
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	SAMMIE WAYNE SOUTHERN

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	240
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,922
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,922
Insurance broker organization code?	3
Insurance broker name	THOMAS BOYD

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	549
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $87,376
Total amount of fees paid to insurance company	USD $443
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $466,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,553
Amount paid for insurance broker fees	89
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	BARTLEIN AND ASSOC INC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	541
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,109
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,109
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	754
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $118,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118,575
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

25D0918

Policy instance

Insurance contract or identification number	25D0918
Number of Individuals Covered	662
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $9,866
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9866
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Insurance broker name	BATES AND HEWETT INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	231
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,550
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,550
Insurance broker organization code?	3
Insurance broker name	THOMAS BOYD

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

25D0918

Policy instance

Insurance contract or identification number	25D0918
Number of Individuals Covered	660
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $8,883
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8883
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Insurance broker name	BATES & HEWITT INC

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	741
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $117,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $117,577
Insurance broker organization code?	3
Insurance broker name	BATES & HEWITT INC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	538
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,458
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,458
Insurance broker organization code?	3
Insurance broker name	BATES & HEWITT INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	580
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $91,152
Total amount of fees paid to insurance company	USD $2,402
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $464,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,673
Amount paid for insurance broker fees	633
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	GEORGE WILLIAMS AND COMPANY

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	775
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $13,917
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

25D0918

Policy instance

Insurance contract or identification number	25D0918
Number of Individuals Covered	677
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $9,657
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

16331

Policy instance

Insurance contract or identification number	16331
Number of Individuals Covered	764
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $114,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

554078

Policy instance

Insurance contract or identification number	554078
Number of Individuals Covered	490
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,814
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	347
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $125,249
Total amount of fees paid to insurance company	USD $7,222
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $529,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

217973

Policy instance

Insurance contract or identification number	217973
Number of Individuals Covered	218
Insurance policy start date	2011-06-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,652
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

25D0918

Policy instance

Insurance contract or identification number	25D0918
Number of Individuals Covered	460
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $5,974
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $148,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0716135

Policy instance

Insurance contract or identification number	0716135
Number of Individuals Covered	980
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $77,829
Total amount of fees paid to insurance company	USD $2,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,721,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OW514

Policy instance

Insurance contract or identification number	OW514
Number of Individuals Covered	347
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $61,776
Total amount of fees paid to insurance company	USD $3,179
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $359,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ANDERSON COLUMBIA CO., INC.
Employer identification number (EIN):	592871935
NAIC Classification:	237310
NAIC Description:	Highway, Street, and Bridge Construction

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1988-03-08
Company Identification Number:	M71821
Legal Registered Office Address:	871 NW GUERDON ST LAKE CITY 32055