401k Plan data: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P plan

THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 401k Plan overview

Plan Name	THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P
Plan identification number	002

THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ASSURANCE MFG CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: ASSURANCE MFG CO., INC.

Employer identification number (EIN): 410904770

NAIC Classification: 332110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01 SCOTT COLBY 2022-06-28 SCOTT COLBY 2022-06-28
002 2020-01-01 JEFF SWENSON 2021-06-28 SCOTT COLBY 2021-06-28
002 2019-01-01 JEFF SWENSON 2020-07-14 SCOTT COLBY 2020-07-14
002 2018-01-01 JEFF SWENSON 2019-05-29 DONNA KROYER 2019-05-29
002 2017-01-01 JEFF SWENSON 2018-06-21 DONNA KROYER 2018-06-21
002 2016-01-01 JEFF SWENSON DONNA KROYER 2017-07-18
002 2015-01-01 HERB LINDBERG DONNA KROYER 2016-07-20
002 2014-01-01 HERB LINDBERG DONNA KROYER 2015-07-14
002 2013-01-01 HERB LINDBERG DONNA KROYER 2014-07-30
002 2012-01-01 HERB LINDBERG DONNA KROYER 2013-07-17
002 2011-01-01 DONNA KROYER
002 2010-01-01 HERB LINDBERG DONNA KROYER 2011-08-02
002 2009-01-01 DONNA KROYER HERB LINDBERG 2010-07-01
002 2009-01-01 DONNA KROYER HERB LINDBERG 2010-09-28
002 2009-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01	SCOTT COLBY	2022-06-28	SCOTT COLBY	2022-06-28
002	2020-01-01	JEFF SWENSON	2021-06-28	SCOTT COLBY	2021-06-28
002	2019-01-01	JEFF SWENSON	2020-07-14	SCOTT COLBY	2020-07-14
002	2018-01-01	JEFF SWENSON	2019-05-29	DONNA KROYER	2019-05-29
002	2017-01-01	JEFF SWENSON	2018-06-21	DONNA KROYER	2018-06-21
002	2016-01-01	JEFF SWENSON		DONNA KROYER	2017-07-18
002	2015-01-01	HERB LINDBERG		DONNA KROYER	2016-07-20
002	2014-01-01	HERB LINDBERG		DONNA KROYER	2015-07-14
002	2013-01-01	HERB LINDBERG		DONNA KROYER	2014-07-30
002	2012-01-01	HERB LINDBERG		DONNA KROYER	2013-07-17
002	2011-01-01	DONNA KROYER
002	2010-01-01	HERB LINDBERG		DONNA KROYER	2011-08-02
002	2009-01-01	DONNA KROYER		HERB LINDBERG	2010-07-01
002	2009-01-01	DONNA KROYER		HERB LINDBERG	2010-09-28
002	2009-01-01

Plan Statistics for THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P

401k plan membership statisitcs for THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P

Measure Date Value
2022: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2022 401k membership
Total participants, beginning-of-year 2022-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 130
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 12
Total of all active and inactive participants 2022-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 142
Number of participants with account balances 2022-01-01 129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 16
2016: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2016 401k membership
Total participants, beginning-of-year 2016-01-01 81
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 71
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 77
Number of participants with account balances 2016-01-01 68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1
2015: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2015 401k membership
Total participants, beginning-of-year 2015-01-01 88
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 78
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 80
Number of participants with account balances 2015-01-01 70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2014 401k membership
Total participants, beginning-of-year 2014-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 82
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 3
Total of all active and inactive participants 2014-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 85
Number of participants with account balances 2014-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2013 401k membership
Total participants, beginning-of-year 2013-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 83
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 85
Number of participants with account balances 2013-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2012 401k membership
Total participants, beginning-of-year 2012-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 82
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 5
Total of all active and inactive participants 2012-01-01 87
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 87
Number of participants with account balances 2012-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2011 401k membership
Total participants, beginning-of-year 2011-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 85
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 89
Number of participants with account balances 2011-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2010: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2010 401k membership
Total participants, beginning-of-year 2010-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 87
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 6
Total of all active and inactive participants 2010-01-01 93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 93
Number of participants with account balances 2010-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2009 401k membership
Total participants, beginning-of-year 2009-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 86
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 94
Number of participants with account balances 2009-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 13

Measure	Date	Value
2022: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2022 401k membership
Total participants, beginning-of-year	2022-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	130
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	12
Total of all active and inactive participants	2022-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	142
Number of participants with account balances	2022-01-01	129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	16
2016: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2016 401k membership
Total participants, beginning-of-year	2016-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	71
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	77
Number of participants with account balances	2016-01-01	68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2015 401k membership
Total participants, beginning-of-year	2015-01-01	88
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	78
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	80
Number of participants with account balances	2015-01-01	70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2014 401k membership
Total participants, beginning-of-year	2014-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	82
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	3
Total of all active and inactive participants	2014-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	85
Number of participants with account balances	2014-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2013 401k membership
Total participants, beginning-of-year	2013-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	83
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	85
Number of participants with account balances	2013-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2012 401k membership
Total participants, beginning-of-year	2012-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	82
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	5
Total of all active and inactive participants	2012-01-01	87
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	87
Number of participants with account balances	2012-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2011 401k membership
Total participants, beginning-of-year	2011-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	85
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	89
Number of participants with account balances	2011-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2010: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2010 401k membership
Total participants, beginning-of-year	2010-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	87
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	6
Total of all active and inactive participants	2010-01-01	93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	93
Number of participants with account balances	2010-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2009 401k membership
Total participants, beginning-of-year	2009-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	86
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	94
Number of participants with account balances	2009-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	13

Financial Data on THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P

Measure	Date	Value
2022 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets	2022-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$0
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total transfer of assets to this plan	2022-12-31	$0
Total transfer of assets from this plan	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Expenses. Interest paid	2022-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$1,575,826
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,452,699
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,419,165
Expenses. Certain deemed distributions of participant loans	2022-12-31	$0
Value of total corrective distributions	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,201,238
Value of total assets at end of year	2022-12-31	$13,397,611
Value of total assets at beginning of year	2022-12-31	$13,274,484
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$33,534
Total income from rents	2022-12-31	$0
Total interest from all sources	2022-12-31	$41,150
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$0
Assets. Real estate other than employer real property at end of year	2022-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2022-12-31	$0
Administrative expenses professional fees incurred	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2022-12-31	$0
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$791,739
Participant contributions at end of year	2022-12-31	$185,916
Participant contributions at beginning of year	2022-12-31	$192,639
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$1,214,041
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$0
Assets. Loans (other than to participants) at end of year	2022-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Other income not declared elsewhere	2022-12-31	$224,182
Administrative expenses (other) incurred	2022-12-31	$0
Liabilities. Value of operating payables at end of year	2022-12-31	$0
Liabilities. Value of operating payables at beginning of year	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$0
Total non interest bearing cash at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Income. Non cash contributions	2022-12-31	$0
Value of net income/loss	2022-12-31	$123,127
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$13,397,611
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$13,274,484
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Assets. partnership/joint venture interests at end of year	2022-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2022-12-31	$0
Investment advisory and management fees	2022-12-31	$31,218
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$48,428
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$0
Value of interest in pooled separate accounts at end of year	2022-12-31	$5,203,168
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$5,403,364
Interest on participant loans	2022-12-31	$11,805
Income. Interest from loans (other than to participants)	2022-12-31	$0
Interest earned on other investments	2022-12-31	$29,345
Income. Interest from US Government securities	2022-12-31	$0
Income. Interest from corporate debt instruments	2022-12-31	$0
Value of interest in master investment trust accounts at end of year	2022-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2022-12-31	$0
Value of interest in common/collective trusts at end of year	2022-12-31	$0
Value of interest in common/collective trusts at beginning of year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$7,960,099
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$7,678,481
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$0
Asset value of US Government securities at end of year	2022-12-31	$0
Asset value of US Government securities at beginning of year	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,774
Net investment gain/loss from pooled separate accounts	2022-12-31	$-887,970
Net investment gain or loss from common/collective trusts	2022-12-31	$0
Net gain/loss from 103.12 investment entities	2022-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Assets. Invements in employer securities at end of year	2022-12-31	$0
Assets. Invements in employer securities at beginning of year	2022-12-31	$0
Assets. Value of employer real property at end of year	2022-12-31	$0
Assets. Value of employer real property at beginning of year	2022-12-31	$0
Contributions received in cash from employer	2022-12-31	$195,458
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Income. Dividends from preferred stock	2022-12-31	$0
Income. Dividends from common stock	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,419,165
Asset. Corporate debt instrument preferred debt at end of year	2022-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2022-12-31	$0
Contract administrator fees	2022-12-31	$2,316
Assets. Corporate common stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2022-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2022-12-31	$0
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Aggregate proceeds on sale of assets	2022-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2022-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2022-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2022-12-31	$0
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2022-12-31	450250958
2016 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2016 401k financial data
Total income from all sources	2016-12-31	$1,873,080
Expenses. Total of all expenses incurred	2016-12-31	$1,146,144
Benefits paid (including direct rollovers)	2016-12-31	$1,111,462
Total plan assets at end of year	2016-12-31	$8,918,219
Total plan assets at beginning of year	2016-12-31	$8,191,283
Value of fidelity bond covering the plan	2016-12-31	$1,000,000
Total contributions received or receivable from participants	2016-12-31	$345,528
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$1,062,314
Other income received	2016-12-31	$399,250
Net income (gross income less expenses)	2016-12-31	$726,936
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$8,918,219
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$8,191,283
Assets. Value of participant loans	2016-12-31	$202,153
Total contributions received or receivable from employer(s)	2016-12-31	$65,988
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$32,912
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,770
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2015 401k financial data
Total income from all sources	2015-12-31	$1,189,902
Expenses. Total of all expenses incurred	2015-12-31	$498,550
Benefits paid (including direct rollovers)	2015-12-31	$465,244
Total plan assets at end of year	2015-12-31	$8,191,283
Total plan assets at beginning of year	2015-12-31	$7,499,931
Value of fidelity bond covering the plan	2015-12-31	$1,000,000
Total contributions received or receivable from participants	2015-12-31	$344,905
Expenses. Other expenses not covered elsewhere	2015-12-31	$3,433
Contributions received from other sources (not participants or employers)	2015-12-31	$703,810
Other income received	2015-12-31	$53,201
Net income (gross income less expenses)	2015-12-31	$691,352
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$8,191,283
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$7,499,931
Assets. Value of participant loans	2015-12-31	$230,213
Total contributions received or receivable from employer(s)	2015-12-31	$87,986
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$28,458
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,415
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2014 401k financial data
Total income from all sources	2014-12-31	$1,313,324
Expenses. Total of all expenses incurred	2014-12-31	$1,569,641
Benefits paid (including direct rollovers)	2014-12-31	$1,540,988
Total plan assets at end of year	2014-12-31	$7,499,931
Total plan assets at beginning of year	2014-12-31	$7,756,248
Value of fidelity bond covering the plan	2014-12-31	$1,000,000
Total contributions received or receivable from participants	2014-12-31	$389,784
Expenses. Other expenses not covered elsewhere	2014-12-31	$929
Contributions received from other sources (not participants or employers)	2014-12-31	$505,060
Other income received	2014-12-31	$320,217
Net income (gross income less expenses)	2014-12-31	$-256,317
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$7,499,931
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$7,756,248
Assets. Value of participant loans	2014-12-31	$266,260
Total contributions received or receivable from employer(s)	2014-12-31	$98,263
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$25,699
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$2,025
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2013 401k financial data
Total income from all sources	2013-12-31	$1,562,355
Expenses. Total of all expenses incurred	2013-12-31	$621,571
Benefits paid (including direct rollovers)	2013-12-31	$574,640
Total plan assets at end of year	2013-12-31	$7,756,248
Total plan assets at beginning of year	2013-12-31	$6,815,464
Value of fidelity bond covering the plan	2013-12-31	$1,000,000
Total contributions received or receivable from participants	2013-12-31	$402,256
Expenses. Other expenses not covered elsewhere	2013-12-31	$898
Contributions received from other sources (not participants or employers)	2013-12-31	$198,181
Other income received	2013-12-31	$862,336
Net income (gross income less expenses)	2013-12-31	$940,784
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$7,756,248
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$6,815,464
Assets. Value of participant loans	2013-12-31	$267,506
Total contributions received or receivable from employer(s)	2013-12-31	$99,582
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$43,183
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$2,850
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2012 401k financial data
Total income from all sources	2012-12-31	$1,700,499
Expenses. Total of all expenses incurred	2012-12-31	$503,891
Benefits paid (including direct rollovers)	2012-12-31	$484,563
Total plan assets at end of year	2012-12-31	$6,815,464
Total plan assets at beginning of year	2012-12-31	$5,618,856
Total contributions received or receivable from participants	2012-12-31	$400,005
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$702,202
Other income received	2012-12-31	$503,518
Net income (gross income less expenses)	2012-12-31	$1,196,608
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$6,815,464
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$5,618,856
Assets. Value of participant loans	2012-12-31	$236,257
Total contributions received or receivable from employer(s)	2012-12-31	$94,774
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$17,343
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,985
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2011 401k financial data
Total income from all sources	2011-12-31	$539,403
Expenses. Total of all expenses incurred	2011-12-31	$995,343
Benefits paid (including direct rollovers)	2011-12-31	$986,245
Total plan assets at end of year	2011-12-31	$5,618,856
Total plan assets at beginning of year	2011-12-31	$6,074,796
Total contributions received or receivable from participants	2011-12-31	$404,194
Expenses. Other expenses not covered elsewhere	2011-12-31	$736
Contributions received from other sources (not participants or employers)	2011-12-31	$6,159
Other income received	2011-12-31	$37,154
Net income (gross income less expenses)	2011-12-31	$-455,940
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$5,618,856
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$6,074,796
Assets. Value of participant loans	2011-12-31	$197,531
Total contributions received or receivable from employer(s)	2011-12-31	$91,896
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$6,342
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$2,020
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2010 401k financial data
Total income from all sources	2010-12-31	$1,178,247
Expenses. Total of all expenses incurred	2010-12-31	$887,879
Benefits paid (including direct rollovers)	2010-12-31	$874,433
Total plan assets at end of year	2010-12-31	$6,074,796
Total plan assets at beginning of year	2010-12-31	$5,784,428
Total contributions received or receivable from participants	2010-12-31	$364,549
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$242,184
Other income received	2010-12-31	$486,331
Net income (gross income less expenses)	2010-12-31	$290,368
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$6,074,796
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$5,784,428
Assets. Value of participant loans	2010-12-31	$223,894
Total contributions received or receivable from employer(s)	2010-12-31	$85,183
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$10,736
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,710
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P

2022: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2016: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: THE ASSURANCE MANUFACTURING COMPANY, INC. 401(K) P 2009 form 5500 responses
2009-01-01	Type of plan entity	Single 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 funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

781504-01

Policy instance

Insurance contract or identification number	781504-01
Number of Individuals Covered	128
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	80
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	85
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	85
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	87
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	89
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 8109

Policy instance

Insurance contract or identification number	FL 8109
Number of Individuals Covered	93
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ASSURANCE MFG CO., INC.
Employer identification number (EIN):	410904770
NAIC Classification:	332110