401k Plan data: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN plan

MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN
Plan identification number	001

MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 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.
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

MIDSOTA MANUFACTURING has sponsored the creation of one or more 401k plans.

Company Name: MIDSOTA MANUFACTURING

Employer identification number (EIN): 411919039

NAIC Classification: 331200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 JOEL BAUER 2019-02-11 JOEL BAUER 2019-02-11
001 2017-01-01 JOEL BAUER 2018-07-24 JOEL BAUER 2018-07-24
001 2016-01-01 JOEL BAUER 2017-09-12 JOEL BAUER 2017-09-12
001 2015-01-01 JOEL BAUER 2016-06-13 JOEL BAUER 2016-06-13
001 2014-01-01 JOEL BAUER 2015-02-27 JOEL BAUER 2015-02-27
001 2013-01-01 JOEL BAUER 2014-01-22 JOEL BAUER 2014-01-22
001 2012-01-01 JOEL BAUER 2013-02-18 JOEL BAUER 2013-02-18
001 2011-01-01 JOEL BAUER 2012-09-21 JOEL BAUER 2012-09-21
001 2010-01-01 JOEL BAUER 2011-07-20 JOEL BAUER 2011-07-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	JOEL BAUER	2019-02-11	JOEL BAUER	2019-02-11
001	2017-01-01	JOEL BAUER	2018-07-24	JOEL BAUER	2018-07-24
001	2016-01-01	JOEL BAUER	2017-09-12	JOEL BAUER	2017-09-12
001	2015-01-01	JOEL BAUER	2016-06-13	JOEL BAUER	2016-06-13
001	2014-01-01	JOEL BAUER	2015-02-27	JOEL BAUER	2015-02-27
001	2013-01-01	JOEL BAUER	2014-01-22	JOEL BAUER	2014-01-22
001	2012-01-01	JOEL BAUER	2013-02-18	JOEL BAUER	2013-02-18
001	2011-01-01	JOEL BAUER	2012-09-21	JOEL BAUER	2012-09-21
001	2010-01-01	JOEL BAUER	2011-07-20	JOEL BAUER	2011-07-20

Plan Statistics for MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN

Measure Date Value
2021: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 0
Number of participants with account balances 2021-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 111
Total of all active and inactive participants 2020-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 111
Number of participants with account balances 2020-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 10
2019: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 101
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 16
Total of all active and inactive participants 2019-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 117
Number of participants with account balances 2019-01-01 108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 23

Measure	Date	Value
2021: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	0
Number of participants with account balances	2021-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	111
Total of all active and inactive participants	2020-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	111
Number of participants with account balances	2020-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	10
2019: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	101
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	16
Total of all active and inactive participants	2019-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	117
Number of participants with account balances	2019-01-01	108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	23

Financial Data on MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2021 : MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-02-12	$128,655
Total of all expenses incurred	2021-02-12	$2,835,139
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-02-12	$2,827,891
Value of total assets at end of year	2021-02-12	$0
Value of total assets at beginning of year	2021-02-12	$2,706,484
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-02-12	$7,248
Total interest from all sources	2021-02-12	$182
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-02-12	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2021-02-12	$0
Was this plan covered by a fidelity bond	2021-02-12	Yes
Value of fidelity bond cover	2021-02-12	$200,000
If this is an individual account plan, was there a blackout period	2021-02-12	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-02-12	$0
Were there any nonexempt tranactions with any party-in-interest	2021-02-12	No
Participant contributions at end of year	2021-02-12	$0
Participant contributions at beginning of year	2021-02-12	$28,692
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-02-12	No
Value of net income/loss	2021-02-12	$-2,706,484
Value of net assets at end of year (total assets less liabilities)	2021-02-12	$0
Value of net assets at beginning of year (total assets less liabilities)	2021-02-12	$2,706,484
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-02-12	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-02-12	No
Were any leases to which the plan was party in default or uncollectible	2021-02-12	No
Investment advisory and management fees	2021-02-12	$44
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-02-12	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-02-12	$2,677,733
Interest on participant loans	2021-02-12	$182
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-02-12	$128,473
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-02-12	No
Was there a failure to transmit to the plan any participant contributions	2021-02-12	No
Has the plan failed to provide any benefit when due under the plan	2021-02-12	No
Employer contributions (assets) at end of year	2021-02-12	$0
Employer contributions (assets) at beginning of year	2021-02-12	$59
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-02-12	$2,827,891
Contract administrator fees	2021-02-12	$7,204
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-02-12	Yes
Did the plan have assets held for investment	2021-02-12	No
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	2021-02-12	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-02-12	Yes
Opinion of an independent qualified public accountant for this plan	2021-02-12	Disclaimer
Accountancy firm name	2021-02-12	ELLINGSON & ELLINGSOM, LTD
Accountancy firm EIN	2021-02-12	411399624
2020 : MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$43
Total income from all sources (including contributions)	2020-12-31	$755,151
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$297,719
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$274,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$405,493
Value of total assets at end of year	2020-12-31	$2,706,484
Value of total assets at beginning of year	2020-12-31	$2,249,095
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$22,803
Total interest from all sources	2020-12-31	$1,731
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$200,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$241,559
Participant contributions at end of year	2020-12-31	$28,692
Participant contributions at beginning of year	2020-12-31	$33,365
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$38,838
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$43
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$457,432
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,706,484
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,249,052
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,677,733
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,212,819
Interest on participant loans	2020-12-31	$1,731
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$2,911
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$347,927
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$125,096
Employer contributions (assets) at end of year	2020-12-31	$59
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$274,916
Contract administrator fees	2020-12-31	$22,803
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	ELLINGSON & ELLINGSON, LTD
Accountancy firm EIN	2020-12-31	411399624
2019 : MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$43
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$783,193
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$120,752
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$114,127
Value of total corrective distributions	2019-12-31	$757
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$427,353
Value of total assets at end of year	2019-12-31	$2,249,095
Value of total assets at beginning of year	2019-12-31	$1,586,611
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,868
Total interest from all sources	2019-12-31	$1,603
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$200,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$257,666
Participant contributions at end of year	2019-12-31	$33,365
Participant contributions at beginning of year	2019-12-31	$27,098
Participant contributions at beginning of year	2019-12-31	$46
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$31,570
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$330
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$43
Administrative expenses (other) incurred	2019-12-31	$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	2019-12-31	No
Value of net income/loss	2019-12-31	$662,441
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,249,052
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,586,611
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,212,819
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,559,119
Interest on participant loans	2019-12-31	$1,603
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$2,911
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$354,237
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$138,117
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$18
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$114,127
Contract administrator fees	2019-12-31	$5,868
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	ELLINGSON & ELLINGSON, LTD
Accountancy firm EIN	2019-12-31	411399624

Form 5500 Responses for MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN

2021: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MIDSOTA MANUFACTURING 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

86121

Policy instance

Insurance contract or identification number	86121
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-02-12
Total amount of commissions paid to insurance broker	USD $1,773
Total amount of fees paid to insurance company	USD $113
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	GROUP ANNUITY CONTRACT
Commission paid to Insurance Broker	USD $1,773
Insurance broker organization code?	3
Amount paid for insurance broker fees	113
Additional information about fees paid to insurance broker	TPA COMPENSATION

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

86121

Policy instance

Insurance contract or identification number	86121
Number of Individuals Covered	111
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,013
Total amount of fees paid to insurance company	USD $1,144
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	GROUP ANNUITY CONTRACT
Commission paid to Insurance Broker	USD $9,013
Insurance broker organization code?	3
Amount paid for insurance broker fees	1144
Additional information about fees paid to insurance broker	TPA COMPENSATION

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

86121

Policy instance

Insurance contract or identification number	86121
Number of Individuals Covered	133
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,528
Total amount of fees paid to insurance company	USD $963
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	GROUP ANNUITY CONTRACT
Commission paid to Insurance Broker	USD $1,682
Insurance broker organization code?	3
Amount paid for insurance broker fees	963
Additional information about fees paid to insurance broker	TPA COMPENSATION & OTHER ALLOWANCES

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Company Name:	MIDSOTA MANUFACTURING
Employer identification number (EIN):	411919039
NAIC Classification:	331200