401k Plan data: CO-OP 401(K) PLAN plan

CO-OP 401(K) PLAN 401k Plan overview

Plan Name	CO-OP 401(K) PLAN
Plan identification number	001

CO-OP 401(K) 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

MEDFORD COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.

Company Name: MEDFORD COOPERATIVE, INC.

Employer identification number (EIN): 391396113

NAIC Classification: 115110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CO-OP 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 ANDREW STOTKA 2019-08-30
001 2017-01-01 ANDREW STOTKA 2018-07-25
001 2016-01-01 ANDREW STOTKA 2017-05-02
001 2015-01-01 ANDREW STOTKA 2016-05-19
001 2014-01-01 ANDREW STOTKA 2015-09-09
001 2014-01-01 ANDREW STOTKA 2015-09-08
001 2014-01-01 ANDREW STOTKA 2015-09-09
001 2013-01-01 ANDREW STOTKA 2014-07-10
001 2012-01-01 ANDREW STOTKA 2013-05-29
001 2011-01-01 ANDREW STOTKA 2012-07-02
001 2010-01-01 ANDREW STOTKA
001 2009-01-01 GRAHAM COURTNEY, JR.

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	ANDREW STOTKA	2019-08-30
001	2017-01-01	ANDREW STOTKA	2018-07-25
001	2016-01-01	ANDREW STOTKA	2017-05-02
001	2015-01-01	ANDREW STOTKA	2016-05-19
001	2014-01-01	ANDREW STOTKA	2015-09-09
001	2014-01-01	ANDREW STOTKA	2015-09-08
001	2014-01-01	ANDREW STOTKA	2015-09-09
001	2013-01-01	ANDREW STOTKA	2014-07-10
001	2012-01-01	ANDREW STOTKA	2013-05-29
001	2011-01-01	ANDREW STOTKA	2012-07-02
001	2010-01-01	ANDREW STOTKA
001	2009-01-01	GRAHAM COURTNEY, JR.

Plan Statistics for CO-OP 401(K) PLAN

401k plan membership statisitcs for CO-OP 401(K) PLAN

Measure Date Value
2022: CO-OP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 201
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 35
Total of all active and inactive participants 2022-01-01 236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 3
Total participants 2022-01-01 239
Number of participants with account balances 2022-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: CO-OP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 100
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 37
Total of all active and inactive participants 2021-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 3
Total participants 2021-01-01 140
Number of participants with account balances 2021-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 114
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 26
Total of all active and inactive participants 2020-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 3
Total participants 2020-01-01 144
Number of participants with account balances 2020-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: CO-OP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 125
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 0
Total of all active and inactive participants 2019-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 3
Total participants 2019-01-01 128
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2010: CO-OP 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 65
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 53
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 12
Total of all active and inactive participants 2010-01-01 67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 67
Number of participants with account balances 2010-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: CO-OP 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 73
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 53
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 12
Total of all active and inactive participants 2009-01-01 67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 67
Number of participants with account balances 2009-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2022: CO-OP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	201
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	35
Total of all active and inactive participants	2022-01-01	236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	3
Total participants	2022-01-01	239
Number of participants with account balances	2022-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: CO-OP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	100
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	37
Total of all active and inactive participants	2021-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	3
Total participants	2021-01-01	140
Number of participants with account balances	2021-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	114
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	26
Total of all active and inactive participants	2020-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	3
Total participants	2020-01-01	144
Number of participants with account balances	2020-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: CO-OP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	125
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	0
Total of all active and inactive participants	2019-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	3
Total participants	2019-01-01	128
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2010: CO-OP 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	65
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	53
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	12
Total of all active and inactive participants	2010-01-01	67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	67
Number of participants with account balances	2010-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: CO-OP 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	73
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	53
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	12
Total of all active and inactive participants	2009-01-01	67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	67
Number of participants with account balances	2009-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on CO-OP 401(K) PLAN

Measure	Date	Value
2022 : CO-OP 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$684
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$607
Total income from all sources (including contributions)	2022-12-31	$-419,264
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$884,014
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$859,294
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$454,935
Value of total assets at end of year	2022-12-31	$3,984,467
Value of total assets at beginning of year	2022-12-31	$5,287,668
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$24,720
Total interest from all sources	2022-12-31	$395
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$166,750
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$166,750
Administrative expenses professional fees incurred	2022-12-31	$23,329
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
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	$201,143
Participant contributions at end of year	2022-12-31	$13,158
Participant contributions at beginning of year	2022-12-31	$589
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$105,642
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$684
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$607
Other income not declared elsewhere	2022-12-31	$-68,661
Administrative expenses (other) incurred	2022-12-31	$1,391
Total non interest bearing cash at end of year	2022-12-31	$6,458
Total non interest bearing cash at beginning of year	2022-12-31	$414
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
Value of net income/loss	2022-12-31	$-1,303,278
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,983,783
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,287,061
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,231,273
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,528,102
Interest on participant loans	2022-12-31	$395
Value of interest in common/collective trusts at end of year	2022-12-31	$15,644
Value of interest in common/collective trusts at beginning of year	2022-12-31	$32,604
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$136
Asset value of US Government securities at end of year	2022-12-31	$224,730
Asset value of US Government securities at beginning of year	2022-12-31	$315,187
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-972,974
Net investment gain or loss from common/collective trusts	2022-12-31	$291
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
Contributions received in cash from employer	2022-12-31	$148,150
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$859,294
Asset. Corporate debt instrument preferred debt at end of year	2022-12-31	$173,033
Asset. Corporate debt instrument preferred debt at beginning of year	2022-12-31	$138,726
Asset. Corporate debt instrument debt (other) at end of year	2022-12-31	$320,035
Asset. Corporate debt instrument debt (other) at beginning of year	2022-12-31	$272,046
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
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	CLIFTON LARSEN ALLEN, LLP
Accountancy firm EIN	2022-12-31	410746749
2021 : CO-OP 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$607
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$753
Total income from all sources (including contributions)	2021-12-31	$1,103,072
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$2,304,719
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$2,269,981
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$280,268
Value of total assets at end of year	2021-12-31	$5,287,668
Value of total assets at beginning of year	2021-12-31	$6,489,461
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$34,738
Total interest from all sources	2021-12-31	$175
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$361,645
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$361,645
Administrative expenses professional fees incurred	2021-12-31	$33,184
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$181,378
Participant contributions at end of year	2021-12-31	$589
Participant contributions at beginning of year	2021-12-31	$2,551
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$607
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$753
Other income not declared elsewhere	2021-12-31	$-36,552
Administrative expenses (other) incurred	2021-12-31	$1,554
Total non interest bearing cash at end of year	2021-12-31	$414
Total non interest bearing cash at beginning of year	2021-12-31	$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-1,201,647
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,287,061
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,488,708
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,528,102
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$5,514,622
Interest on participant loans	2021-12-31	$175
Value of interest in common/collective trusts at end of year	2021-12-31	$32,604
Value of interest in common/collective trusts at beginning of year	2021-12-31	$81,271
Asset value of US Government securities at end of year	2021-12-31	$315,187
Asset value of US Government securities at beginning of year	2021-12-31	$408,683
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$497,511
Net investment gain or loss from common/collective trusts	2021-12-31	$25
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$98,890
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$2,269,981
Asset. Corporate debt instrument preferred debt at end of year	2021-12-31	$138,726
Asset. Corporate debt instrument preferred debt at beginning of year	2021-12-31	$180,664
Asset. Corporate debt instrument debt (other) at end of year	2021-12-31	$272,046
Asset. Corporate debt instrument debt (other) at beginning of year	2021-12-31	$301,667
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	CLIFTON LARSEN ALLEN, LLP
Accountancy firm EIN	2021-12-31	410746749
2020 : CO-OP 401(K) 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	$753
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$754
Total income from all sources (including contributions)	2020-12-31	$1,246,285
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$310,688
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$279,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$273,165
Value of total assets at end of year	2020-12-31	$6,489,461
Value of total assets at beginning of year	2020-12-31	$5,553,865
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$31,325
Total interest from all sources	2020-12-31	$344
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$243,168
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$243,168
Administrative expenses professional fees incurred	2020-12-31	$29,852
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
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	$154,065
Participant contributions at end of year	2020-12-31	$2,551
Participant contributions at beginning of year	2020-12-31	$6,086
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$26,701
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$753
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$754
Other income not declared elsewhere	2020-12-31	$77,645
Administrative expenses (other) incurred	2020-12-31	$1,473
Total non interest bearing cash at end of year	2020-12-31	$3
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	$935,597
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,488,708
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,553,111
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	$5,514,622
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$4,682,721
Interest on participant loans	2020-12-31	$344
Value of interest in common/collective trusts at end of year	2020-12-31	$81,271
Value of interest in common/collective trusts at beginning of year	2020-12-31	$40,756
Asset value of US Government securities at end of year	2020-12-31	$408,683
Asset value of US Government securities at beginning of year	2020-12-31	$313,735
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$651,750
Net investment gain or loss from common/collective trusts	2020-12-31	$213
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	$92,399
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$279,363
Asset. Corporate debt instrument preferred debt at end of year	2020-12-31	$180,664
Asset. Corporate debt instrument preferred debt at beginning of year	2020-12-31	$182,595
Asset. Corporate debt instrument debt (other) at end of year	2020-12-31	$301,667
Asset. Corporate debt instrument debt (other) at beginning of year	2020-12-31	$327,972
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	CLIFTON LARSEN ALLEN, LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : CO-OP 401(K) 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	$754
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$682
Total income from all sources (including contributions)	2019-12-31	$1,226,358
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$244,693
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$215,081
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$222,308
Value of total assets at end of year	2019-12-31	$5,553,865
Value of total assets at beginning of year	2019-12-31	$4,572,128
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$29,612
Total interest from all sources	2019-12-31	$527
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$206,190
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$206,190
Administrative expenses professional fees incurred	2019-12-31	$28,077
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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	$141,068
Participant contributions at end of year	2019-12-31	$6,086
Participant contributions at beginning of year	2019-12-31	$13,676
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$754
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$682
Other income not declared elsewhere	2019-12-31	$39,844
Administrative expenses (other) incurred	2019-12-31	$1,535
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	$981,665
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,553,111
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,571,446
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	$4,682,721
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,787,779
Interest on participant loans	2019-12-31	$527
Value of interest in common/collective trusts at end of year	2019-12-31	$40,756
Value of interest in common/collective trusts at beginning of year	2019-12-31	$113,198
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$1,689
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$1,689
Asset value of US Government securities at end of year	2019-12-31	$313,735
Asset value of US Government securities at beginning of year	2019-12-31	$252,677
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$756,899
Net investment gain or loss from common/collective trusts	2019-12-31	$590
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	$81,240
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$215,081
Asset. Corporate debt instrument preferred debt at end of year	2019-12-31	$182,595
Asset. Corporate debt instrument preferred debt at beginning of year	2019-12-31	$148,079
Asset. Corporate debt instrument debt (other) at end of year	2019-12-31	$327,972
Asset. Corporate debt instrument debt (other) at beginning of year	2019-12-31	$255,030
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	CLIFTON LARSEN ALLEN, LLP
Accountancy firm EIN	2019-12-31	410746749
2010 : CO-OP 401(K) PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$436,939
Expenses. Total of all expenses incurred	2010-12-31	$382,588
Benefits paid (including direct rollovers)	2010-12-31	$365,544
Total plan assets at end of year	2010-12-31	$2,501,281
Total plan assets at beginning of year	2010-12-31	$2,446,930
Value of fidelity bond covering the plan	2010-12-31	$400,000
Total contributions received or receivable from participants	2010-12-31	$122,040
Expenses. Other expenses not covered elsewhere	2010-12-31	$17,044
Other income received	2010-12-31	$243,347
Net income (gross income less expenses)	2010-12-31	$54,351
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,501,281
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,446,930
Assets. Value of participant loans	2010-12-31	$27,152
Total contributions received or receivable from employer(s)	2010-12-31	$71,552
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CO-OP 401(K) PLAN 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 CO-OP 401(K) PLAN

2022: CO-OP 401(K) PLAN 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 benefit arrangement – Insurance	Yes
2021: CO-OP 401(K) 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	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CO-OP 401(K) 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 benefit arrangement – Insurance	Yes
2019: CO-OP 401(K) 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 benefit arrangement – Insurance	Yes
2010: CO-OP 401(K) PLAN 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CO-OP 401(K) PLAN 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MDA01360TR

Policy instance

Insurance contract or identification number	MDA01360TR
Number of Individuals Covered	239
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

062491

Policy instance

Insurance contract or identification number	062491
Number of Individuals Covered	239
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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

G-027795

Policy instance

Insurance contract or identification number	G-027795
Number of Individuals Covered	239
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

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

1666920

Policy instance

Insurance contract or identification number	1666920
Number of Individuals Covered	239
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

MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MDA01360TR

Policy instance

Insurance contract or identification number	MDA01360TR
Number of Individuals Covered	140
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

062491

Policy instance

Insurance contract or identification number	062491
Number of Individuals Covered	140
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

G-027795

Policy instance

Insurance contract or identification number	G-027795
Number of Individuals Covered	140
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

1666920

Policy instance

Insurance contract or identification number	1666920
Number of Individuals Covered	140
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MDA01360TR

Policy instance

Insurance contract or identification number	MDA01360TR
Number of Individuals Covered	144
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

062491

Policy instance

Insurance contract or identification number	062491
Number of Individuals Covered	144
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

G-027795

Policy instance

Insurance contract or identification number	G-027795
Number of Individuals Covered	144
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

1666920

Policy instance

Insurance contract or identification number	1666920
Number of Individuals Covered	144
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MDA01360TR

Policy instance

Insurance contract or identification number	MDA01360TR
Number of Individuals Covered	123
Insurance policy start date	2019-09-03
Insurance policy end date	2019-12-31
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?	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?	No
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

062491

Policy instance

Insurance contract or identification number	062491
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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?	No
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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

G-027795

Policy instance

Insurance contract or identification number	G-027795
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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?	No
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

35938

Policy instance

Insurance contract or identification number	35938
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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?	No
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

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

1666920

Policy instance

Insurance contract or identification number	1666920
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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?	No
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

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Company Name:	MEDFORD COOPERATIVE, INC.
Employer identification number (EIN):	391396113
NAIC Classification:	115110