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	002

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

NORTHERN STAR COOPERATIVE SERVICE has sponsored the creation of one or more 401k plans.

Company Name: NORTHERN STAR COOPERATIVE SERVICE

Employer identification number (EIN): 410248090

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
002 2022-10-01
002 2021-10-01
002 2020-10-01
002 2020-10-01
002 2019-10-01 BRADLEY BOX 2021-07-09 NIKKI OSSE 2021-07-09
002 2018-10-01 BRADLEY BOX 2020-05-01
002 2017-10-01 BRADLEY BOX 2019-07-01
002 2016-10-01 BRADLEY BOX 2017-12-20 NIKKI OSSE 2017-12-20
002 2015-10-01 BRADLEY BOX 2017-03-27
002 2014-10-01 DAVE DELAWYER 2016-02-10 NICOLE OSSE 2016-02-10
002 2014-10-01 DAVE DELAWYER 2015-12-15 NICOLE OSSE 2015-12-15
002 2013-10-01 DAVE DELAWYER 2015-07-10
002 2012-10-01 DAVE DELAWYER 2014-01-29
002 2011-10-01 DAVE DELAWYER 2012-11-30
002 2010-10-01 DAVE DELAWYER 2012-03-09
002 2009-10-01 JOHN REED

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-10-01
002	2021-10-01
002	2020-10-01
002	2020-10-01
002	2019-10-01	BRADLEY BOX	2021-07-09	NIKKI OSSE	2021-07-09
002	2018-10-01	BRADLEY BOX	2020-05-01
002	2017-10-01	BRADLEY BOX	2019-07-01
002	2016-10-01	BRADLEY BOX	2017-12-20	NIKKI OSSE	2017-12-20
002	2015-10-01	BRADLEY BOX	2017-03-27
002	2014-10-01	DAVE DELAWYER	2016-02-10	NICOLE OSSE	2016-02-10
002	2014-10-01	DAVE DELAWYER	2015-12-15	NICOLE OSSE	2015-12-15
002	2013-10-01	DAVE DELAWYER	2015-07-10
002	2012-10-01	DAVE DELAWYER	2014-01-29
002	2011-10-01	DAVE DELAWYER	2012-11-30
002	2010-10-01	DAVE DELAWYER	2012-03-09
002	2009-10-01	JOHN REED

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 2022-10-01 130
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 80
Number of retired or separated participants receiving benefits 2022-10-01 1
Number of other retired or separated participants entitled to future benefits 2022-10-01 49
Total of all active and inactive participants 2022-10-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-10-01 3
Total participants 2022-10-01 133
Number of participants with account balances 2022-10-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-10-01 11
2021: CO-OP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 134
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 76
Number of retired or separated participants receiving benefits 2021-10-01 1
Number of other retired or separated participants entitled to future benefits 2021-10-01 50
Total of all active and inactive participants 2021-10-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-10-01 2
Total participants 2021-10-01 129
Number of participants with account balances 2021-10-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-10-01 9
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 130
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 77
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 53
Total of all active and inactive participants 2020-10-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-10-01 2
Total participants 2020-10-01 132
Number of participants with account balances 2020-10-01 128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-10-01 15
2009: CO-OP 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 85
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 69
Number of retired or separated participants receiving benefits 2009-10-01 1
Number of other retired or separated participants entitled to future benefits 2009-10-01 10
Total of all active and inactive participants 2009-10-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 1
Total participants 2009-10-01 81
Number of participants with account balances 2009-10-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 2

Measure	Date	Value
2022: CO-OP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	130
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	80
Number of retired or separated participants receiving benefits	2022-10-01	1
Number of other retired or separated participants entitled to future benefits	2022-10-01	49
Total of all active and inactive participants	2022-10-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-10-01	3
Total participants	2022-10-01	133
Number of participants with account balances	2022-10-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-10-01	11
2021: CO-OP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	134
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	76
Number of retired or separated participants receiving benefits	2021-10-01	1
Number of other retired or separated participants entitled to future benefits	2021-10-01	50
Total of all active and inactive participants	2021-10-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-10-01	2
Total participants	2021-10-01	129
Number of participants with account balances	2021-10-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-10-01	9
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	130
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	77
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	53
Total of all active and inactive participants	2020-10-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-10-01	2
Total participants	2020-10-01	132
Number of participants with account balances	2020-10-01	128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-10-01	15
2009: CO-OP 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	85
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	69
Number of retired or separated participants receiving benefits	2009-10-01	1
Number of other retired or separated participants entitled to future benefits	2009-10-01	10
Total of all active and inactive participants	2009-10-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	1
Total participants	2009-10-01	81
Number of participants with account balances	2009-10-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	2

Financial Data on CO-OP 401(K) PLAN

Measure	Date	Value
2023 : CO-OP 401(K) PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-09-30	$711
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-09-30	$1,045
Total income from all sources (including contributions)	2023-09-30	$1,220,810
Total loss/gain on sale of assets	2023-09-30	$0
Total of all expenses incurred	2023-09-30	$784,568
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-09-30	$745,540
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-09-30	$478,639
Value of total assets at end of year	2023-09-30	$6,596,911
Value of total assets at beginning of year	2023-09-30	$6,161,003
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-09-30	$39,028
Total interest from all sources	2023-09-30	$2,697
Total dividends received (eg from common stock, registered investment company shares)	2023-09-30	$276,745
Total dividends received from registered investment company shares (eg mutual funds)	2023-09-30	$276,745
Administrative expenses professional fees incurred	2023-09-30	$36,708
Was this plan covered by a fidelity bond	2023-09-30	Yes
Value of fidelity bond cover	2023-09-30	$500,000
If this is an individual account plan, was there a blackout period	2023-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2023-09-30	No
Contributions received from participants	2023-09-30	$235,785
Participant contributions at end of year	2023-09-30	$65,762
Participant contributions at beginning of year	2023-09-30	$65,608
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-09-30	$711
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-09-30	$1,045
Other income not declared elsewhere	2023-09-30	$49,458
Administrative expenses (other) incurred	2023-09-30	$2,320
Total non interest bearing cash at end of year	2023-09-30	$20,025
Total non interest bearing cash at beginning of year	2023-09-30	$20,523
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-09-30	No
Value of net income/loss	2023-09-30	$436,242
Value of net assets at end of year (total assets less liabilities)	2023-09-30	$6,596,200
Value of net assets at beginning of year (total assets less liabilities)	2023-09-30	$6,159,958
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-09-30	No
Were any leases to which the plan was party in default or uncollectible	2023-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-09-30	$5,702,967
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-09-30	$4,885,953
Interest on participant loans	2023-09-30	$2,697
Value of interest in common/collective trusts at end of year	2023-09-30	$21,115
Value of interest in common/collective trusts at beginning of year	2023-09-30	$43,164
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2023-09-30	$217
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2023-09-30	$495
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2023-09-30	$495
Asset value of US Government securities at end of year	2023-09-30	$258,583
Asset value of US Government securities at beginning of year	2023-09-30	$356,746
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-09-30	$412,507
Net investment gain or loss from common/collective trusts	2023-09-30	$764
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-09-30	No
Was there a failure to transmit to the plan any participant contributions	2023-09-30	No
Has the plan failed to provide any benefit when due under the plan	2023-09-30	No
Contributions received in cash from employer	2023-09-30	$242,854
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-09-30	$745,540
Asset. Corporate debt instrument preferred debt at end of year	2023-09-30	$165,334
Asset. Corporate debt instrument preferred debt at beginning of year	2023-09-30	$270,568
Asset. Corporate debt instrument debt (other) at end of year	2023-09-30	$362,908
Asset. Corporate debt instrument debt (other) at beginning of year	2023-09-30	$517,946
Did the plan have assets held for investment	2023-09-30	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	2023-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-09-30	No
Opinion of an independent qualified public accountant for this plan	2023-09-30	Unqualified
Accountancy firm name	2023-09-30	CARLSON SV, LLP
Accountancy firm EIN	2023-09-30	411562398
2022 : CO-OP 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-09-30	$1,045
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-09-30	$974
Total income from all sources (including contributions)	2022-09-30	$-957,240
Total loss/gain on sale of assets	2022-09-30	$0
Total of all expenses incurred	2022-09-30	$437,481
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-09-30	$397,439
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-09-30	$464,091
Value of total assets at end of year	2022-09-30	$6,161,003
Value of total assets at beginning of year	2022-09-30	$7,555,653
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-09-30	$40,042
Total interest from all sources	2022-09-30	$2,749
Total dividends received (eg from common stock, registered investment company shares)	2022-09-30	$444,315
Total dividends received from registered investment company shares (eg mutual funds)	2022-09-30	$444,315
Administrative expenses professional fees incurred	2022-09-30	$37,941
Was this plan covered by a fidelity bond	2022-09-30	Yes
Value of fidelity bond cover	2022-09-30	$500,000
If this is an individual account plan, was there a blackout period	2022-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2022-09-30	No
Contributions received from participants	2022-09-30	$231,486
Participant contributions at end of year	2022-09-30	$65,608
Participant contributions at beginning of year	2022-09-30	$47,514
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-09-30	$1,045
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-09-30	$974
Other income not declared elsewhere	2022-09-30	$-133,222
Administrative expenses (other) incurred	2022-09-30	$2,101
Total non interest bearing cash at end of year	2022-09-30	$20,523
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-09-30	No
Value of net income/loss	2022-09-30	$-1,394,721
Value of net assets at end of year (total assets less liabilities)	2022-09-30	$6,159,958
Value of net assets at beginning of year (total assets less liabilities)	2022-09-30	$7,554,679
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-09-30	No
Were any leases to which the plan was party in default or uncollectible	2022-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-09-30	$4,885,953
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-09-30	$6,222,291
Interest on participant loans	2022-09-30	$2,749
Value of interest in common/collective trusts at end of year	2022-09-30	$43,164
Value of interest in common/collective trusts at beginning of year	2022-09-30	$102,148
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-09-30	$495
Asset value of US Government securities at end of year	2022-09-30	$356,746
Asset value of US Government securities at beginning of year	2022-09-30	$569,641
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-09-30	$-1,735,452
Net investment gain or loss from common/collective trusts	2022-09-30	$279
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-09-30	No
Was there a failure to transmit to the plan any participant contributions	2022-09-30	No
Has the plan failed to provide any benefit when due under the plan	2022-09-30	No
Contributions received in cash from employer	2022-09-30	$232,605
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-09-30	$397,439
Asset. Corporate debt instrument preferred debt at end of year	2022-09-30	$270,568
Asset. Corporate debt instrument preferred debt at beginning of year	2022-09-30	$190,977
Asset. Corporate debt instrument debt (other) at end of year	2022-09-30	$517,946
Asset. Corporate debt instrument debt (other) at beginning of year	2022-09-30	$423,082
Did the plan have assets held for investment	2022-09-30	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	2022-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-09-30	No
Opinion of an independent qualified public accountant for this plan	2022-09-30	Unqualified
Accountancy firm name	2022-09-30	CARLSON SV, LLP
Accountancy firm EIN	2022-09-30	411562398
2021 : CO-OP 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-09-30	$974
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-09-30	$0
Total income from all sources (including contributions)	2021-09-30	$1,673,522
Total loss/gain on sale of assets	2021-09-30	$0
Total of all expenses incurred	2021-09-30	$890,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-09-30	$852,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-09-30	$404,187
Value of total assets at end of year	2021-09-30	$7,555,653
Value of total assets at beginning of year	2021-09-30	$6,771,391
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-09-30	$37,293
Total interest from all sources	2021-09-30	$2,321
Total dividends received (eg from common stock, registered investment company shares)	2021-09-30	$226,735
Administrative expenses professional fees incurred	2021-09-30	$35,167
Was this plan covered by a fidelity bond	2021-09-30	Yes
Value of fidelity bond cover	2021-09-30	$400,000
If this is an individual account plan, was there a blackout period	2021-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-09-30	No
Contributions received from participants	2021-09-30	$201,402
Participant contributions at end of year	2021-09-30	$47,514
Participant contributions at beginning of year	2021-09-30	$43,487
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-09-30	$974
Other income not declared elsewhere	2021-09-30	$89,146
Administrative expenses (other) incurred	2021-09-30	$2,126
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-09-30	No
Value of net income/loss	2021-09-30	$783,288
Value of net assets at end of year (total assets less liabilities)	2021-09-30	$7,554,679
Value of net assets at beginning of year (total assets less liabilities)	2021-09-30	$6,771,391
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-09-30	No
Were any leases to which the plan was party in default or uncollectible	2021-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-09-30	$6,222,291
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-09-30	$6,727,904
Interest on participant loans	2021-09-30	$2,321
Value of interest in common/collective trusts at end of year	2021-09-30	$102,148
Asset value of US Government securities at end of year	2021-09-30	$569,641
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-09-30	$951,096
Net investment gain or loss from common/collective trusts	2021-09-30	$37
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-09-30	No
Was there a failure to transmit to the plan any participant contributions	2021-09-30	No
Has the plan failed to provide any benefit when due under the plan	2021-09-30	No
Contributions received in cash from employer	2021-09-30	$202,785
Income. Dividends from preferred stock	2021-09-30	$226,735
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-09-30	$852,941
Asset. Corporate debt instrument preferred debt at end of year	2021-09-30	$190,977
Asset. Corporate debt instrument debt (other) at end of year	2021-09-30	$423,082
Did the plan have assets held for investment	2021-09-30	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	2021-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-09-30	No
Opinion of an independent qualified public accountant for this plan	2021-09-30	Unqualified
Accountancy firm name	2021-09-30	CARLSON SV, LLP
Accountancy firm EIN	2021-09-30	411562398
2010 : CO-OP 401(K) PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-09-30	$0

Form 5500 Responses for CO-OP 401(K) PLAN

2022: CO-OP 401(K) PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan funding arrangement – Trust	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement - Trust	Yes
2021: CO-OP 401(K) PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – Trust	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement - Trust	Yes
2020: CO-OP 401(K) PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan funding arrangement – Trust	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement - Trust	Yes
2009: CO-OP 401(K) PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	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	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

166920

Policy instance

Insurance contract or identification number	166920
Number of Individuals Covered	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	129
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	129
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	129
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

166920

Policy instance

Insurance contract or identification number	166920
Number of Individuals Covered	129
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	132
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	132
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	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	132
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

166920

Policy instance

Insurance contract or identification number	166920
Number of Individuals Covered	132
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTHERN STAR COOPERATIVE SERVICE
Employer identification number (EIN):	410248090
NAIC Classification:	115110