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.
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

COMMUNITY FOOD CO-OP, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY FOOD CO-OP, INC.

Employer identification number (EIN): 810387034

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Additional information about COMMUNITY FOOD CO-OP, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1978-07-12

Company Identification Number: 743561

Legal Registered Office Address: 413 SUMMIT

LAKE HELEN

32744

More information about COMMUNITY FOOD CO-OP, INC.

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 2022-01-01 HANAH MCCARTHY OR MICHELLE HINTZ 2023-09-27 HANAH MCCARTHY OR MICHELLE HINTZ 2023-09-27
002 2021-01-01 HANAH MCCARTHY OR MICHELLE HINTZ 2022-08-29 HANAH MCCARTHY OR MICHELLE HINTZ 2022-08-29
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 DANA HUSCHLE 2018-08-02
002 2016-01-01 DANA HUSCHLE 2017-07-13
002 2015-01-01 DANA HUSCHLE 2016-05-31 DANA HUSCHLE 2016-05-31
002 2014-01-01 DANA HUSCHLE 2015-07-29 DANA HUSCHLE 2015-07-29
002 2013-01-01 DANA HUSCHLE 2014-07-10
002 2012-01-01 DANA HUSCHLE 2013-08-29
002 2011-01-01 DANA HUSCHLE 2012-07-10
002 2010-01-01 DANA HUSCHLE 2011-10-04 DANA HUSCHLE 2011-10-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	HANAH MCCARTHY OR MICHELLE HINTZ	2023-09-27	HANAH MCCARTHY OR MICHELLE HINTZ	2023-09-27
002	2021-01-01	HANAH MCCARTHY OR MICHELLE HINTZ	2022-08-29	HANAH MCCARTHY OR MICHELLE HINTZ	2022-08-29
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	DANA HUSCHLE	2018-08-02
002	2016-01-01	DANA HUSCHLE	2017-07-13
002	2015-01-01	DANA HUSCHLE	2016-05-31	DANA HUSCHLE	2016-05-31
002	2014-01-01	DANA HUSCHLE	2015-07-29	DANA HUSCHLE	2015-07-29
002	2013-01-01	DANA HUSCHLE	2014-07-10
002	2012-01-01	DANA HUSCHLE	2013-08-29
002	2011-01-01	DANA HUSCHLE	2012-07-10
002	2010-01-01	DANA HUSCHLE	2011-10-04	DANA HUSCHLE	2011-10-04

Plan Statistics for CO-OP 401(K) PLAN

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

Measure Date Value
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 89
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 31
Total of all active and inactive participants 2020-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 120
Number of participants with account balances 2020-01-01 89
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 84
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 27
Total of all active and inactive participants 2019-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 111
Number of participants with account balances 2019-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CO-OP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 97
Number of other retired or separated participants entitled to future benefits 2018-01-01 17
Total of all active and inactive participants 2018-01-01 114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 114
Number of participants with account balances 2018-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3

Measure	Date	Value
2020: CO-OP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	89
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	31
Total of all active and inactive participants	2020-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	120
Number of participants with account balances	2020-01-01	89
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	84
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	27
Total of all active and inactive participants	2019-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	111
Number of participants with account balances	2019-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CO-OP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	97
Number of other retired or separated participants entitled to future benefits	2018-01-01	17
Total of all active and inactive participants	2018-01-01	114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	114
Number of participants with account balances	2018-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3

Financial Data on CO-OP 401(K) PLAN

Measure	Date	Value
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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$559,035
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$300,331
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$292,508
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$218,202
Value of total assets at end of year	2020-12-31	$2,282,768
Value of total assets at beginning of year	2020-12-31	$2,024,064
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$7,823
Total interest from all sources	2020-12-31	$1,297
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$94,734
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$94,734
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$160,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$129,436
Participant contributions at beginning of year	2020-12-31	$5,160
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$2,049
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$9,289
Administrative expenses (other) incurred	2020-12-31	$7,823
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	$258,704
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,282,768
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,024,064
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,204,784
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,894,017
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$1,297
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$77,984
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$116,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$244,802
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	$79,477
Employer contributions (assets) at beginning of year	2020-12-31	$6,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$292,508
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	Unqualified
Accountancy firm name	2020-12-31	AMATICS
Accountancy firm EIN	2020-12-31	453057681
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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$595,350
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$80,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$76,132
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$216,261
Value of total assets at end of year	2019-12-31	$2,024,064
Value of total assets at beginning of year	2019-12-31	$1,509,455
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$4,609
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$78,112
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$78,112
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$160,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$121,510
Participant contributions at end of year	2019-12-31	$5,160
Participant contributions at beginning of year	2019-12-31	$6,658
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$2,049
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$2,396
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$16,232
Administrative expenses (other) incurred	2019-12-31	$4,609
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	$514,609
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,024,064
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,509,455
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	$1,894,017
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,403,235
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$116,088
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$97,166
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$146,467
Net investment gain/loss from pooled separate accounts	2019-12-31	$154,510
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	$78,519
Employer contributions (assets) at end of year	2019-12-31	$6,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$76,132
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	AMATICS
Accountancy firm EIN	2019-12-31	453057681
2018 : CO-OP 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$111,778
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$115,102
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$114,702
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$171,120
Value of total assets at end of year	2018-12-31	$1,509,455
Value of total assets at beginning of year	2018-12-31	$1,512,779
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$400
Total interest from all sources	2018-12-31	$1,563
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$160,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$103,932
Participant contributions at end of year	2018-12-31	$6,658
Participant contributions at beginning of year	2018-12-31	$6,414
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$2,396
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$118
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$5,017
Administrative expenses (other) incurred	2018-12-31	$400
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-3,324
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,509,455
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,512,779
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$1,403,235
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,423,492
Interest earned on other investments	2018-12-31	$581
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$982
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$97,166
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$82,755
Net investment gain/loss from pooled separate accounts	2018-12-31	$-60,905
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$62,171
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$114,702
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	AMATICS
Accountancy firm EIN	2018-12-31	453057681

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

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
2018: CO-OP 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942531-01

Policy instance

Insurance contract or identification number	942531-01
Number of Individuals Covered	8
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942531-01

Policy instance

Insurance contract or identification number	942531-01
Number of Individuals Covered	9
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?	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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942531-01

Policy instance

Insurance contract or identification number	942531-01
Number of Individuals Covered	70
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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

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Company Name:	COMMUNITY FOOD CO-OP, INC.
Employer identification number (EIN):	810387034
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1978-07-12
Company Identification Number:	743561
Legal Registered Office Address:	413 SUMMIT LAKE HELEN 32744