FILING FEE: $10.00 ANNUAL REPORT OF COOPERATIVE ASSOCIATION TO THE NEW MEXICO PUBLIC REGULATION COMMISSION REPORT DUE WITHIN 60 DAYS OF THE CLOSE OF FINANCIAL YEAR The cooperative herein named does hereby make the following Report in compliance with the provisions of Section 53-4-34, NMSA 1978: (attach schedules, as needed) I. The name and principal address (including mailing address) of the association is______________________________________________________________ _______________________________________________________________________________________________ NMPRC#_____________________________. II. The names and addresses of the officers and directors (the association must have five or more directors; the president and at least one vice-president must be directors but no other officer need be a director) PRESIDENT_________________________________________________________________________________________________________________________ VICE-PRESIDENT___________________________________________________________________________________________________________________ SECRETARY________________________________________________________________________________________________________________________ TREASURER________________________________________________________________________________________________________________________ DIRECTOR_________________________________________________________________________________________________________________________ DIRECTOR_________________________________________________________________________________________________________________________ DIRECTOR_________________________________________________________________________________________________________________________ III. The name and street address of its registered agent and the registered office is:_______________________________________________________________ ______________________________________________________________________________________________________________________________________. IV. For share association: (1) Amount and nature of authorized capital____________________________________________________________________________________________. Amount of capital paid in_________________________________________________________________________________________________________. (2) Number of its shareholders________________________________________________________________________________________________________. (3) Par value of shares_______________________________________________________________________________________________________________. (4) Rate at which any interest dividends have been paid___________________________________________________________________________________. For non-share association: (1) Total number of members_________________________________________________________________________________________________________. (2) Number admitted________________________________________________________________________________________________________________. (3) Number withdrawn_______________________________________________________________________________________________________________. (4) Membership fees received $________________________________________________________________________________________________________. V. Financial year ending date is ____________________________________ and the receipts, expenditures, assets and liabilities of the association are as follows: RECEIPTS $___________________________________ EXPENDITURES $______________________________ _______________________________________________________________ PRESIDENT ASSETS $_______________________________ LIABILITIES $___________________________ _______________________________________________________________ SECRETARY Subscribed and sworn to me before this____________________________________________________ day of__________________________________________. My commission expires:__________________________________________________ ___________________________________________________________ NOTARY PUBLIC A COPY OF THIS REPORT SHALL BE KEPT ON FILE AT THE PRINCIPAL OFFICE OF THE ASSOCIATION AR-COOP (REV 09/09) American LegalNet, Inc. www.FormsWorkFlow.com GENERAL INFORMATION 53-4-34. Annual report. A. An association shall, annually within sixty days of the close of its operations for that year, make a report of its condition sworn to by the president and secretary, which report shall be filed with the Public Regulation Commission. The report shall state: (1) the name and principal address of the association; (2) the names and addresses of the officers and directors, and the name and address of the initial registered agent and registered office of the association. (3) the amount and nature of the association’s authorized, subscribed and paid-in capital, the number of its shareholders, the par value of its shares and the rate at which any interest-dividends have been paid. For nonshare associations, the annual report shall state the total number of members, the number admitted or withdrawn during the year and the amount of membership fees received; and (4) the receipts, expenditures, assets and liabilities of the association. B. A copy of the report required pursuant to Subsection A of this section shall be kept on file at the principal office of the association. A person who signs or verifies a report required pursuant to Subsection A of this section that contains a false statement known to that person to be false, shall upon conviction be fined not exceeding five hundred dollars ($500) or imprisoned not exceeding one year, or both. Every association shall pay an annual fee of ten dollars ($10.00) upon filing the report. C. D. 53-4-32. Bonding. Every individual acting as officer or employee of an association and handling funds or securities amounting to one thousand dollars ($1,000.00) or more, in any one year, shall be covered by an adequate bond as determined by the board of directors, and at the expense of the association; and the by-laws [by-laws] may also provide for the bonding of other employees or officers. 53-4-33. Books; auditing. To record its business operation, every association shall keep a set of books, which shall be audited at the end of each fiscal year by an experienced bookkeeper or accountant who shall not be an officer or director. Where the annual business amounts to less than ten thousand dollars ($10,000.00), the audit may be performed by an auditing committee of three, who shall not be directors, officers, or employees. A written report of the audit, including a statement of the amount of business transacted with members, and the amount transacted with non-members, the balance sheet, and the income and expenses, shall be submitted to the annual meeting of the association. 53-4-45. Taxation. Associations formed under Chapter 53, Article 4 NMSA 1978 and foreign corporations admitted under Section 53-4-41 NMSA 1978 to do business in this state shall pay an annual fee of twenty dollars ($20.00). (NOTE: License fee paid annually on date of incorporation or qualification.) RETURN TO: Public Regulation Commission Corporation Bureau Report Compliance Division P.O. Box 1269 Santa Fe, NM 87504-1269 American LegalNet, Inc. www.FormsWorkFlow.com