401k Plan data: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN plan

SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN
Plan identification number	001

SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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

SOUTHERN MAINE AGENCY ON AGING has sponsored the creation of one or more 401k plans.

Company Name: SOUTHERN MAINE AGENCY ON AGING

Employer identification number (EIN): 010360259

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about SOUTHERN MAINE AGENCY ON AGING

Jurisdiction of Incorporation: Maine Bureau of Corporations, Elections & Commissions

Incorporation Date:

Company Identification Number: 19790181ND

More information about SOUTHERN MAINE AGENCY ON AGING

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MEGAN WALTON 2023-07-26
001 2021-01-01 MEGAN WALTON 2022-07-01
001 2020-01-01 MEGAN WALTON 2021-06-25
001 2019-01-01 MEGAN WALTON 2020-07-29
001 2018-01-01 LAURENCE GROSS 2019-07-11
001 2017-01-01 LAURENCE GROSS 2018-07-23
001 2016-01-01 LAURENCE GROSS 2017-04-10
001 2015-01-01 LAURENCE GROSS 2016-05-09
001 2014-01-01 LAURENCE GROSS 2015-06-24
001 2013-01-01 LAURENCE GROSS 2014-06-03
001 2012-01-01 LAURENCE W. GROSS 2013-10-08 LAURENCE W. GROSS 2013-10-08
001 2011-01-01 LAURENCE GROSS LAURENCE GROSS 2012-09-27
001 2009-01-01 LAURENCE GROSS LAURENCE GROSS 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	MEGAN WALTON	2023-07-26
001	2021-01-01	MEGAN WALTON	2022-07-01
001	2020-01-01	MEGAN WALTON	2021-06-25
001	2019-01-01	MEGAN WALTON	2020-07-29
001	2018-01-01	LAURENCE GROSS	2019-07-11
001	2017-01-01	LAURENCE GROSS	2018-07-23
001	2016-01-01	LAURENCE GROSS	2017-04-10
001	2015-01-01	LAURENCE GROSS	2016-05-09
001	2014-01-01	LAURENCE GROSS	2015-06-24
001	2013-01-01	LAURENCE GROSS	2014-06-03
001	2012-01-01	LAURENCE W. GROSS	2013-10-08	LAURENCE W. GROSS	2013-10-08
001	2011-01-01	LAURENCE GROSS		LAURENCE GROSS	2012-09-27
001	2009-01-01	LAURENCE GROSS		LAURENCE GROSS	2010-10-14

Plan Statistics for SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN

Measure Date Value
2011: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 84
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 12
Total of all active and inactive participants 2011-01-01 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 98
Number of participants with account balances 2011-01-01 70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 90
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 36
Total of all active and inactive participants 2009-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 127
Number of participants with account balances 2009-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	84
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	12
Total of all active and inactive participants	2011-01-01	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	98
Number of participants with account balances	2011-01-01	70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	90
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	36
Total of all active and inactive participants	2009-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	127
Number of participants with account balances	2009-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2011 : SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,670
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$2,063
Total income from all sources (including contributions)	2011-12-31	$174,942
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$560,972
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$538,438
Expenses. Certain deemed distributions of participant loans	2011-12-31	$2,034
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$221,072
Value of total assets at end of year	2011-12-31	$2,372,392
Value of total assets at beginning of year	2011-12-31	$2,758,815
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$20,500
Total interest from all sources	2011-12-31	$15,163
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$39,997
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$39,997
Administrative expenses professional fees incurred	2011-12-31	$6,000
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$142,487
Participant contributions at end of year	2011-12-31	$5,212
Participant contributions at beginning of year	2011-12-31	$5,261
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$1,670
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$74,270
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$1,670
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$2,063
Other income not declared elsewhere	2011-12-31	$6,000
Total non interest bearing cash at end of year	2011-12-31	$32
Total non interest bearing cash at beginning of year	2011-12-31	$32
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-386,030
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,370,722
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,756,752
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$3,694
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,836,977
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,030,260
Interest on participant loans	2011-12-31	$124
Interest earned on other investments	2011-12-31	$15,038
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$3,531
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$96,468
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$96,468
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$465,158
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$552,524
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-107,290
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$78,585
Employer contributions (assets) at end of year	2011-12-31	$59,812
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$538,438
Contract administrator fees	2011-12-31	$10,806
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PURDY POWERS AND COMPANY
Accountancy firm EIN	2011-12-31	010463013
2010 : SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$2,063
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,497
Total income from all sources (including contributions)	2010-12-31	$554,661
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$337,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$316,920
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$199,084
Value of total assets at end of year	2010-12-31	$2,758,815
Value of total assets at beginning of year	2010-12-31	$2,541,175
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$20,667
Total interest from all sources	2010-12-31	$21,027
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$47,657
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$47,657
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$137,174
Participant contributions at end of year	2010-12-31	$5,261
Participant contributions at beginning of year	2010-12-31	$11,318
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$15,080
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$74,270
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$1,496
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$2,063
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,497
Other income not declared elsewhere	2010-12-31	$6,000
Total non interest bearing cash at end of year	2010-12-31	$32
Total non interest bearing cash at beginning of year	2010-12-31	$32
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$217,074
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,756,752
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,539,678
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,030,260
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,925,487
Interest on participant loans	2010-12-31	$252
Interest earned on other investments	2010-12-31	$20,774
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$96,468
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$4,842
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$4,842
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$552,524
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$598,000
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$280,893
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$46,830
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$316,920
Contract administrator fees	2010-12-31	$14,667
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	Yes
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PURDY POWERS AND COMPANY
Accountancy firm EIN	2010-12-31	010463013
2009 : SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY 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 SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN

2011: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: SOUTHERN MAINE AGENCY ON AGING TAX SHELTERED ANNUITY 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 – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

892728-007

Policy instance

Insurance contract or identification number	892728-007
Number of Individuals Covered	25
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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?	No
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891583-006

Policy instance

Insurance contract or identification number	891583-006
Number of Individuals Covered	8
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $147
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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

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

Policy contract number

1083795

Policy instance

Insurance contract or identification number	1083795
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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?	No
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

892728-007

Policy instance

Insurance contract or identification number	892728-007
Number of Individuals Covered	25
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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?	No
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891583-006

Policy instance

Insurance contract or identification number	891583-006
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $38
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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

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

Policy contract number

1083795

Policy instance

Insurance contract or identification number	1083795
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
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?	No
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:	SOUTHERN MAINE AGENCY ON AGING
Employer identification number (EIN):	010360259
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Maine Bureau of Corporations, Elections & Commissions
Incorporation Date:
Company Identification Number:	19790181ND