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RESOLUTION
RE: APPROVE AUTHORIZATION FOR CHAIRMAN TO SIGN DOCUMENTS FOR
FUTURE FUNDS - DEFERRED COMPENSATION PLAN
WHEREAS , the Board of County Commissioners of Weld County,
Colorado, pursuant to Colorado statute and the Weld County Home
Rule Charter, is vested with the authority of administering the
affairs of Weld County, Colorado, and
WHEREAS , Documents for Future Funds for the Deferred
Compensation Program have been presented to the Board for the
Chairman' s signature, with the program offering five different
investment options to those employees who are currently
participating in said Program, and
WHEREAS, after study and review, the Board deems it advisable
to authorize the Chairman to sign said Documents, a copy of which
is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County
Commissioners of Weld County, Colorado, that the Chairman be, and
hereby is, authorized to sign the Documents for Future Funds.
The above and foregoing Resolution was, on motion duly made
and seconded, adopted by the following vote on the 7th day of
August, A.D. , 1985 .
gu ,ri BOARD OF COUNTY COMMISSIONERS
ATTEST: WELD COUNTY, COLORADO
n �
Weld County Clerk and Recorder
and Clerk to the Board acq line J son, Chairman
EXCUSED
BY: /`r))L-1fl .o L, t Gene R. Brantner, Pro-Tem
l/4")14--11C--e---.2.-.)
puty County Cl'erk
APPROVED AS TO FORM: C.W. Ki,cyy
Go d La
County Attorney C c i7
Fran Yamag i
851364
/ ' ' _ is
APPLICATION FOR GROUP DEFERRED COMPENSATION ANNUITY CONTRACT
Exact Name: �%'/o^ 7 D ti Tjp 1 !: �i /! nvD
(herein called the Group Policyholder) applies to Great-West Life & Annuity Insurance Company for a Group Deferred
Compensation Annuity Contract(herein called the Group Annuity Contract)in the form of the copy attached to this Application.
It is agreed that the Group Policyholder will accept the Group Annuity Contract when issued.
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Specify the effective date of the Group Annuity Contract: / 'Y /,X
(which is not earlier than the first day of the year in which this Application has been made) N! ' Ir
Specify the name of the Deferred Compensation Plan: Weld ( ,'rl��� i" e 7 e r r P rl
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air r-P/1 r--1i I;,:'✓`. 1�//f'/1
This Group Annuity Contract is only available to policyholders whose Deferred Compensation Plan is an eligible State deferred
compensation plan described in Section 457(b) of the Internal Revenue Code of 1954, as amended.
The Insurance Company requires that a copy of the currently effective plan document accompany this application, for its
information.
PAYMENTS AND VALUES PROVIDED BY THE CONTRACT APPLIED FOR MAY BE VARIABLE AND NOT
GUARANTEED AS TO DOLLAR AMOUNT.
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Agent/Broker Name of Grou Policyholder
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Application Great-West
E E ANNVi'Y INSUAANCE COMPANY
Group Deferred Compensation Annuity P.O. Box 1400
G520 Denver, Colorado 80201
TABLE OF CONTENTS
DEFINITIONS Page 3
OWNERSHIP PROVISIONS
Ownership of Series Account 5
Ownership of Group Annuity Contract 5
Transfer and Assignment 5
GENERAL PROVISIONS
The Group Annuity Contract 6
Entire Contract 6
The Plan 6
Non-Participating 6
Currency and Payment of Contributions 6
Age 6
Voting Rights and Reports 7
Notice and Proof 7
PURCHASE PROVISIONS
Commencement and Termination of Coverage 8
Contributions 8
Allocation of Contributions g
CONTRACT VALUE PROVISIONS
Variable Contract Value 9
Accumulation Unit 9
Accumulation Unit Value 9
Annuity Unit Value 9
Net Investment Factor 10
Risk Charge 10
Guaranteed Contract Value 11
Guaranteed Sub-Account Riders 11
Asset Management Fee 11
Variable and Guaranteed Contract Value Provisions 11
Contract Maintenance Charge 11
Transfer Charge II
TRANSFERS
Transfer Terms 12
No Receipt of Transferred Amounts 12
RETIREMENT PROVISIONS
Adequate Proof 13
Payment On Retirement 13
TABLE OF CONTENTS (continued)
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER. AND SURRENDER
Amount Payable On Death of Participant 14
Partial Surrender 14
Amount Payable on Partial Surrender 14
Surrender 14
Amount Payable on Surrender 15
Contingent Deferred Sales Charge 15
Contingent Deferred Sales Charge Free Amount 15
Adequate Proof 15
Payment On Death, Partial Surrender, and Surrender 15
METHODS OF PAYMENT PROVISIONS
Amount To Be Applied 16
Variable Dollar Method of Payment 16
Amount of First Monthly Payment 16
Annuity Units 16
Amount of Monthly Payments After the First 16
Variable Dollar Method of Payment Options 17
Fixed Dollar Method of Payment 17
Amount of Payment 17
Fixed Dollar Method of Payment Options 17
How to Elect Method of Payment Option 18
Availability of Options 18
Settlement 18
CONTRACT MODIFICATION
Modification of Tables 19
Modification of Guaranteed Sub-Account Riders, If Any 19
Modification of Offering of Guaranteed Sub-Accounts 19
Modification of Interest Guarantee Period 19
CESSATION OF DEPOSITS
Options On Date of Cessation of Deposits 20
TABLE A 21
TABLE B 21
TABLE C 22
TABLED 1 23
TABLE E 23
GUARANTEED SUB-ACCOUNT RIDERS, IF ANY
DEFINITIONS
Accumulation Period — the period during which the Participant is Covered under this Group Annuity Contract prior to
the Participant's Annuity Commencement Date.
Accumulation Unit — an accounting unit used to determine the Variable Contract Value before the Annuity
Commencement Date.
Annuitant — the person upon whose life the payment of an annuity is based.
Annuity Commencement Date — the date on which annuity payments commence under a Method of Payment Option,which for
any Participant is not later than the first of the month after the month he/she must retire under
the terms of the Plan, unless earlier permitted by the Group Policyholder.
Annuity Payment Period — the period during which the Participant is Covered under this Group Annuity Contract after the
Participant's Annuity Commencement Date.
Annuity Unit — an accounting unit used to determine the dollar value of any Variable Dollar Annuity Payment
after the First Payment.
Company — the Great-West Life & Annuity Insurance Company.
Deposit — includes Contributions, Transfers and other amounts Deposited into Guaranteed or Variable
Sub-Accounts.
Eligible Fund — a registered management investment company in which the assets of the Series Account may be
invested.
Group Annuity Contract Date — the effective date indicated by the Group Policyholder on the Application for this Group
Annuity Contract, or such other date which is acceptable to the Company.
Group Policyholder — the employer of a Participant and the Applicant for this Group Annuity Contract.
Guaranteed Account — the portion of this Group Annuity Contract providing Guaranteed Sub-Accounts,each having a
Guaranteed Interest Rate and containing fixed dollar amounts.
Guaranteed Contract Value — the sum of the values of the Guaranteed Sub-Accounts credited to the Group Policyholder in
respect of a Participant under a Participant Annuity Account.
Guaranteed Interest Rate — the minimum interest rate applicable to Guaranteed Sub-Accounts which on an annual
effective basis is 4%.
Guaranteed Sub-Account — a subdivision of the Guaranteed Account having a Guaranteed Interest Rate and containing
fixed dollar amounts.This subdivision is described in greater detail in the attached Guaranteed
Sub-Account Riders, if any.
Investment Division — a division of the Series Account containing the shares of a specific portfolio of the Eligible
Fund. There is an Investment Division for each portfolio of the Eligible Fund.
Participant — a person in the employ of the Group Policyholder on the day the Group Policyholder has made
Application for Coverage for him/her and who is reported by the Group Policyholder as having
complied with the terms of the Plan as to eligibility.
DEFINITIONS (continued)
Participant Annuity Account — a separate record established in the name of each Participant which reflects the total of the
Guaranteed and Variable Contract Values.
Participant Annuity Account Value — the sum of the Variable and Guaranteed Contract Values credited to the Group Policyholder in
respect of a Participant under a Participant Annuity Account.
Participant Effective Date — the date on which the first Deposit is credited to a Participant Annuity Account.
Payee — the Group Policyholder or the person,including the Participant,designated by it to receive the
value of the Participant Annuity Account.
Premium Tax — the amount of premium tax, if any, charged by a state or other government authority.
Series Account — the segregated investment account called "FUTUREFUNDS Series Account"established by
Great-West Life & Annuity Insurance Company under Kansas law and registered as a unit
investment trust under the Investment Company Act of 1940, as amended.
Transfer — amounts moved from any Sub-Account to another Sub-Account on one day upon each Written
Request of the Group Policyholder in respect of the Participant.
Valuation Date — the date on which the net asset value of each Eligible Fund is determined.
Valuation Period — the period between the ending of two successive Valuation Dates.
Variable Contract Value — the sum of the values of the Variable Sub-Accounts credited to the Group Policyholder in
respect of a Participant under a Participant Annuity Account.
Variable Sub-Account — a sub-division of an Investment Division which separates Contributions received under tax
qualified arrangements from those received under non-tax qualified arrangements. Each
Variable Sub-Account has its own Accumulation Unit and Annuity Unit Value.
Written Request — the Request required in the Allocation of Contributions, Transfers, Surrender, Partial
Surrender,How to Elect Method of Payment Option,and Cessation of Deposits provisions,the
Contract Value and Retirement Provisions,the Guaranteed Sub-Account Riders,if any,and at
other times as required by the Company. It must be in writing from the Group Policyholder or
its designee and in a form satisfactory to the Company,and to be effective must be received bx
the Company at its Administrative Offices. A form or direction in lieu of the Written Request
may be accepted by the Company. 1
4
OWNERSHIP PROVISIONS
Ownership of Series Account •
The Company has absolute ownership of the assets of the Series Account.
Ownership of Group Annuity Contract
Upon the Group Policyholder's Application for this Group Annuity Contract, the Group Policyholder becomes the owner of the Group
Annuity Contract. It alone has all rights, remedies and recourses given in the Group Annuity Contract, and, while the Group Annuity
Contract and the Participant Annuity Accounts are held in respect of Participants, there is no contractual relationship between the
Company and the Participants. While the Group Policyholder may request the opinion of the Participant on matters and transactions
affecting the Participant Annuity Account,the Group Policyholder may act according to the dictates of its own judgment and discretion.
Subject to the Plan Participation provisions, each employee for whom Contributions have been made is a Participant for whom a
Participant Annuity Account is established.
Transfer and Assignment
The interest of the Group Policyholder in this Group Annuity Contract may not be transferred, sold, assigned, pledged, charged,
encumbered, or in any way alienated without the prior written consent of the Company.
5
GENERAL PROVISIONS
The Group Annuity Contract
The Group Annuity Contract is issued by the Company to the Group Policyholder.
Entire Contract
This Group Annuity Contract, its Application.Tables,and Guaranteed Sub-Account Riders, if any, form the entire contract between the
Group Policyholder and the Company. A copy of the Application is attached to the Group Annuity Contract when issued to the Group
Policyholder.
After issue,Modifications to the Group Annuity Contract under the Contract Modification provisions become part of the Group Annuity
Contract.
All statements in the Application, in the absence of fraud, have been accepted as representations and not as warranties.
Only the President, a Vice-President. or the Secretary of the Company can Modify or waive any provisions of the Group Annuity
Contract.
The Plan
The terms and provisions of the Plan do not for any purpose form any part of this Group Annuity Contract and are not binding on the
Company.
Notwithstanding the fact that it may have knowledge of the terms of the Plan, the obligations of the Company are measured and
determined solely by the terms and provisions of this Group Annuity Contract.
Non-Participating
This Group Annuity Contract is non-participating. It is not eligible to share in the Company's divisible surplus.
Currency and Payment of Contributions
All amounts to be paid to or by the Company must be in the currency of the United States of America. All Contributions to this Group
Annuity Contract must be made payable to the Company or its designated agent.
Age
If the age of the Participant or Payee has been misstated.the payments established for him/her under the Participant Annuity Account will
be made on the basis of his/her correct age. -
If payments were too large because of misstatement.the difference with interest may be deducted by the Company from the next payment
or payments. If payments were too small,the difference with interest may be added by the Company to the next payment.This interest will
be not less than 4% per year.
GENERAL PROVISIONS (continued)
Voting Rights and Reports
The Company will vote the shares of an Eligible Fund held in a Variable Sub-Account of the Investment Division of the Series Account.To
the extent required by law,the Company will vote according to the instructions of the Group Policyholder in proportion to its interest in the
Variable Sub-Account. In such event,the Company will send proxy materials and form(s)to the Group Policyholder for its reply. If no
reply is received,the Company will vote shares of the appropriate Eligible Fund in the same proportion as shares of the Eligible Fund for
which replies have been received.
During the Annuity Payment Period under the Participant Annuity Account, the number of votes will decrease as the assets held to fund
annuity payments decrease, the Payee will be entitled to receive the proxy materials and form(s) otherwise provided to the Group
Policyholder,and all other provisions concerning Voting Rights will apply to the Payee of a Variable Dollar Method of Payment Option.
The Company will furnish the Group Policyholder or the Payee of a Variable Dollar Method of Payment Option copies of any shareholder
reports of the Eligible Funds and of any other notices, reports or documents required by law to be furnished to either of them.
Semi-annual reports of the Eligible Funds will be furnished as required by law to the Group Policyholder,who shall promptly deliver them
to each Participant or Payee of a Variable Dollar Method of Payment Option. The Company will furnish the Group Policyholder not less
frequently than annually a statement of each Participant's Participant Annuity Account Value, which the Group Policyholder will
promptly deliver to the Participant. The Group Policyholder may direct the Company to deliver these reports and statements to the
Participants.
Notice and Proof
Any notice or demand by the Company to or upon the Group Policyholder or any Payee may be given by mailing it to that person's last
known address as stated in the Company's file.
An application, report, request, election, direction, notice or demand by the Group Policyholder or Payee will be made in a form
satisfactory to the Company. When the Company requires it, the Group Policyholder will obtain the signature of the Participant's or
Payee's spouse on forms provided by the Company.
The Company may require adequate proof of the age and death of any Payee before it admits a claim for or pays any payment. -
Written materials developed by the Group Policyholder to describe this Group Annuity Contract must first be approved by the Company.
7
PURCHASE PROVISIONS
Commencement and Termination of Coverage
The Group Policyholder may make Application for Coverage of any employee if the Company is then accepting Applications for
Coverage under this Group Annuity Contract, unless a Date of Cessation of Deposits has been declared.
An employee for whom an adequate Application has been made becomes Covered as a Participant as of the Participant Effective Date.
Coverage of a Participant terminates upon the Group Policyholder's Surrender or Partial Surrender which results in a Participant Annuity
Account Value of$0.
Contributions
Unless a Date of Cessation of Deposits has been declared, the Group Policyholder may from time to time pay Contributions in cash in
respect of a Participant until the earlier of his/her Death, Annuity Commencement Date, or the Surrender of the Participant Annuity
Account.
The amount of Contributions to be paid by the Group Policyholder in respect of any Participant will be determined by the Group
Policyholder.
The Group Policyholder will report the amount paid as Contributions on forms acceptable to the Company. The Group Policyholder's
report is conclusive and binding on it and any person or entity claiming an interest under the Group Annuity Contract or any Participant
Annuity Contract. When the Group Policyholder's report does not coincide with the Contributions received, the Company may return
them.
Allocation of Contributions
After an adequate application in respect of a Participant has been made,Contributions, less Premium Tax,if any,will be Allocated in the
Participant Annuity Account when received by the Company at its Administrative Offices.
Contributions in respect of the Participant will be Allocated among any number of currently offered Variable and Guaranteed
Sub-Accounts in accordance with the latest recorded Written Request of the Group Policyholder in respect of the Participant.
The Allocation of Contributions may be Changed at any time upon the Company's receipt at its Administrative Offices of the Written
Request of the Group Policyholder in respect of the Participant. A Change of Allocation will be effective for Contributions which are
received after the Company's receipt and recording of the Change.
8
CONTRACT VALUE PROVISIONS
Variable Contract Value
The Variable Contract Value in respect of the Participant on any date during the Accumulation Period will be the sum of the values of the
Variable Sub-Accounts of the Series Account held in respect of the Participant.
The value of a Group Policyholder's interest in a Variable Sub-Account in respect of a Participant will be determined by multiplying the
number of Accumulation Units held in respect of the Participant for that Variable Sub-Account by the Accumulation Unit Value for that
Variable Sub-Account.
Accumulation Unit
Contributions and Transfers received at the Administrative Offices of the Company before the close of a Valuation Date will be allocated
as requested and applied as of that date,otherwise as of the next Valuation Date,to provide Accumulation Units of the selected Variable
Sub-Accounts of the Series Account.
The number of Accumulation Units credited in respect of each Participant to a Variable Sub-Account will be determined by dividing the
amount of the Contributions and Transfers then applied to such Variable Sub-Account by the Accumulation Unit Value for that Variable
Sub-Account on the Valuation Date on which the Contributions were allocated and Transfers were made.
The number of Accumulation Units will not change because of a later change in the Accumulation Unit Value,but the Accumulation Unit
Value will vary to reflect the investment experience of the Variable Sub-Account.
Accumulation Unit Value
The initial Accumulation Unit Value of each Variable Sub-Account was established at $10 on the date a Deposit was first made to the
Variable Sub-Account.
The Accumulation Unit Value of a Variable Sub-Account on any subsequent Valuation Date is equal to the Accumulation Unit Value of
that Variable Sub-Account as of the immediately preceding Valuation Date multiplied by the Net Investment Factor for the Valuation
Period ending on the Valuation Date on which the Accumulation Unit Value is being determined.
The Accumulation Unit Value may increase, decrease, or remain unchanged as a result of the value of the Net Investment Factor.
Annuity Unit Value
The initial Annuity Unit Value of each Variable Sub-Account was established at S I on the date a Deposit was first made under a Variable
Annuity Method of Payment to the Variable Sub-Account(s).
The Annuity Unit Value of any Variable Sub-Account on any subsequent Valuation Date is equal to the Annuity Unit Value for the
immediately preceding Valuation Date multiplied by the Net Investment Factor for that Variable Sub-Account for the Valuation Period
ending on the Valuation Date on which the Annuity Unit Value is being determined, and multiplying the result by a factor of.999905 to
neutralize the assumed investment rate of 3.5%per year used in the applicable Table for Variable Dollar Method of Payment Options I,2,
3. and 4. -
9
CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Net Investment Factor
The Net Investment Factor for any Variable Sub-Account for any Valuation Period is determined by dividing(a)by(b),and subtracting(c)
from the result where:
(a) is the net result of:
(i) the net asset value per share of the Eligible Fund shares held in the Variable Sub-Account determined as of the end of the current
Valuation Period, plus
(ii) the per share amount of any dividend(or, if applicable,capital gain distributions)made by the Eligible Fund on shares held in
the Variable Sub-Account if the "ex-dividend" date occurs during the current Valuation Period, minus or plus
(iii) a per unit charge or credit for any taxes incurred by or reserved for in the Variable Sub-Account, which is determined by the
Company to have resulted from the investment operations of the Variable Sub-Account.
(b) is the net result of:
(i) the net asset value per share of the Eligible Fund shares held in the Variable Sub-Account determined as of the end of the
immediately preceding Valuation Period, minus or plus,
(ii) the per unit charge or credit for any taxes incurred by or reserved for in the Variable Sub-Account for the immediately preceding
Valuation Period.
(c) is a factor representing the Risk Charge deducted from each Variable Sub-Account on a daily basis. Such factor is equal to 1.25%on
an annual basis of the daily net asset value of each Variable Sub-Account.
The Net Investment Factor may be greater than, less than, or equal to one. Therefore, the Accumulation Unit Value may increase,
decrease or remain unchanged.
The per share amount of any dividend referred to in paragraph (a) (ii) includes a deduction for an investment advisory fee. This fee
compensates the investment adviser for services provided to the Eligible Fund. The fee may differ between Eligible Funds and may be
renegotiated each year, but will never exceed an annual rate of 1.00% of the aggregate average daily net assets of the Eligible Fund.
Risk Charge
The Company will deduct the Risk Charge for expense and mortality guarantees in the calculation of the Net Investment Factor. This
Charge is equal to 1.25% on an annual basis of the daily net asset value of each Variable Sub-Account. This deduction is made daily.
I tl
CONTRACT VALUE PROVISIONS (continued)
Guaranteed Contract Value
The Guaranteed Contract Value of a Participant Annuity Account on any date during the Accumulation Period will be the sum of the
values of the Guaranteed Sub-Accounts credited to such Participant Annuity Account.
The Company may offer one or more Guaranteed Sub-Accounts into which Contributions will be Deposited at the Written Request of the
Group Policyholder in respect of the Participant in accordance with the Allocation of Contributions provisions.
Guaranteed Sub-Account Riders
The computation of the value of a Guaranteed Sub-Account is described in greater detail in the attached Guaranteed Sub-Account Riders,
if any.
Asset Management Fee
On the first day of each calendar year an Asset Management Fee to be assessed against Guaranteed Contract Values will be declared by the
Company.The amount to be deducted from the Guaranteed Contract Values will be determined and applied by the Company on the first
day of each calendar quarter.
Variable and Guaranteed Contract Value Provisions
The following Charges are applicable to the Variable and Guaranteed Contract Values.
Contract Maintenance Charge
On the first day of each calendar year,a Contract Maintenance Charge of not more than$60 annually will be deducted from the Participant
Annuity Account. If a Participant Annuity Account is established in respect of a Participant after that date,a Contract Maintenance Charge
will be deducted on the first day of the next quarter and will be pro-rated for the year remaining. No refund of this Charge will be made.
The deduction will be pro-rated among the Variable and Guaranteed Sub-Accounts based upon their Variable and Guaranteed
Sub-Account values on the date of deduction. Whenever a deduction for a Contract Maintenance Charge is to be made from a Variable
Sub-Account, the Company will cancel Accumulation Units having a total value equal to the amount of the deduction.
Transfer Charge
With the exception of the first two Transfers in a calendar year,a Transfer Charge of$10 per Transfer will be deducted from the Participant
Annuity Account after the Transfer.
TRANSFERS
The Group Policyholder in respect of the Participant may by Written Request Transfer amounts within and between the currently offered
Variable and Guaranteed Sub-Accounts.
Transfer Terms
The following provisions will apply to any Transfer:
• a Transfer will take effect on the later of the date Elected or the date the Written Request is received at the Administrative Offices of the
Company.
• if a Transfer is made within 30 days of the Annuity Commencement Date,the Company may delay the Annuity Commencement Date
by 30 days.
• if a Participant dies prior to the Annuity Commencement Date, one Transfer may be made after the Death of the Participant by the
Group Policyholder in respect of the Payee to effect the Election of a Method of Payment Option.
• with the exception of the first two Transfers in a calendar year, a Transfer Charge of$10 will be deducted.
• when the Company requires it, the Group Policyholder in respect of the Participant or the Payee will execute forms provided by the
Company as necessary to the requested Transfer.
• no Transfers are permitted after the Annuity Commencement Date.
• a Transfer will be subject to terms described in greater detail in the attached Guaranteed Sub-Account Riders, if any.
No Receipt of Transferred Amounts
No Transfer made within these Transfer Provisions will result in the Participant's receipt of the Transferred amounts,which shall continue
to be held under the Participant Annuity Account.
12
RETIREMENT PROVISIONS
On the Company's receipt of the Written Request at least 30 days before the Annuity Commencement Date,the Group Policyholder in
respect of the Participant may in the Written Request:
• Elect or Change a Method of Payment Option.
• make a Partial Surrender or Surrender.
• Elect or Change the Participant's Annuity Commencement Date to any future date which is not later than the first of the month after the
month the Participant must retire under the terms of the Plan. If any Annuity Commencement Date would be less than 30 days from the
date that the Written Request is received, the Company may delay the Annuity Commencement Date Elected by 30 days.
• if the Group Policyholder in respect of the Participant has failed to Elect a Method of Payment Option within 30 days of his/her Annuity
Commencement Date,the Company will pay the Group Policyholder in respect of the Participant a Variable Life Annuity with 10 Year
Guaranteed Period from the Variable Contract Value and a Fixed Life Annuity with 10 Year Guaranteed Period from the Guaranteed
Contract Value.
Adequate Proof
The Company is entitled to require the receipt of adequate proof of age,death,or any other event or contingency, or to establish the fact
that a benefit has become payable under the provisions of the Plan, prior to making any payment under this Group Annuity Contract.
Payment On Retirement
Payment under the Retirement Provisions will only be made if then available to the Participant under the terms and provisions of the Plan
as determined by the Group Policyholder,and will only be made to the Group Policyholder or to the order of the person designated in the
Written Request by the Group Policyholder to receive payment.
13
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND SURRENDER
Amount Payable On Death of Participant.
If the Participant dies before the Annuity Commencement Date, the Amount Payable on Death will be:
(a) where Death occurs before the Participant's 70th birthday, the greater of:
(i) the Participant Annuity Account Value, less Premium Tax, if any, and
(ii) the sum of Contributions paid to, less any Partial Surrenders made from,the Participant Annuity Account, less Premium Tax,if
any.
(b) where Death occurs on or after the Participant's 70th birthday, the Participant Annuity Account Value, less Premium Tax, if any.
The Payee of an Amount Payable on Death may Elect that payment be made under the Methods of Payment Provisions,a combination of
the Partial Surrender and Methods of Payment Provisions,or under the Surrender Provisions. If the Payee Elects either a Partial Surrender
or the Surrender of the Participant Annuity Account, the Contingent Deferred Sales Charge of the Partial Surrender or Surrender
provisions will not apply. The Election of the Payee must be made not later than 60 days after the date the Company receives Adequate
Proof of the Participant's Death. If no Election is made, a single payment will be made under the Surrender provisions to the Payee.The
Contingent Deferred Sales Charge will not apply to this single payment.
Partial Surrender
By Written Request the Group Policyholder in respect of the Payee may make a Partial Surrender of the Participant Annuity Account.The
Partial Surrender will take effect on the later of the date Elected and the date the Written Request is received at the Administrative Offices
of the Company. Subject to the Amount Payable On Death of Participant provision, a Written Request for Partial Surrender must be
received by the Company at least 30 days before the Annuity Commencement Date.
The Group Policyholder in respect of the Participant must in the Written Request Elect the Variable or Guaranteed Sub-Account(s),or a
combination of them,from which the Partial Surrender is made. If an adequate Election is not made,the Written Request will be returned
to the Group Policyholder, and the Partial Surrender in respect of the Payee will not be made.
Amount Payable On Partial Surrender
The amount payable on Partial Surrender will be paid in one sum under the Partial Surrender provisions equal to:
(a) the amount requested as the Partial Surrender as of the effective date of the Partial Surrender, less
(b) the Contingent Deferred Sales Charge, if any, less
(c) Premium Tax, if any.
Surrender
By Written Request the Group Policyholder in respect of the Payee may Surrender the Participant Annuity Account. The Surrender will
take effect on the later of the date Elected and the date the Written Request is received at the Administrative Offices of the Company. If an
adequate Written Request is not made,the Written Request will be returned to the Group Policyholder and the Surrender will not be made.
Subject to the Amount Payable On Death of Participant provision, a Written Request for Surrender must be received by the Company at
least 30 days before the Annuity Commencement Date.
14
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER,AND SURRENDER(continued)
Surrender (continued)
Amount Payable on Surrender
The Amount Payable on Surrender may be Applied under the Methods of Payment Provisions or will be paid in one sum under these
Surrender provisions equal to:
(a) the Participant Annuity Account Value as of the effective date of the Surrender, less
(b) the Contingent Deferred Sales Charge. if any, less
(c) Premium Tax, if any.
Contingent Deferred Sales Charge
Subject to the Amount Payable On Death of Participant provision, on any Partial Surrender or the Surrender of the Participant Annuity
Account a Contingent Deferred Sales Charge will be deducted from.the Amount Surrendered.
The Contingent Deferred Sales Charge applicable to any Partial Surrender or the Surrender will be equal to 6%of the Amount Surrendered
in excess of the Contingent Deferred Sales Charge Free Amount, if any, and is limited so that the amount then charged will not cause the
cumulative total of all Contingent Deferred Sales Charges charged in respect of the Participant under his/her Participant Annuity Account
to exceed 6%of the Contributions made to his/her Participant Annuity Account within 72 months prior to the effective date of the Partial
Surrender or the Surrender.
Contingent Deferred Sales Charge Free Amount
The Amount of the Contingent Deferred Sales Charge Free Amount is equal to 10% of the Participant Annuity Account Value at
December 31 of the calendar year prior to the year in which the Amount is Surrendered.
Only one Contingent Deferred Sales Charge Free Amount is available in respect of a Participant in each calendar year beginning in the
third calendar year after he/she is Covered under this Group Annuity Contract. The Contingent Deferred Sales Charge Free Amount will
be Applied on the Surrender or the first Partial Surrender made under the Participant Annuity Account in that year for the payment of
benefits as a result of financial hardship, as defined in the Plan and approved by the Group Policyholder.
Adequate Proof
The Company is entitled to require the receipt of adequate proof of age,death,or any other event or contingency, or to establish the fact
that a benefit has become payable under the provisions of the Plan, prior to making any payment under this Group Annuity Contract.
Payment On Death, Partial Surrender, and Surrender
Payment under any of the Provisions Relating to Amount Payable On Death. Partial Surrender,and Surrender will only be made if then
available to the Payee under the terms and provisions of the Plan as determined by the Group Policyholder.and will only be made to the
Group Policyholder or to the order of the person designated in the Written Request by the Group Policyholder to receive payment.
15
METHODS OF PAYMENT PROVISIONS
One of the Variable or Fixed Dollar Methods of Payment Options or a combination of them may be Elected under the Methods of Payment
Provisions.
Amount To Be Applied
The Amount to be Applied under the Methods of Payment Provisions is the Participant Annuity Account Value less Premium Tax,if any.
If a Variable Dollar Method of Payment Option is Elected, the Amount to be Applied is the Variable Contract Value as of the date the
Amount of the First Monthly Payment is determined.
If a Fixed Dollar Method of Payment Option is Elected, the Amount to be Applied is the Guaranteed Contract Value as of the Annuity
Commencement Date.
If the Group Policyholder in respect of the Payee Elects to Apply any or all of the Guaranteed Contract Value to a Variable Dollar Method
of Payment Option,or any or all of the Variable Contract Value to a Fixed Dollar Method of Payment Option,a Transfer(s)must be made
prior to the Annuity Commencement Date. The Transfer(s) must comply with the provisions on Transfers.
•
Variable Dollar Method of Payment
The following Variable Dollar Method of Payment Options are available. They are subject to the following provisions.
Amount of First Monthly Payment
The First Monthly Payment under a Variable Dollar Method of Payment Option will be based on the Variable Contract Value credited in
respect of the Participant Annuity Account on the 5th Valuation Date preceding the Annuity Commencement Date. It will be determined
by applying the appropriate rate from the applicable Table to the Amount Applied under the Option. The First Monthly Payment will be
the sum of the variable dollar annuity payments for each Variable Sub-Account.
Annuity Units
The number of Annuity Units for each Variable Sub-Account to be credited in respect of the Participant Annuity Account will be
determined by dividing the portion of the First Monthly Payment to be taken from such Sub-Account by the Sub-Account's Annuity Unit
Value on the 5th Valuation Date preceding the date the First Payment is due for which the number of Annuity Units is being computed.
The number of Annuity Units for a Variable Sub-Account remains fixed during the Annuity Payment Period.
Amount of Monthly Payments After the First
Monthly Payments After the First under a Variable Dollar Method of Payment Option will vary in amount from time to time depending
upon the investment experience of the Variable Sub-Accounts of the Series Account.
The dollar amount of each variable dollar annuity payment to the Participant or Payee after the first for each Variable Sub-Account is
determined by multiplying (a) the number of Sub-Account Annuity Units credited to the Participant Annuity Account by (b) the
Sub-Account Annuity Unit Value on the 5th Valuation Date preceding the date the annuity payment is due.The total dollar amount of each
variable dollar annuity payment will be the sum of the variable dollar annuity payments for each Variable Sub-Account.
The Company guarantees that the dollar amount of each Payment After the First will not be affected by variations in expenses or mortality
experience.
16
METHODS OF PAYMENT PROVISIONS (continued)
Variable Dollar Method of Payment (continued)
Variable Dollar Method of Payment Options
OPTION I: Variable Life Annuity with Guaranteed Period
The Company will pay a monthly payment for the guaranteed Annuity Payment Period Elected. Payments will continue for the lifetime of
the Payee.The guaranteed Annuity Payment Period elected may be 5, 10, 15 or 20 years.The provision on Settlement applies to amounts
payable after the death of the Payee. Table A is applicable to this Option.
OPTION 2: Variable Life Annuity
The Company will pay a monthly payment during the Payee's lifetime. Table A is applicable to this Option.
OPTION 3: Joint and One-Half Survivor Variable Annuity
A joint and one-half survivor variable annuity provides a variable monthly payment to an Annuitant for his/her lifetime; thereafter, and
upon receipt by the Company of adequate proof of the Annuitant's death, one-half of the variable payment amount continues to a
designated Payee, if living, and terminates upon his/her death. Table B is applicable to this Option.
OPTION 4: Any Other Form
The Company will pay any other form of Variable Annuity which is acceptable to it.
Fixed Dollar Method of Payment
The following Fixed Dollar Method of Payment Options are available. They are subject to the following provisions.
Amount of Payment
Payments under a Fixed Dollar Method of Payment Option are guaranteed by the Company as to dollar amount throughout the Annuity
Payment Period.
The Amount of Payment under any Fixed Dollar Method of Payment Option will be determined by applying the Company's then current
non-participating group single premium rates for this class of group annuity contracts to the Amount Applied under the Option. These
current rates will not be less than the rate obtained from the Table which is applicable to the Elected Option.
Fixed Dollar Method of Payment Options
OPTION I: Income of Specified Amount
The Company will pay an income,at 12-,6-, 3-,or I-month intervals,of an amount Elected by the Payee for an Annuity Payment Period
of not less than 36 months nor more than 240 months.The provision on Settlement applies to amounts payable after the death of the Payee.
Table C is applicable to this Option.
OPTION 2: Income for a Specified Period
The Company will pay an income, at 12-, 6-, 3-, or 1-month intervals, for the number of years Elected by the Payee for an Annuity
Payment Period of not less than 36 months nor more than 240 months.The provision on Settlement applies to amounts payable after the
death of the Payee. Table C is applicable to this Option.
17
METHODS OF PAYMENT PROVISIONS (continued)
Fixed Dollar Method of Payment Options (continued)
OPTION 3: Fixed Life Annuity with Guaranteed Period
The Company will pay a monthly payment for the guaranteed Annuity Payment Period Elected. Payments will continue for the lifetime of
the Payee. The provision on Settlement applies to amounts payable after the death of the Payee. Table D is applicable to this Option.
The guaranteed Annuity Payment Period elected may be 5. 10, 15 or 20 years.or may be a period referred to as "Installment Refund".
Under the Installment Refund period. payments will be made until the total of the Payments made equals the Amount Applied.
OPTION 4: Fixed Life Annuity
The Company will pay a monthly payment during the Payee's lifetime. Table D is applicable to this Option.
OPTION 5: Joint and One-Half Survivor Fixed Annuity
A joint and one-half survivor fixed annuity provides a fixed monthly payment to an Annuitant for his/her lifetime;thereafter, and upon
receipt by the Company of adequate proof of the Annuitant's death, one-half of the fixed payment amount continues to a designated
Payee, if living, and terminates upon his/her death. Table E is applicable to this Option.
OPTION 6: Any Other Form
The Company will pay any other form of Fixed Annuity which is acceptable to it.
How to Elect Method of Payment Option
The Written Request of the Group Policyholder in respect of the Participant or Payee is required to Elect, or Change the Election of, a
Method Payment Option and must be received by the Company at least 30 days prior to the Annuity Commencement Date, or, if the
Participant dies prior to the Annuity Commencement Date, within 60 days of the date the Company receives Adequate Proof of the
Participant's Death.
Availability of Options
If any payment to be made under the Elected Option will be less than $50. the Company may make the payments in the most frequent
interval which produces a payment of at least $50.
The minimum Amount that may be Applied under a Variable or Fixed Dollar Method of Payment Option is$2,000. If the amount is less
than $2.000, the Company may pay it in one sum.
The maximum Amount that may be Applied under any Option is S I,000.000. For the Application of any greater Amount,the Company's
consent is required.
Settlement
If the Payee has received payments or was to receive payments which had not yet commenced under Variable Dollar Method of Payment
Options I or 4,or under Fixed Dollar Method of Payment Options 1, 2. 3 or 6.any remaining amounts payable under the Option Elected
will be paid to the Group Policyholder or other Payee designated by the Group Policyholder.
IS
CONTRACT MODIFICATION
This Group Annuity Contract may be Modified at any time by written agreement between the Company and the Group Policyholder. No
such Modification will, without the written consent of the Group Policyholder, affect the terms, provisions, or conditions of this Group
Annuity Contract which are or may be applicable to Contributions paid in respect of Participants prior to the date of such Modification.
However,the Company may at any time and without the consent of the Group Policyholder or any Participant or other person,but upon 30
days'written notice to the Group Policyholder.Modify this Group Annuity Contract in any respect to conform it to changes in tax or other
law, including applicable regulations or rulings.
Modification of Tables
The Company may at any time and without the consent of the Group Policyholder or any Participant or other person. but upon 30 days'
written notice to the Group Policyholder,Modify Tables A.B,C,D,and E,or any of them. However,no such Modification will affect the
terms, provisions or conditions of the Group Annuity Contract which are or may be applicable to Contributions paid in respect of
Participants prior to the date of such Modification.
Modification of Guaranteed Sub-Account Riders, If Any
Any Guaranteed Sub-Account Rider may be Modified at any time by written agreement between the Company and the Group
Policyholder. No such Modification will, without the written consent of the Group Policyholder, affect the terms, provisions, or
conditions of the Rider which are or may be applicable to Contributions paid in respect of Participants prior to the date of such
Modification.
Modification of Offering of Guaranteed Sub-Accounts
Notwithstanding the other Contract Modification provisions, the Company may offer or cease offering Guaranteed Sub-Accounts to
receive Deposits.No such offering or cessation of offering shall affect the terms,provisions,or conditions which are or may be applicable
to Contributions paid to any Guaranteed Sub-Account which is no longer offered by the Company.The Company will periodically notify
the Group Policyholder in respect of Participants of the current offering of Guaranteed Sub-Accounts.
Modification of Interest Guarantee Period
Notwithstanding the other Contract Modification provisions, the Interest Guarantee Period of amounts Deposited into Guaranteed
Sub-Accounts, if any, may be Modified by the Company in accordance with the Interest Guarantee Period Modification provisions as
described in greater detail in the attached Guaranteed Sub-Account Riders, if any.
19
CESSATION OF DEPOSITS
Upon 60 days'written notice to the other, the Group Policyholder or the Company may declare that, as from the date stated in the notice
(that date being called a Date of Cessation of Deposits), no further Deposits will be made to certain or all Sub-Accounts of the Group
Annuity Contract.
If a Date of Cessation of Deposits has been declared for certain Sub-Accounts,the Group Policyholder in respect of the Participant may by
Written Request make a Change of Allocation of his/her Contributions. When no Change of Allocations is received, the Company may
return all Contributions affected by the declaration of the Date of Cessation of Deposits, or allocate such Contributions to a currently
offered Guaranteed Sub-Account.
After the Date of Cessation of Deposits declared in respect of all Sub-Accounts, no Participant Annuity Account will be established.
Options on Date of Cessation of Deposits
Upon declaring the Date of Cessation of Deposits for all Sub-Accounts or upon receiving notice of its declaration by the Company, the
Group Policyholder may by Written Request Elect one of the following Cessation Options. If the Group Policyholder has not Elected a
Cessation Option within 30 days of the Date of Cessation, Cessation Option (I) will be deemed to have been Elected.
CESSATION OPTION (I) Maintenance of Each Participant Annuity Account Value:
The Company will maintain each Participant Annuity Account Value until it is Applied or paid under the
Group Annuity Contract.
CESSATION OPTION (2) Installment Settlement of Guaranteed Contract Values:
The Company will pay the sum of the Variable Contract Values in respect of Participants as of the Date of
Cessation of Deposits to a person designated in writing by the Group Policyholder as the successor insurer of
the Plan or to the Group Policyholder within 30 days of the date the Cessation Option is Elected.
The Company will pay the sum of the Guaranteed Contract Values in respect of Participants as of the Date of
Cessation of Deposits to a person designated in Writing by the Group.Policyholder as the successor insurer of
the Plan or to the Group Policyholder in 20 equal quarterly installments.The amount of the installments will
be the amount determined by the Company on the date of the first such payment, but not less than$514.80
for each$10,000 of Guaranteed Contract Values. The first payment will be made 30 days after the date the
Cessation Option is Elected.
20
TABLE A — Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
Age of Without With Guaranteed Period
Payee Guaranteed Period 5 Years 10 Years 15 Years 20 Years
50 3.83 3.83 3.82 3.80 3.78
55 4.13 4.12 4.10 4.07 4.02
60 4.52 4.51 4.48 4.41 4.31
65 5.06 5.04 4.97 4.84 4.64
70 5.82 5.77 5.61 5.33 4.94
75 6.93 6.80 6.41 5.82 5.19
If payments commence on any other date than the exact age of the Payee as shown above, the amount of the monthly payment shall be
determined by the Company on the actuarial basis used by it in determining the above amounts.
TABLE B —Joint and One-Half Survivor Variable Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
t
i
Age of If Designated Payee Is Age
Annuitant 50 55 60 65 70 75
• 50 3.72 3.75 3.78 3.80 3.81 3.82
55 3.92 3.98 4.02 4.06 4.08 4.10
60 4.16 4.25 4.33 4.39 4.44 4.47
65 4.45 4.58 4.70 4.81 4.89 4.95
70 4.79 4.96 5.14 5.32 5.47 5.59
75 5.18 5.42 5.67 5.94 6.20 6.42
If payments commence on any other date than the exact age of the Annuitant or designated Payee as shown above, the amount of the
monthly payment shall be determined by the Company on the actuarial basis used by it in determining the above amounts.
21
TABLE C — Income of Specified Amount
— Income of a Specified Period
Monthly Payment for Each $1,000
of Participant Annuity Account Value
Years Payment
3 27.44
4 20.93
5 17.03
6 14.43
7 12.57
8 11.18
9 10.11
10 9.24
11 8.54
12 7.96
13 7.46
14 7.04
15 6.68
16 6.36
17 6.08
18 5.83
19 5.61
20 5.41
To determine the payment for other frequencies of payment, multiply the above monthly payment by the following factors:
Factor
Quarterly payment 2.99
Semi-annual payment 5.96
Annual payment 11.81
If payments are for an amount or duration different than that outlined above,the Company will determine the proper amount or duration
using the actuarial basis used to determine the above Table.
22
•
TABLE D — Fixed Life Annuity
Monthly Payment for Each $1.000
of Participant Annuity Account Value
Age of Without With Guaranteed Period
Payee Guaranteed Period 5 Years 10 Years 15 Years 20 Years
50 3.83 3.83
3.82 3.80 3.78
55 4.13 4.12 4.10 4.07 4.02
60 4.52 4.51 4.48 4.41 4.31
65 5.06 5.04 4.97 4.84 4.64
70 5.82 5.77 5.61 5.33 4.94
75 6.93 6.80
6.-11 5.82 5.19
If payments commence on any other date than the exact age of the Payee as shown above, the amount of the monthly payment shall be
determined by the Company on the actuarial basis used by it in determining the above amounts.
•
TABLE E—Joint and One-Half Survivor Fixed Annuity
Monthly Payment for Each $1.000
of Participant Annuity Account Value
, t
Age of If Designated Payee Is Age
Annuitant 50 55 60 65 70 75
50 3.72 3.75 3.78 3.80 3.81 3.82
55 3.92 3.98 4.02 4.06 4.08 4.10
60 4.16 4.25 4.33 4.39 4.44 4.47
65 4.45 4.58 4.70 4.81 4.89 4.95
70 4.79 4.96 5.14 5.32 5.47 5.59
75 5.18 5.4? 5.67 5.94 6.20 6.42
If payments commence on any other date than the exact age of the Annuitant or designated Payee as shown above, the amount of the
monthly payment shall be determined by the Company on the actuarial basis used by it in determining the above amounts.
23
DAILY INTEREST GUARANTEE FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF
THE GROUP ANNUITY CONTRACT
The Daily Interest Guarantee Fund is a Guaranteed Sub-Account.Contributions may be Deposited into the Daily Interest Guarantee Fund
at any time. Interest will be earned on the Daily Interest Guarantee Fund value and compounded daily. The Credited Interest Rate may
change daily but on an annual effective basis will not be less than the Guaranteed Interest Rate.
Value of Daily Interest Guarantee Fund
The value of the Daily Interest Guarantee Fund in respect of the Participant will be determined by adding his/her Guaranteed Sub-Account
Contributions, interest, and Transfers from other Guaranteed Sub-Accounts and from Variable Sub-Accounts, and subtracting his/her
Partial Surrenders, Surrenders, Amounts Payable on Death, Amounts Applied under a Method of Payment Option, Transfers to other
Guaranteed Sub-Accounts and to Variable Sub-Accounts,Transfer Charges,Contract Maintenance Charge,Asset Management Fee,and
Premium Tax.
This Rider, unless and until Modified, forms part of the Group Annuity Contract.
Daily Interest Guarantee Fund Rider— I
GUARANTEED CERTIFICATE FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
The Guaranteed Certificate Fund is a Guaranteed Sub-Account, whereby Credited Interest Rates, not less than the Guaranteed Interest
Rate,are credited to Deposits held for varying Interest Guarantee Periods.The Company may offer Certificates to the Group Policyholder
who may by Written Request Allocate any Deposit in respect of the Participant to any one Certificate.The Group Policyholder in respect
of the Participant may Allocate Deposits only to those Certificates currently being offered by the Company.
If the Group Policyholder in respect of the Participant Allocates Contributions to Certificates not currently offered by the Company, the
Company may return such Contributions.Allocate such Contributions to a currently offered Certificate,or Allocate such Contributions to
another currently offered Guaranteed Sub-Account.
DEFINITIONS
Certificates — represents the amount Deposited into the Guaranteed Certificate Fund under each Interest Guarantee
Period. Each Certificate has its own interest rate and Term.
Term — the duration of the Certificate which begins on the first day of the calendar quarter following the date of the
Deposit and ends on the date specified by the Company.The number of Terms available maybe limited by
the Company.
Certificate Maturity Date — the last day of the Term.
Interest Guarantee Period — the period from the date of the Deposit to the Certificate Maturity Date.
Credited Interest Rate
Subject to the provisions on Application of Certificate on Partial Surrender, Surrender, or Retirement, a Deposit to the Guaranteed
Certificate Fund will earn a Credited Interest Rate for the Certificate's Interest Guarantee Period. The Credited Interest Rate will be
compounded daily, and on an annual effective basis will not be less than the Guaranteed Interest Rate.
Certificate Maturity
Prior to the Certificate Maturity Date. the Company will offer a Guaranteed Sub-Account into which the value of the Certificate will be
Deposited on its Maturity Date. The Guaranteed Sub-Account so offered may be either the Guaranteed Certificate Fund or another
Guaranteed Sub-Account. i
•
Guaranteed Certificate Fund Rider— I
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
If the Guaranteed Certificate Fund is offered,the value of the Certificate on its Maturity Date will establish a new Certificate which has its
own interest rate and Term.The Credited Interest Rate of this new Certificate may be higher or lower than the Credited Interest Rate of any
other Certificate or Deposit.
If another Guaranteed Sub-Account is offered, the value of the Certificate on its Maturity Date will be Deposited into that Guaranteed
Sub-Account. The Credited Interest Rate of this Deposit may be higher or lower than the Credited Interest Rate of any other Deposit.
The Participant may Elect by Written Request to Transfer the value of the Certificate on its Maturity Date.
Interest Guarantee Period Modification
On 30 days'written notice to the Group Policyholder in respect of the Participant the Company may Modify the Interest Guarantee Period
of amounts previously Deposited into the Guaranteed Certificate Fund.
If such Modification is made,the Group Policyholder in respect of the Participant may,within 30 days of notification,by Written Request
Elect the Transfer or Surrender of any or all of these amounts without incurring the Contingent Deferred Sales Charge,and interest will be
applied to the date of Transfer or Surrender at the Credited Interest Rate applicable prior to the date of Modification.
Transfers
The following provisions will apply to the Transfer of amounts to or from the Guaranteed Certificate Fund:
• if any amount has been Transferred out of the Guaranteed Certificate Fund, no Transfer into the Guaranteed Certificate Fund may be
made for 90 continuous days from the date of the Transfer out.
• a Transfer from the Guaranteed Certificate Fund may be made only on the Maturity Date of the Certificate under the Guaranteed
Certificate Fund. The amount that is then available for Transfer is the value of that Certificate on its Maturity Date.
• the Group Policyholder's Written Request to Transfer from the Guaranteed Certificate Fund must be received by the Company no later
than 15 days prior to the Maturity Date of the Certificate.
• the terms of the provisions on Transfers will apply to any Transfer to or from the Guaranteed Certificate Fund.
Guaranteed Certificate Fund Rider—
•
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
Application of Certificate On Death, Partial Surrender, Surrender, or Retirement
If any amount Deposited into a Certificate of the Guaranteed Certificate Fund is Applied prior to the Maturity Date of the Certificate under
the provisions concerning Amount Payable On Death of Participant.Partial Surrender.Surrender,or Retirement the Amount Applied will
receive the Credited Interest Rate from the date of Deposit to the date the Amount is Applied.
Value of Guaranteed Certificate Fund
The value of the Guaranteed Certificate Fund in respect of the Participant will be determined by adding his/her Guaranteed Sub-Account's
Contributions, interest, and Transfers from other Guaranteed Sub-Accounts and from Variable Sub-Accounts, and subtracting his/her
Partial Surrenders. Surrenders, Amounts Payable on Death. Amounts Applied under a Method of Payment Option, Transfers to other
Guaranteed Sub-Accounts and to Variable Sub-Accounts,Transfer Charges.Contract Maintenance Charge,Asset Management Fee,and
Premium Tax.
This Rider, unless and until Modified, forms part of the Group Annuity Contract.
Guaranteed Certificate Fund Rider— 3
(b) an amount which is the result of multiplying the Conversion Deposit by
the appropriate percentage as chosen from the following chart:
If number of years of
coverage of Participant
under Previous The percentage
Contract and this Contract is shall be
Less than 5 Years 6%
At least 5 years but less than 10 years 5%
At least 10 years 4%
Contract Modification
The Contract Modification provisions of the Contract are applicable to the
Conversion Deposit, as appropriate.
() •
)
'Name of Group policyholder
V
136 v Sign ure
I 1/`J/6'4!7/71, �dm1 C/ v i,Ct4.7'/ (i4r/r,5 n fly
Title j �
This Rider, unless and until Modified, forms part of the Group Annuity
Contract.
Conversion Deposit Rider - 2
Form No. GCDRDC 184
CONVERSION DEPOSIT RIDER
ATTACKED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
A Conversion Deposit is defined as the amount Deposited into this Group
Annuity Contract from the Great-West Life Assurance Company contract
4A /'i'if GP (the "Previous Contract") , on the Group Policyholder's
acceptance, on behalf of each Participant, of the offer to do so in effect at
the time and made by the Great-West Life Assurance Company and the Company to
the Group Policyholder. No such Conversion Deposit will result in the
Participant's receipt of the Deposit.
After an adequate Application for a Participant has been made, the Conversion
Deposit, less Premium Tax, if any, will be allocated in the Participant
Annuity Account when received by the Company at its Administrative Offices.
The Conversion Deposit for the Participant will be Allocated in accordance
with the provisions currently being offered by the Company.
The Conversion Deposit increases the value of the Sub-Account to which it is
allocated.
Amount Payable On Death of Participant
Notwithstanding any other provision within this Group Annuity Contract to the
contrary, if the Participant dies before the Annuity Commencement Date, the
Amount Payable On Death will be :
(a) where Death occurs before the Participant's 70th Birthday, the greater
of:
(i) the Participant Annuity Account Value, less Premium Tax, if any,
and
(ii) the sum of the Conversion Deposit and Contributions paid to,
less any Partial Surrenders made from, the Participant Annuity
Account, less Premium Tax, if any.
(b) where Death occurs on or after the Participant's 70th birthday, the
Participant Annuity Account Value, less Premium Tax, if any.
Contingent Deferred Sales Charge
Notwithstanding any other provision in this Group Annuity Contract to the
contrary, the Contingent Deferred Sales Charge applicable to any Partial
Surrender or the Surrender will be equal to 6% of the Amount Surrendered in
excess of the Contingent Deferred Sales Charge Free Amount, if any, and is
limited so that the amount then charged will not cause the cumulative total of
all Contingent Deferred Sales Charges charged in respect of the Participant
under his/her Participant Annuity Account to exceed an amount equal to :
(a) 6% of the Contributions made to his/her Participant Annuity Account
within 72 months prior to the effective date of the Partial Surrender or
the Surrender, plus
Conversion Deposit Rider — 1
Form No. GCDRDC 184
t`°
CT
Great -West°
LIFE & ANNUITY INSURANCE COMPANY
HOME OFFICE - WICHITA, KANSAS
ADMINISTRATIVE OFFICES
DENVER, COLORADO
GROLP FOLICYIOLDBZ COUNTY OF WELD, STATE OF COLORADO
CROUP POLICY NUMBER 88041
CROLP ANNUITY CONTRACT DATE September 1 , 1985
Group Deferred Compensation Annuity, Nbn-Participating
The provisions on the following pages, together with the Application for this
Group Annuity Contract , are part of this Group Annuity Contract.
For the purposes of this Group Annuity Contract, "Plan" means the plan and
adoption agreement that the Group Policyholder has designated as the PBC
Ih iversity Deferred Compensation Plan.
Si geed for the Great-West Life & Annuity Insurance Company on the issuance of
the Group Annuity Contract on the Annuity Contract Date.
•
Secretary President
71--ar-A.A—kr
For the Actuary
This Group Annuity Contract is a legal contract between the Group Policyholder
and the Great-West Life & Annuity Insurance Company. PLEASE READ THIS ANNUITY
CONTRACT CAREFULLY. IT IS A CONTRACT WHICH MAY PROVIDE FOR PAYMENTS OR VALUES
WHICH PRE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT MAY VARY ACCORDING TO
THE INVESTMENT EXPERIENCE OF A VARIABLE ANNUITY ACCOUNT.
Group Deferred Compensation Annuity
GOCMF184
c c
TABLE OF CONTENTS
DEFINITIONS Page 4
OWNRSHIP PROVISIONS
Ownership of Series Account 7
Ownership of Group Annuity Contract 7
Transfer and Assignment 7
GENERAL PROVISIONS
The Group Annuity_Contract 8
Entire Contract 8
The P1 an 8
Non-Participating 8
Currency and Payment of Contributions 8
Age 8
Voting Rights and Reports 9
Notice and Proof 9
PURCHASE PROVISIONS
Commencement and Termination of Coverage 10
Contributions 10
Allocation of Contributions 10
CONTRACT VALUE PROVISIONS
Variable Contract Value 11
Accumulation Unit 11
Accumulation Unit Value 11
Annuity Unit Value 11
Net Investment Factor 12
Risk Charge 13
Guaranteed Contract Value 13
Guaranteed Sub-Account Riders 13
Asset Management Fee 13
Variable and Guaranteed Contract Value Provisions 13
Contract Maintenance Charge 13
Transfer Charge 14
TRANSF RS
Transfer Terms 15
No Receipt of Transferred Amounts 15
RETIREMENT PROVISIONS
Adequate Proof 16
Payment On Retirement 16
C C
TABLE OF CONTENTS (Continued)
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER
Amount Payable On Death of Participant 17
Partial Surrender 17
Amount Payable on Partial Surrender 18
Surrender 18
Amount Payable on Surrender 18
Contingent Deferred Sales Charge 18
Contingent Deferred Sales Charge Free Amount 19
Adequate Proof 19
Payment On Death, Partial Surrender, and Surrender 19
•
METHODS OF PAYMENT PROVISIONS
Amount To Be Applied 20
Variable Dollar Method of Payment 20
Amount of First Monthly Payment 20
Annuity Units 20
Amount of Monthly Payments After the First 21
Variable Dollar Method of Payment Options 21
Fixed Dollar Method of Payment 22
Amount of Payment 22
Fixed Dollar Method of Payment Options 22
How to Elect Method of Payment Option 23
Availability of Options 23
Settlement 23
CONTRACT MODIFICATION
Modification of Tables 24
Modification of Guaranteed Sub-Account Riders, If Any 24
Modification of Offering of Guaranteed Sub-Accounts 24
Modification of Interest Guarantee Period 24
CESSATION OF DEPOSITS
Options On Date of Cessation of Deposits 25
TABLE A 26
TABLE B 27
TABLE C 28
TABLE D 29
TABLE E 30
GUARANTEED SUB-ACCOUNT RIDERS, IF ANY
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DEFINITIONS
Accumulation Period - the period during which the Participant
is Covered under tnis Group Annuity
Contract prior to the Participant's
Annuity Commencement Date.
Accumulation Unit - an accounting unit used to determine the
Variable Contract Value before the
Annuity Commencement Date.
Annuitant - the person upon whose life the payment
of an annuity is based.
Annuity Commencement Date - the date on which annuity payments
commence under a Method of Payment
Option, which for any Participant is not
later than the first of the month after
the month he/she must retire under the
terms of the Plan, unless earlier
permitted by the Group Policyholder.
Annuity Payment Period - the period during which the Participant
is Covered under this Group Annuity
Contract after the Participant's Annuity
Commencement Date.
Annuity Unit - an accounting unit used to determine the
dollar value of any Variable Dollar
Annuity Payment after the First Payment.
Company - the Great-West Life & Annuity Insurance
Company.
Deposit - includes Contributions, Transfers and
other amounts Deposited into Guaranteed
or Variable Sub-Accounts.
Eligible Fund - a registered management investment
company in which the assets of the
Series Account may be invested.
Group Annuity Contract Date - the effective date indicated by the
Group Policyholder on the Application
for this Group Annuity Contract , or such
other date which is acceptable to the
Company.
Group Policyholder - the employer of a Participant and the
Applicant for this Group Annuity
Contract.
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DEFINITI0P6 (continued)
Guaranteed Account - the portion of this Group Annuity
Contract providing Guaranteed
Sub-Accounts, each having a Guaranteed
Interest Rate and containing fixed
dollar amounts.
Guaranteed Contract Value - the sum of the values of the Guaranteed
Sub-Accounts creditea to the Group
Policyholder in respect of a Participant
under a Participant Annuity Account.
Guaranteed Interest Rate - the minimum interest rate applicable to
Guaranteed Sub-Accounts which on an
annual effective basis is 4%.
Guaranteed Sub-Account - a subdivision of the Guaranteed Account
having a Guaranteed Interest Rate and
containing fixed dollar amounts. This
subdivision is described in greater
detail in the attached Guaranteed
Sub-Account Riders, if any.
Investment Division - a division of the Series Account
containing the shares of a specific
portfolio of the Eligible Fund. There
is an Investment Division for each
portfolio of the Eligible Fund.
Participant - a person in the employ of the Group
Policyholder on the day the Group
Policyholder has made Application for
Coverage for him/her and who is reported
by the Group Policyholder as having
complied with the terms of the Plan as
to eligibility.
Participant Annuity Account - a separate record established in the
name of each Participant which reflects
the total of the Guaranteed and Variable
Contract Values.
Participant Annuity Account Value - the sum of the Variable and Guaranteed
Contract Values credited to the Group
Policyholder in respect of a Participant
under a Participant Annuity Account.
Participant Effective Date - the date on which the first Deposit is
credited to a Participant Annuity
Account .
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DEFINITIONS (continued)
Payee - the Group Policyholder or the person, including
the Participant , designated by it to receive the
value of the Participant Annuity Account.
Premium Tax - the amount of premium tax , if any , charged by a
state or other government authority.
Series Account - the segregated investment account called
"FUTUREFUNDS Series Account" established by
Great-West Life & Annuity Insurance Company under
Kansas law and registered as a unit investment
trust under the Investment Company Act of 1940,
as amended.
Transfer - amounts moved from any Sub-Account to another
Sub-Account on one day upon each Written Request
of the Group Policyholder in respect of the
Participant.
Valuation Date - the date on which the net asset value of each
Eligible Fund is determined.
Valuation Period - the period between the ending of two successive
Valuation Dates.
Variable Contract Value - the sum of the values of the Variable
Sub-Accounts credited to the Group Policyholder
in respect of a Participant under a Participant
Annuity Account.
Variable Sub-Account - a sub-division of an Investment Division which
separates Contributions received under tax
qualified arrangements from those received under
non-tax qualified arrangements. Each Variable
Sub-Account has its own Accumulation Unit and
Annuity Unit Value.
Written Request - the Request required in the Allocation of
Contributions, Transfers, Surrender, Partial
Surrender, How to Elect Method of Payment Option,
and Cessation of Deposits provisions, the
Contract Value and Retirement Provisions, the
Guaranteed Sub-Account Riders, if any, and at
other times as required by the Company. It must
be in writing from the Group Policyholder or its
designee and in a form satisfactory to the
Company, and to be effective must be received by
the Company at its Administrative Offices. A
form or direction in lieu of the Written Request
may be accepted by the Company.
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OWNERSHIP PROVISIONS
Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
Ownership of Group Annuity Contract
Upon the Group Policyholder' s Application for this Group Annuity Contract , the
Group Policyholder becomes the owner of the Group Annuity Contract. It alone
has all rights, remedies and recourses given in the Group Annuity Contract ,
and, while the Group Annuity Contract and the Participant Annuity Accounts are
held in respect of Participants, there is no contractual relationship between
the Company and the Participants. While the Group Policyholder may request
the opinion of the Participant on matters and transactions affecting the
Participant Annuity Account , the Group 2olicyholder may act according to the
dictates of its own judgment and discretion.
Subject to the Plan Participation provisions, each employee for whom
Contributions have been made is a Participant for whom a Participant Annuity
Account is established.
Transfer and Assignment
The interest of the Group Policyholder in this Group Annuity Contract may not
be transferred , sold , assigned , pledged , charged , encumbered , or in any way
alienated without the prior written consent of the Company.
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GENERAL PROVISIONS
The Group Annuity Contract
The Group Annuity Contract is issued by the Company to the Group Policyholder.
Entire Contract
This Group Annuity Contract, its Application, Tables, and Guaranteed
Sub-Account Riders, if any, form the entire contract between the Group
Policyholder and the Company. A copy of the Application is attached to the
Group Annuity Contract when issued to the Group Policyholder.
After issue, Modifications to the Group Annuity Contract under the Contract
Modification provisions become part of the Group Annuity Contract .
All statements in the Application, in the absence of fraud, have been accepted
as representations and not as warranties.
Only the President, a Vice-President, or the Secretary of the Company can
Modify or waive any provisions of the Group Annuity Contract .
The Plan
The terms and provisions of the Plan ao not for any purpose form any part of
this Group Annuity Contract and are not binding on the Company.
Notwithstanding the fact that it may have knowledge of the terms of the Plan,
the obligations of the Company are measured and determined solely by the terms
and provisions of this Group Annuity Contract .
Non-Participating
This Group Annuity Contract is non-participating. It is not eligible to share
in the Company's divisible surplus.
Currency and Payment of Contributions
All amounts to be paid to or by the Company must be in the currency of the
United States of America. All Contributions to this Group Annuity Contract
must be made payable to the Company or its designated agent.
Age
If the age of the Participant or Payee has been misstated, the payments
established for him/her under the Participant Annuity Account will be made on
the basis of his/her correct age.
If payments were too large because of misstatement, the difference with
interest may be deducted by the Company from the next payment or payments. If
payments were too small, the difference with interest may be added by the
Company to the next payment. This interest will be not less than 4% per year.
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GENERAL PROVISIONS (continued)
Voting Rights and Reports
The Company will vote the shares of an Eligible Fund held in a Variable
Sub-Account of the Investment Division of the Series Account. To the extent
required by law, the Company will vote according to the instructions of the
Group Policyholder in proportion to its interest in the Variable Sub-Account .
In such event, the Company will send proxy materials and form(s) to the Group
Policyholder for its reply. If no reply is received , the Company will vote
shares of the appropriate Eligible Fund in the same proportion as shares of
the Eligible Fund for which replies have been received .
•
During the Annuity Payment Period under the Participant Annuity Account, the
number of votes will decrease as the assets held to fund annuity payments
decrease, the Payee will be entitled to receive the proxy materials and
form(s) otherwise provided to the Group Policyholder, and all other provisions
concerning Voting Rights will apply to the Payee of a Variable Dollar Method
of Payment Option.
The Company will furnish the Group Policyholder or the Payee of a Variable
Dollar Method of Payment Option copies of any shareholder reports of the
Eligible Funds and of any other notices, reports or documents required by law
to be furnished to either of them.
Semi -annual reports of the Eligible Funds will be furnished as requirea by law
to the Group Policyholder, who shall promptly deliver them to each Participant
or Payee of a Variable Dollar Method of Payment Option. The Company will
furnish the Group Policyholder not less frequently than annually a statement
of each Participant's Participant Annuity Account Value, which the Group
Policyholder will promptly deliver to the Participant. The Group Policyholder
may direct the Company to deliver these reports and statements to the
Participants.
Notice and Proof
Any notice or demand by the Company to or upon the Group Policyholoer or any
Payee may be given by mailing it to that person's last known address as stated
in the Company 's file.
An application, report , request, election, direction, notice or demand by the
Group Policyholder or Payee will be made in a form satisfactory to the
Company. When the Company requires it, the Group Policyholder will obtain the
signature of the Participant 's or Payee's spouse on forms provided by the
Company.
The Company may require adequate proof of the age and death of any Payee
before it admits a claim for or pays any payment .
Written materials developed by the Group Policyholder to describe this Group
Annuity Contract must first be approved by the Company.
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PURCHASE PROVISIONS
Commencement and Termination of Coverage
The Group Policyholder may make Application for Coverage of any employee if
the Company is then accepting Applications for Coverage under this Group
Annuity Contract , unless a Date of Cessation of Deposits has been declared .
An employee for whom an adequate Application has been made becomes Covered as
a Participant as of the Participant Effective Date. Coverage of a Participant
terminates upon the Group Policyholder' s Surrender or Partial Surrender which
results in a Participant Annuity Account Value of $0.
Contributions
Unless a Date of Cessation of Deposits has been declared, the Group
Policyholder may from time to time pay Contributions in cash in respect of a
Participant until the earlier of his/her Death, Annuity Commencement Date, or
the Surrender of the Participant Annuity Account .
The amount of Contributions to be paid by the Group Policyholder in respect of
any Participant will be determined by the Group Policyholder.
The Group Policyholder will report the amount paid as Contributions on forms
acceptable to the Company. The Group Policyholder' s report is conclusive and
binding on it and any person or entity claiming an interest under the Group
Annuity Contract or any Participant Annuity Account. When the Group
Policyholder' s report does not coincide with the Contributions received, the
Company may return them.
Allocation of Contributions
After an adequate application in respect of a Participant has been made,
Contributions, less Premium Tax , if any, will be Allocated in the Participant
Annuity Account when received by the Company at its Administrative Offices.
Contributions in respect of the Participant will be Allocated among any number
of currently offered Variable and Guaranteed Sub-Accounts in accordance with
the latest recorded Written Request of the Group Policyholder in respect of
the Participant.
The Allocation of Contributions may be Changed at any time upon the Company's
receipt at its Administrative offices of the Written Request of the Group
Policyholder in respect of the Participant. A Change of Allocation will be
effective for Contributions which are received after the Company ' s receipt and
recording of the Change.
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CONTRACT VALUE PROVISIONS
Variable Contract Value
The Variable Contract Value in respect of the Participant on any date during
the Accumulation Period will be the sum of the values of the Variable
Sub-Accounts of the Series Account held in respect of the Participant.
The value of a Group Policyholder's interest in a Variable Sub-Account in
respect of a Participant will be determined by multiplying the number of
Accumulation Units held in respect of the Participant for that Variable
Sub-Account by the Accumulation Unit Value for that Variable Sub-Account.
Accumulation Unit
Contributions and Transfers received at the Administrative Offices of the
Company before the close of a Valuation Date will be allocated as requested
and applied as of that date, otherwise as of the next Valuation Date, to
provide Accumulation Units of the selected Variable Sub-Accounts of the Series
Account.
The number of Accumulation Units credited in respect of each Participant to a
Variable Sub-Account will be determined by dividing the amount of the
Contributions and Transfers then applied to such Variable Sub-Account by the
Accumulation Unit Value for that Variable Sub-Account on the Valuation Date on
which the Contributions were allocated and Transfers were made.
The number of Accumulation Units will not change because of a later change in
the Accumulation Unit Value, but the Accumulation Unit Value will vary to
reflect the investment experience of the Variable Sub-Account .
Accumulation Unit Value
The initial Accumulation Unit Value of each Variable Sub-Account was
established at $10 on the date a Deposit was first made to the Variable
Sub-Account.
The Accumulation Unit Value of a Variable Sub-Account on any subsequent
Valuation Date is equal to the Accumulation Unit Value of that Variable
Sub-Account as of the immediately preceding Val uation Date multiplied by the
Net Investment Factor for the Valuation Period ending on the Valuation Date on
which the Accumulation Unit Value is being determined.
The Accumulation Unit Value may increase, decrease , or remain unchanged as a
result of the value of the Net Investment Factor.
Annuity Unit Value
The initial Annuity Unit Value of each Variable Sub-Account was established at
$1 on the date a Deposit was first made under a Variable Annuity Method of
Payment to the Variable Sub-Account(s) .
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CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Annuity Unit Value (continued)
The Annuity Unit Value of any Variable Sub-Account on any subsequent Valuation
Date is equal to the Annuity Unit Value for the immediately preceding
Valuation Date multiplied by the Net Investment Factor for that Variable
Sub-Account for the Valuation Period ending on the Valuation Date on which the
Annuity Unit Value is-being determined, and multiplying the result by a factor
of .999905 to neutralize the assumed investment rate of 3.5% per year used in
the applicable Table for Variable Dollar Method of Payment Options 1 , 2, 3,
and 4.
Net Investment Factor
The Net Investment Factor for any Variable Sub-Account for any Valuation
Period is determined by dividing (a) by (b) , and subtracting (c ) from the
result where:
(a) is the net result of:
(i ) the net asset value per share of the Eligible Fund shares held in
the Variable Sub-Account determined as of the end of the current
Valuation Period, plus
(ii) the per share amount of any dividend (or, if applicable, capital
gain distributions) made by the Eligible Fund on shares held in
the Variable Sub-Account if the "ex-dividend" date occurs during
the current Valuation Period , minus or plus
(iii) a per unit charge or credit for any taxes incurred by or reserved
for in the Variable Sub-Account , which is determined by the
Company to have resulted from the investment operations of the
Variable Sub-Account .
(b) is the net result of:
( i) the net asset value per share of the Eligible Fund shares held in
the Variable Sub-Account determined as of the end of the
immediately preceding Valuation Period, minus or plus,
(ii ) the per unit charge or credit for any taxes incurred by or
reserved for in the Variable Sub-Account for the immediately
preceding Valuation Period .
(c) is a factor representing the Risk Charge deducted from each Variable
Sub-Account on a daily basis. Such factor is equal to of 1 .25% on an
annual basis of the daily net asset value of each Variable Sub-Account.
The Net Investment Factor may be greater than, less than, or equal to one.
Therefore, the Accumulation Unit Value may increase, decrease or remain
unchanged.
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CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Net Investment Factor (continued)
The per share amount of any dividend referred to in paragraph (a) lii ) includes
a deduction for an investment advisory fee. This fee compensates the
investment adviser for services provided to the Eligible Fund. The fee may
differ between Eligible Funds and may be renegotiated each year, but will
never exceed an annual rate of 1 .00% of the aggregate average daily net assets
of the Eligible Fund.-
Risk Charge
The Company will deduct the Risk Charge for expense and mortality guarantees
in the calculation of the Net Investment Factor. This Charge is equal to
1.25% on an annual basis of the daily,net asset value of each Variable
Sub-Account. This deduction is made daily .
Guaranteed Contract Value •
The Guaranteed Contract Value of a Participant Annuity Account on any date
during the Accumulation Period will be the sum of the values of the Guaranteed
Sub-Accounts credited to such Participant Annuity Account.
The Company may offer one or more Guaranteed Sub-Accounts into which
Contributions will be Deposited at the Written Request of the Group
Policyholder in respect of the Participant in accordance with the Allocation
of Contributions provisions.
Guaranteed Sub-Account Riders
The computation of the value of a Guaranteed Sub-Account is descrioed in
greater detail in the attached Guaranteed Sub-Account Riders, if any.
Asset Management Fee
On the first day of each Calendar Year an Asset Management Fee to be assessed
against Guaranteed Contract Values will be declared by the Company. The
amount to be deducted from the Guaranteed Contract Values will be determined
and applied by the Company on the first day of each calendar quarter.
Variable and Guaranteed Contract Value Provisions
The following Charges are applicable to the Variable and Guaranteed Contract
Values.
Contract Maintenance Charge
On the first day of each calendar year, a Contract Maintenance Charge of not
more than $60 annually will be deducted from the Participant Annuity Account .
If a Participant Annuity Account is established in respect of a Participant
after that date, a Contract Maintenance Charge will be deducted on the first
day of the next quarter and will be pro-rated for the year remaining. No
refund of this Charge will be made.
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CON1RACT VALUE PROVISIONS (continued)
Variable and Guaranteed Contract Value Provisions (continued )
Contract Maintenance Charge (continued)
The deduction will be pro-rated among the Variable and Guaranteed Sub-Accounts
based upon their Variable and Guaranteed Sub-Account values on the date of
deduction. Whenever a deduction for a Contract Maintenance Charge is to be
made from a Variable Sub-Account, the Company will cancel Accumulation Units
having a total value equal to the amount of the deduction.
Transfer Charge
With the exception of the first two Transfers in a calendar year, a Transfer
Charge of $10 per Transfer will be deducted from the Participant Annuity
Account after the Transfer.
•
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TRANSFERS
The Group Policyholder in respect of the Participant may by Written Request
Transfer amounts within and between the currently offered Variable and
Guaranteed Sub-Accounts.
Transfer Terms
The following provisions will apply to any Transfer:
• a Transfer will take effect on the later of the date Elected or the date
the Written Request is received at the Administrative Uffices of the
Company.
• if a Transfer is made within 30 days of the Annuity Commencement Date, the
Company may delay the Annuity Commencement Date by 30 days.
• if a Participant dies prior to the Annuity Commencement Date, one Transfer
may be made after the Death of the Participant by the Group Policyholder
in respect of the Payee to effect the Election of a Method of Payment
Option.
• with the exception of the first two Transfers in a calendar year, a
Transfer Charge of $10 will be deducted.
• when the Company requires it, the Group Policyholder in respect of the
Participant or the Payee will execute forms provided by the Company as
necessary to the requested Transfer.
• no Transfers are permitted after the Annuity Commencement Date.
• a Transfer will be subject to terms described in greater detail in the
attached Guaranteed Sub-Account Riders, if any.
No Receipt of Transferred Amounts
No Transfer made within these Transfer Provisions will result in the
Participant ' s receipt of the Transferred amounts, which shall continue to be
held under the Participant Annuity Account.
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RETIREMENT PROVISIONS
On the Company's receipt of the Written Request at least 30 days before the
Annuity Commencement Date , the Group Policyholder in respect of the
Participant may in the Written Request:
• Elect or Change a Method of Payment Option.
• make a Partial Surrender or Surrender.
• Elect or Change the Participant's Annuity Commencement Date to any future
date which is not later than the first of the month after the month the
Participant must retire under the terms of the Plan. If any Annuity
Commencement Date would be less than 30 days from the date that the
Written Request is received, the Company may delay the Annuity
Commencement Date Elected by 30 days.
• if the Group Policyholder in respect of the Participant has failed to
Elect a Method of Payment Option within 30 days of his/her Annuity
Commencement Date, the Company will pay the Group Policyholder in respect
of the Participant a Variable Life Annuity with 10 Year Guaranteed Period
from the Variable Contract Value and a Fixed Life Annuity with 10 Year
Guaranteed Period from the Guaranteed Contract Value.
Adequate Proof
The Company is entitled to require the receipt of adequate proof of age,
death, or any other event or contingency , or to establish the fact that a
benefit has become payable under the provisions of the Plan, prior to making
any payment under this Group Annuity Contract .
Payment On Retirement
Payment under the Retirement Provisions will only be made if then available to
the Participant under the terms and provisions of the Plan as determined by
the Group Policyholder, and will only be made to the Group Policyholder or to
the order of the person designated in the Written Request by the Group
Policyholder to receive payment.
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PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER
Amount Payable On Death of Participant
If the Participant dies before the Annuity Commencement Date , the Amount
Payable on Death will be:
(a) where Death occurs before the Participant's 70th birthday, the greater of:
(i ) the Participant Annuity Account Value , less Premium Tax , if any,
and
(ii ) the sum of Contributions paid to, less any Partial Surrenders made
from, the Participant Annuity Account , less Premium Tax , if any .
(b) where Death occurs on or after the Participant's 70th birthday, the
Participant Annuity Account Value, less Premium Tax , if any.
The Payee of an Amount Payable on Death may Elect that payment be made under
the Methods of Payment Provisions, a combination of the Partial Surrender and
Methods of Payment Provisions, or under the Surrender Provisions. If the
Payee Elects either a Partial Surrender or the Surrender of the Participant
Annuity Account, the Contingent Deferred Sales Charge of the Partial Surrender
or Surrender provisions will not apply. The Election of the Payee must be
made not later than 60 days after the date the Company receives Adequate Proof
of the Participant 's Death. If no Election is made, a single payment will be
made under the Surrender provisions to the Payee. The Contingent Deferred
Sales Charge will not apply to this single payment .
Partial Surrender
By Written Request the Group Policyholder in respect of the Payee may make a
Partial Surrender of the Participant Annuity Account. The Partial Surrender
will take effect on the later of the date Elected and the date the Written
Request is received at the Administrative Offices of the Company. Subject to
the Amount Payable On Death of Participant provision, a Written Request for
Partial Surrender must be received by the Company at least 30 days before the
Annuity Commencement Date.
The Group Policyholder in respect of the Participant must in the Written
Request Elect the Variable or Guaranteed Sub-Account(s) , or a combination of
them, from which the Partial Surrender is made. If an adequate Election is
not made, the Written Request will be returned to the Group Policyholder, and
the Partial Surrender in respect of the Payee will not be made.
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PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER (continued)
Amount Payable On Partial Surrender
The amount payable on Partial Surrender will be paid in one sum under the
Partial Surrender provisions equal to:
(a) the amount requested as the Partial Surrender as of the effective date of
the Partial Surrender, less
(b) the Contingent Deferred Sales Charge, if any, less
(c) Premium Tax , if any.
Surrender
By Written Request the Group Policyholder in respect of the Payee may
Surrender the Participant Annuity Account. The Surrender will take effect on
the later of the date Elected and the date the Written Request is received at
the Administrative Offices of the Company. If an adequate Written Request is
not made, the Written Request will be returned to the Group Policyholder and
the Surrender will not be made. Subject to the Amount Payable On Death of
Participant provision, a Written Request for Surrender must be received by the
Company at least 30 days before the Annuity Commencement Date.
Amount Payable on Surrender
The Amount Payable on Surrender may be Applied under the Methods of Payment
Provisions or will be paid in one sum under these Surrender provisions equal
to:
(a) the Participant Annuity Account Value as of the effective date of the
Surrender, less
(b) the Contingent Deferred Sales Charge, if any, less
(c) Premium Tax , if any.
Contingent Deferred Sales Charge
Subject to the Amount Payable On Death of Participant provision, on any
Partial Surrender or the Surrender of the Participant Annuity Account a •
Contingent Deferred Sales Charge will be deducted from the Amount Surrendered.
The Contingent Deferred Sales Charge applicable to any Partial Surrender or
the Surrender will be equal to 6% of the Amount Surrendered in excess of the
Contingent Deferred Sales Charge Free Amount , if any , and is limited so that
the amount then charged will not cause the cumulative total of all Contingent
Deferred Sales Charges charged in respect of the Participant under his/her
Participant Annuity Account to exceed 6% of the Contributions made to his/her
Participant Annuity Account within 72 months prior to the effective date of
the Partial Surrender or the Surrender.
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PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER (continued)
Contingent Deferred Sales Charge Free Amount
The Amount of the Contingent Deferred Sales Charge Free Amount is equal to 10%
of the Participant Annuity Account Value at December 31 of the calendar year
prior to the year in which the Amount is Surrendered .
Only one Contingent Deferred Sales Charge Free Amount is available in respect
of a Participant in each calendar year beginning in the third calendar year
after he/she is Covered under this Group Annuity Contract . The Contingent
Deferred Sales Charge Free Amount will be Applied on the Surrender or the
first Partial Surrender made under the Participant Annuity Account in that
year for the payment of benefits as a result of financial hardship , as defined
in the Plan and approved by the Group Policyholder.
Adequate Proof
The Company is entitled to require the receipt of adequate proof of age,
death, or any other event or contingency , or- to establish the fact that a
benefit has become payable under the provisions of the Plan, prior to making
any payment under this Group Annuity Contract .
Payment On Death, Partial Surrender, and Surrender
Payment under any of the Provisions Relating to Amount Payable On Death,
Partial Surrender, and Surrender will only be made if then available to the
Payee under the terms and provisions of the Plan as determined by the Group
Policyholder, and will only be made to the Group Policyholder or to the order
of the person designated in the Written Request by the Group Policyholder to
receive payment.
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METHODS OF PAYMENT PROVISIONS
One of the Variable or Fixed Dollar Methods of Payment Options or a
combination of them may be Elected under the Methods of Payment Provisions.
Mount To Be Applied
The Mount to be Applied under the Methods of Payment Provisions is the
Participant Annuity Account Value less Premium Tax , if any.
If a Variable Dollar Method of Payment Option is Elected, the Mount to be
Applied is the Variable Contract Value as of the date the Mount of the First
Monthly Payment is determined.
If a Fixed Dollar Method of Payment Option is Elected, the Mount to be
Applied is the Guaranteed Contract Value as of the Annuity Commencement Date.
If the Group Policyholder in respect of the Payee Elects to Apply any or all
of the Guaranteed Contract Value to a Variable Dollar Method of Payment
Option, or any or all of the Variable Contract Value to a Fixed Dollar Method
of Payment Option, a Transfer(s) must be made prior to the Annuity
Commencement Date. The Transfer(s) must comply with the provisions on
Transfers.
Variable Dollar Method of Payment
The following Variable Dollar Method of Payment Options are available. They
are subject to the following provisions
Mount of First Monthly Payment
The First Monthly Payment under a Variable Dollar Method of Payment Option
will be based on the Variable Contract Value credited in respect of the
Participant Annuity Account on the 5th Valuation Date preceding the Annuity
Commencement Date. It will be determined by applying the appropriate rate
from the applicable Table to the Mount Applied under the Option. The First
Monthly Payment will be the sum of the variable dollar annuity payments for
each Variable Sub-Account.
Annuity Units
The number of Annuity Units for each Variable Sub-Account to be credited in
respect of the Participant Annuity Account will be determined by dividing the •
portion of the First Monthly Payment to be taken from such Sub-Account by the
Sub-Account 's Annuity Unit Value on the 5th Valuation Date preceding the date
the First Payment is due for which the number of Annuity Units is being
computed. The number of Annuity Units for a Variable Sub-Account remains
fixed during the Annuity Payment Period.
- 20 -
C (-
METHODS OF PAYMENT PROVISIONS (continued)
Amount of Monthly Payments After the First
Monthly Payments After the First under a Variable Dollar Method of Payment
Option will vary in amount from time to time depending upon the investment
experience of the Variable Sub-Accounts of the Series Account.
The dollar amount of each variable dollar annuity payment to the Participant
or Payee after the first for each Variable Sub-Account is determined by
multiplying (a) the number of Sub-Account Annuity Units credited to the
Participant Annuity Account by (b) the Sub-Account Annuity Unit Value on the
5th Valuation Date preceding the date the annuity payment is due. The total
dollar amount of each variable dollar annuity payment will be the sum of the
variable dollar annuity payments for each Variable Sub-Account .
The Company guarantees that the dollar amount of each Payment After the First
will not be affected by variations in expenses or mortality experience.
Variable Dollar Method of Payment Options
Option 1 : Variable Life Annuity with Guaranteed Period
The Company will pay a monthly payment for the guaranteed Annuity Payment
Period Elected. Payments will continue for the lifetime of the Payee. The
guaranteed Annuity Payment Period elected may be 5, 10, 15 or 20 years. The
provision on Settlement applies to amounts payable after the death of the
Payee. Table A is applicable to this Option.
Option 2:- Variable Life Annuity
The Company will pay a monthly payment during the Payee's lifetime. Table A
is applicable to this Option.
Option 3: Joint and One-Half Survivor Variable Annuity
A joint and one-half survivor variable annuity provides a variable monthly
payment to an Annuitant for his/her lifetime; thereafter, and upon receipt by
the Company of adequate proof of the Annuitant 's death, one-half of the
variable payment amount continues to a designated Payee, if living, and
terminates upon his/her death. Table B is applicable to this Option.
Option 4 : Any Other Form
The Company will pay any other form of Variable Annuity which is acceptable to
it.
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METHODS OF PAYMENT PROVISIONS (continued)
Fixed Dollar Method of Payment
The following Fixed Dollar Method of Payment Options are available. They are
subject to the following provisions.
Amount of Payment
Payments under a Fixed Dollar Method of Payment Option are guaranteed by the
Company as to dollar amount throughout the Annuity Payment Period .
The Amount of the Payment under any Fixed Dollar Method of Payment Option will
be determined by applying the Company 's then current non-participating group
single premium rates for this class of group annuity contracts to the Amount
Applied under the Option. Those current rates will not be less than the rate
obtained from the Table which is Applicable to the Elected Option.
Fixed Dollar Method of Payment Options:
Option 1 : Income of Specified Amount
The Company will pay an income, at 12-, 6-, 3-, or 1-month intervals, of an
amount Elected by the Payee for an Annuity Payment Period of not less than 36
months nor more than 240 months. The provision on Settlement applies to
amounts payable after the death of the Payee. Table C is applicable to this
Option.
Option 2: Income for a Specified Period
The Company will pay an income, at 12-, 6-, 3-, or 1 -month intervals, for the
number of years Elected by the Payee for an Annuity Payment Period of not less
than 36 months nor more than 240 months. The provision on Settlement applies
to amounts payable after the death of the Payee. Table C is applicable to
this Option.
Option 3: Fixed Life Annuity with Guaranteed Period
The Company will pay a monthly payment for the guaranteed Annuity Payment
Period Elected. Payments will continue for the lifetime of the Payee. The
provision on Settlement applies to amounts payable after the death of the
Payee. Table D is applicable to this Option.
The guaranteed Annuity Payment Period elected may be 5, 10, 15 or 20 years, or
may be a period referred to as " Installment Refund". Under the Installment
Refund period , payments will be made until the total of the Payments made
equals the Amount Applied.
Option 4 : Fixed Life Annuity
The Company will pay a monthly payment during the Payee's lifetime. Table D
is applicable to this Option.
- 22 -
METHJDS OF PAYMENT PROVISIONS (continued)
Fixed Dollar Method of Payment Options: (continued)
Option 5 : Joint and One-Half Survivor Fixed Annuity
A joint and one-half survivor fixed annuity provides a fixed monthly payment
to an Annuitant for his/her lifetime; thereafter, and upon receipt by the
Company of adequate proof of the Annuitant 's death, one-half of the fixed
payment amount continues to a designated Payee, if living, and terminates upon
his/her death. Table _E is applicable to this Option.
Option 6 : Any Other Form:
The Company will pay any other form of Fixed Annuity which is acceptable to it.
How to Elect Method of Payment Option
The Written Request of the Group Policyholder in respect of the Participant or
Payee is required to Elect , or Change the Election of , a Method of Payment
Option and must be received by the Company at least 30 days prior to the
Annuity Commencement Date , or, if the Participant dies prior to the Annuity
Commencement Date, within 60 days of the date the Company receives Adequate
Proof of the Participant 's Death.
Availability of Options
If any payment to be made under the Elected Option will be less than $50, the
Company may make the payments in the most frequent interval which produces a
payment of at least $50.
The minimum Amount that may be Applied under a Variable or Fixed Dollar Method
of Payment Option is 92,000. If the amount is less than 92,000, the Company
may pay it in one sum.
The maximum Amount that may be Applied under any Option is $1 ,000,000. For
the Application of any greater Amount , the Company 's consent is required .
Settlement
If the Payee has received payments or was to receive payments which had not
yet commenced under Variable Dollar Method of Payment Options 1 or 4, or under
Fixed Dollar Method of Payment Options 1 , 2, 3 or 6, any remaining amounts
payable under the Option Elected will be paid to the Group Policyholder or
other Payee designated by the Group Policyholder.
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C C
CONTRACT MODIFICATION
This Group Annuity Contract may be Modified at any time by written agreement
between the Company and the Group Policyholder. No such Modification will ,
without the written consent of the Group Policyholder, affect the terms,
provisions, or conditions of this Group Annuity Contract which are or may be
applicable to Contributions paid in respect of Participants prior to the date
of such Modification.
However, the Company may at any time and without the consent of the Group
Policyholder or any Participant or other person, but upon 30 days' written
notice to the Group Policyholder, Modify this Group Annuity Contract in any
respect to conform it to changes in tax or other law, including applicable
regulations or rulings.
Modification of Tables
The Company may at any time and without the consent of the Group Policyholder
or any Particiant or other person, but upon 30 days written notice to the
Group Policyholder, Modify Tables A, B, C, D, and E, or any of them. However,
no such Modification will affect the terms, provisions or conditions of the
Group Annuity Contract which are or may be applicable to Contributions paid in
respect of Participants prior to the date of such Modification.
Modification of Guaranteed Sub-Account Riders, If Any
Any Guaranteed Sub-Account Rider may be Modified at any time by written
agreement between the Company and the Group Policyholder. No such
Modification will , without the written consent of the Group Policyholder,
affect the terms, provisions, or conditions of the Rider which are or may be
applicable to Contributions paid in respect of Participants prior to the date
of such Modification.
Modification of Offering of Guaranteed Sub-Accounts
Notwithstanding the other Contract Modification provisions, the Company may
offer or cease offering Guaranteed Sub-Accounts to receive Deposits. No such
offering or cessation of offering shall affect the terms, provisions, or
conditions which are or may be applicable to Contributions paid to any
Guaranteed Sub-Account which is no longer offered by the Company. The Company
will periodically notify the Group Policyholder in respect of Participants of
the current offering of Guaranteed Sub-Accounts.
Modification of Interest Guarantee Period
Notwithstanding the other Contract Modification provisions, the Interest
Guarantee Period of amounts Deposited into Guaranteed Sub-Accounts, if any,
may be Modified by the Company in accordance with the Interest Guarantee
Period Modification provisions as described in greater detail in the attached
Guaranteed Sub-Account Riders, if any.
- 24 -
C C .
CESSATION OF DEPOSITS
Upon 60 days' written notice to the other, the Group Policyholder or the
Company may declare that , as from the date stated in the notice (that date
being called a Date of Cessation of Deposits), no further Deposits will oe
made to certain or all Sub-Accounts of the Group Annuity Contract .
If a Date of Cessation of Deposits has been declared for certain Sub-Accounts,
the Group Policyholder in respect of the Participant may by Written Request
make a Change of Allocation of his/her Contributions. When no Change of
Allocations is received , the Company may return all Contributions affected by
the declaration of the Date of Cessation of Deposits, or allocate such
Contributions to a currently offered Guaranteed Sub-Account .
After the Date of Cessation of Deposits declared in respect of all
Sub-Accounts, no Participant Annuity Account will be established .
Options on Date of Cessation of Deposits
Upon declaring the Date of Cessation of Deposits for all Sub-Accounts or upon
receiving notice of its declaration by the Company, the Group Policyholder may
by Written Request Elect one of the following Cessation Options. If the Group
Policyholder has not Elected a Cessation Option within 30 days of the Date of
Cessation, Cessation Option (1 ) will be deemed to have been Elected .
Cessation Option (1 ) Maintenance of Each Participant Annuity Account Value:
The Company will maintain each Participant Annuity
Account Value until it is Applied or paid under the
Group Annuity Contract .
Cessation Option (2) Installment Settlement of Guaranteed Contract Values:
The Company will pay the sum of the Variable Contract
Values in respect of Participants as of the Date of
Cessation of Deposits to a person designated in writing
by the Group Policyholder as the successor insurer of
the Plan or to the Group Policyholder within 30 days of
the date the Cessation Option is Elected.
The Company will pay the sum of the Guaranteed Contract
Values in respect of Participants as of the Date of
Cessation of Deposits to a person designated in Writing
by the Group Policyholder as the successor insurer of
the Plan or to the Group Policyholder in 20 equal
quarterly installments. The amount of the installments
will be the amount determined by the Company on the date
of the first such payment, but not less than $514.80 for
each $10,000 of Guaranteed Contract Values. The first
payment will be made 30 days after the date the
Cessation Option is Elected.
- 25 -
C . C
TABLE A - Variable Life Annuity
Monthly Payment for Each $1 ,000
of Participant Annuity Account Value
Age of Without With Guaranteed Period
Payee Guaranteed Period 5 Years 10 Years 15 Years 20 Years
50 3.83 3.83 3.82 3.80 3.78
55 4.13 4. 12 4.10 4.07 4.02
60 4.52 4.51 4.48 4. 41 4. 31 .
65 5.06 5.04 4.97 4.84 4.64
70 5.82 5.77 5.61 5.33 4.94
75 6.93 6.80 6.41 5.82 5.19
If payments commence on any other date than the exact age of the Payee as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in Determining the above amounts.
•
- 26 -
C •
C
TABLE B - Joint and One-Half Survivor Variable Annuity
Monthly Payment for Each $1 ,000
of Participant Annuity Account Value
Age of If Designated Payee Is Age
Annuitant 50 55 60 65 70 75
-
50 3.72 3.75 3.78 3.80 3.81 3.82
55 3.92 3.98 4.02 4.06 4.08 4.10
•
60 4.16 4.25 4.33 4.39 4.44 4.47
65 4. 45 4.58 4.70 4.81 4.89 4.95
70 - 4.79 4.96 5.14 5.32 5.47 5.59
75 5.18 5.42 5.67 5.94 6.20 6.44
If payments commence on any other date than the exact age of the Annuitant or
designated Payee as shown above, the amount of the monthly payment shall be
determined by the Company on the actuarial basis used by it in determining the
above amounts.
- 27 -
C C
TABLE C - Income of Specified Amount
- Income of a Specified Period
Monthly Payment for Each $1 ,000
of Participant Annuity Account Value
Years Payment
3 27.44
4 20.93
5 17 .03
6 14.43
7 12.57
8 11 .18
9 10.11
10 9.24
11 8.54
12 7 .96
13 7.46
14 7 .04
15 6.68
16 6.36
17 6.08
18 5.83
19 5.61
20 5.41
To determine the payment for other frequencies of payment, multiply the above
monthly payment by the following factors:
Factor
Quarterly payment 2.99
Semi -annual payment 5.96
Annual payment 11 .81
If payments are for an amount or duration different than that outlined above,
the Company will determine the proper amount or duration using the actuarial
basis used to determine the above Table.
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C C
• TABLE D - Fixed Life Annuity
Monthly Payment for Each $1 ,000
of Participant Annuity Account Value
Age of Without With Guaranteed Period
Payee Guaranteed Period 5 Years 10 Years 15 Years 20 Years
50 3.83 3.83 3.82 3.80 3.78
55 4.13 4.12 4.10 4.07 4.02
60 4.52 4.51 4.48 4. 41 4. 31
65 5.06 5.04 4.97 4.84 4.64
70 • 5.82 5.77 5.61 5.33 4.94
75 6.93 6.80 6.41 5.82 5.19
If payments commence on any other date than the exact age of the Payee as
shown above, the amount of the monthly payment shall be determined by the
Company on the actuarial basis used by it in determining the above amounts .
- 29 -
( C
TABLE E - Joint and One-Half Survivor Fixed Annuity
Monthly Payment for Each $1 ,000
of Participant Annuity Account Value
Age of If Designated Payee Is Age
Annuitant 50 55 60 65 70 75
50 3.72 3.75 3.78 3.80 3.81 3.82
55 3.92 3.98 4.02 4.06 4.08 4.10
60 4.16 4.25 4.33 4.39 4.44 4.47
65 4. 45 4.58 4.70 4.81 4.89 4.95
70 4.79 4.96 5.14 5.32 5.47 5.59
75 5.18 5.42 5.67 5.94 6.20 6.42
If payments commence on any other date than the exact age of the Annuitant or
designated Payee as shown above, the amount of the monthly payment shall be
determined by the Company on the actuarial basis used by it in determining the
above amounts.
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C C
DAILY INTEREST GUARANTEE FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF
THE GROUP ANNUITY CONTRACT
The Daily Interest Guarantee Fund is a Guaranteed Sub-Account. Contributions
may be Deposited into the Daily Interest Guarantee Fund at any time. Interest
will be earned on the Daily Interest Guarantee Fund value and compounded
daily. The Credited Interest Rate may change daily but on an annual effective
basis will not be less than the Guaranteed Interest Rate.
Value of Daily Interest Guarantee Fund
The value of the Daily Interest Guarantee Fund in respect of the Participant
will be determined by adding his/her Guaranteed Sub-Account Contributions,
interest, and Transfers from other Guaranteed Sub-Accounts and from Variaule
Sub-Accounts, and subtracting his/her Partial Surrenders, Surrenders, Amounts
Payable on Death, Amounts Applied under a Method of Payment Option, Transfers
to other Guaranteed Sub-Accounts and to Variable Sub-Accounts, Transfer
Charges, Contract Maintenance Charge, Asset Management Fee, and Premium Tax.
This Rider, unless and until Modified , forms part of the Group Annuity
Contract .
Daily Interest Guaranteed Fund Rider - 1
C C
GUARANTEED CERTIFICATE FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
The Guaranteed Certificate Fund is a Guaranteed Sub-Account, whereby Credited
Interest Rates, not less than the Guaranteed Interest Rate, are credited to
Deposits held for varying Interest Guarantee Periods. The Company may offer
Certificates to the Group Policyholder who may by Written Request Allocate any
Deposit in respect of the Participant to any one Certificate. The Group
Policyholder in respect of the Participant may Allocate Deposits only to those
Certificates currently being offered by the Company.
If the Group Policyholder in respect of the Participant Allocates
Contributions to Certificates not currently offered by the Company , the
Company may return such Contributions, Allocate such Contributions to a
currently offered Certificate, or Allocate such Contributions to another
currently offered Guaranteed Sub-Account.
DEF IN IT IONS
Certificates - represents the amount Depositea into the
Guaranteed Certificate Fund under each
Interest Guarantee Period. Each Certificate
has its own interest rate and Term.
Term - the duration of the Certificate which begins
on the first day of the calendar quarter
following the date of the Deposit and ends on
the date specified by the Company. The number
of Terms available may be limited by the
Company.
Certificate Maturity Date - the last day of the Term.
Interest Guarantee Period - the period from the date of the Deposit to the
Certificate Maturity Date.
Credited Interest Rate
Subject to the provisions on Application of Certificate on Partial Surrender,
Surrender, or Retirement , a Deposit to the Guaranteed Certificate Fund will
earn a Credited Interest Rate for the Certificate's Interest Guarantee
Period. The Credited Interest Rate will be compounded daily , and on an annual
effective basis will not be less than the Guaranteed Interest Rate.
Certificate Maturity
Prior to the Certificate Maturity Date, the Company will offer a Guaranteed
Sub-Account into which the value of the Certificate will be Deposited on its
Maturity Date. The Guaranteed Sub-Account so offered may be either the.
Guaranteed Certificate Fund or another Guaranteed Sub-Account .
Guaranteed Certificate Fund Rider - 1
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
If the Guaranteed Certificate Fund is offered , the value of the Certificate on
its Maturity Date will establish a new Certificate which has its own interest
rate and Term. The Credited Interest Rate of this new Certificate may be
higher or lower than the Credited Interest Rate of any other Certificate or
Deposit.
If another Guaranteed Sub-Account is offerea, the value of the Certificate on
its Maturity Date will be Deposited into that Guaranteed Sub-Account. The
Credited Interest Rate of this Deposit may be higher or lower than the
Credited Interest Rate of any other Deposit.
The Participant may Elect by Written Request to Transfer the value of the
Certificate on its Maturity Date.
Interest Guarantee Period Modification
On 30 days' written notice to the Group Policyholder in respect of the
Participant the Company may Modify the Interest Guarantee Perioa of amounts
previously Deposited into the Guaranteed Certificate Fund .
If such Modification is made, the Group Policyholder in respect of the
Participant may, within 30 days of notification, by Written Request Elect the
Transfer or Surrender of any or all of these amounts without incurring the
Contingent Deferred Sales Charge, and interest will be applied to the date of
Transfer or Surrender at the Credited Interest Rate applicable prior to the
date of Modification.
Transfers
The following provisions will apply to the Transfer of amounts to or from the
Guaranteed Certificate Fund:
• if any amount has been Transferred out of the Guaranteed Certificate Fund,
no Transfer into the Guaranteed Certificate Fund may be made for 90
continuous days from the date of the Transfer out.
• a Transfer from the Guaranteed Certificate Fund may be made only on the
Maturity Date of the Certificate under the Guaranteed Certificate Fund.
The amount that is then available for Transfer is the value of that
Certificate on its Maturity Date.
• the Group Policyholder's Written Request to Transfer from the Guaranteea
Certificate Fund must be received by the Company no later than 15 days
prior to the Maturity Date of the Certificate.
• the terms of the provisions on Transfers will apply to any Transfer to or
from the Guaranteed Certificate Fund .
Guaranteed Certificate Fund Rider - 2
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
Application of Certificate On Death, Partial Surrender, Surrender, or
Retirement
If any amount Deposited into a Certificate of the Guaranteed Certificate Fund
is Applied prior to the Maturity Date of the Certificate under the provisions
concerning Amount Payable On Death of Participant, Partial Surrender,
Surrender, or Retirement the Amount Applied will receive the Credited Interest
Rate from the date of Deposit to the date the Amount is Applied.
Value of Guaranteed Certificate Fund
The value of the Guaranteed Certificate Fund in respect of the Participant
will be determined by adding his/her Guaranteed Sub-Account 's Contributions,
interest, and Transfers from other Guaranteed Sub-Accounts and from Variable
Sub-Accounts, and subtracting his/her Partial Surrenders, Surrenders, Amounts
Payable on Death, Amounts Applied under a Method of Payment Option, Transfers
to other Guaranteed Sub-Accounts and to Variable Sub-Accounts, Transfer
Charges, Contract Maintenance Charge, Asset Management Fee, anu Premium Tax.
This Rider, unless and until Modified , forms part of the Group Annuity
Contract .
Guaranteed Certificate Fund Rider - 3
Hello