SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM
N-8B-2
REGISTRATION STATEMENT OF UNIT INVESTMENT TRUSTS
WHICH ARE CURRENTLY ISSUING SECURITIES
PURSUANT TO SECTION 8(B) OF THE
INVESTMENT COMPANY ACT OF 1940
COVA VARIABLE LIFE ACCOUNT ONE
______________________________________________________________________
(NAME OF UNIT INVESTMENT TRUST)
I. ORGANIZATION AND GENERAL INFORMATION
1. (a) Furnish name of the trust and the Internal Revenue Service Employer
Identification Number.
Cova Variable Life Account One ("Separate Account").
IRS Employer Identification Number: N/A
(b) Furnish title of each class or series of securities issued by the trust.
Modified Single Premium Variable Life Insurance Policy ("Policy").
2. Furnish name and principal business address and ZIP Code and the
Internal Revenue Service Employer Identification Number of each depositor of
the trust.
Cova Financial Services Life Insurance Company ("Company")
One Tower Lane, Suite 3000
Oakbrook Terrace, IL 60181
800-523-1661
IRS Employer Identification Number: 43-1236042
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3. Furnish name and principal business address and ZIP Code and the
Internal Revenue Service Employer Identification Number of each custodian or
trustee of the trust indicating for which class or series of securities each
custodian or trustee is acting.
Not Applicable
4. Furnish name and principal business address and ZIP Code and the
Internal Revenue Service Employer Identification Number of each principal
underwriter currently distributing securities of the trust.
The Policy is not currently being distributed. When such distribution
commences, Cova Life Sales Company will be the "Principal Underwriter."
Cova Life Sales Company ("Life Sales")
One Tower Lane, Suite 3000
Oakbrook Terrace, IL 60181
IRS Employer Identification Number: 36-3324851
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5. Furnish name of state or sovereign power, the laws of which govern with
respect to the organization of the trust.
Missouri
6. (a) Furnish the dates of execution and termination of any indenture or
agreement currently in effect under the terms of which the trust was organized
and issued or proposes to issue securities.
The Separate Account was established pursuant to a resolution of the
Board of Directors of the Company on February 24, 1987, and was designated as
an operational Separate Account on 10/23/91. The Separate Account will
continue in existence until its complete liquidation and the distribution of
its assets to the persons entitled to received them.
(b) Furnish the dates of execution and termination of any indenture or
agreement currently in effect pursuant to which the proceeds of payments on
securities issued or to be issued by the trust are held by the custodian or
trustee.
Not Applicable.
7. Furnish in chronological order the following information with respect
to each change of name of the trust since January 1, 1930. If the name has
never been changed, so state.
The Separate Account has never been known by any other name.
8. State the date on which the fiscal year of the trust ends.
The fiscal year of the Separate Account ends on December 31.
9. MATERIAL LITIGATION. Furnish a description of any pending legal
proceedings, material with respect to the security holders of the trust by
reason of the nature of the claim or the amount thereof, to which the trust,
the depositor, or the principal underwriter is a party or of which the assets
of the trust are the subject, including the substance of the claims involved
in such proceeding and the title of the proceeding. Furnish a similar
statement with respect to any pending administrative proceeding commenced by a
governmental authority or any such proceeding or legal proceeding known to be
contemplated by a governmental authority. Include any proceeding which,
altogether immaterial itself, is representative of, or one of, a group which
in the aggregate is material.
There are no legal proceedings to which the Separate Account or the Principal
Underwriter is a party. The Company is engaged in various kinds of routine
litigation, which in its judgement are not of material importance in relation
to the total capital and surplus of the Company.
II. GENERAL DESCRIPTION OF THE TRUST
AND SECURITIES OF THE TRUST
GENERAL INFORMATION CONCERNING THE SECURITIES OF THE TRUST AND THE RIGHTS OF
HOLDERS.
10. Furnish a brief statement with respect to the following matters for
each class or series of securities issued by the trust:
(a) Whether the securities are of the registered or bearer type;
The Policy which is to issued is of the registered type insofar as the Policy
is personal to the Owner, and the records concerning the Owner are maintained
by the Company.
(b) Whether the securities are of the cumulative or distributive type;
The Policy is of the cumulative type.
(c) The rights of security holders with respect to withdrawal or redemption;
The Owner may make withdrawals from the Policy for its Cash Surrender
Value.
(d) The rights of security holders with respect to conversion, transfer,
partial redemption, and similar matters;
The Owner may transfer a Policy's Account Value from one Sub-Account to
another Sub-Account.
(e) If the trust is the issuer of periodic payment plan certificates, the
substance of the provisions of any indenture or agreement with respect to
lapses or defaults by security holders in making principal payments, and with
respect to reinstatement;
Not Applicable
(f) The substance of the provisions of any indenture or agreement with respect
to voting rights, together with the names of any persons other than security
holders given the right to exercise voting rights pertaining to the trust's
securities or the underlying securities and the relationship of such persons
to the trust;
The underlying securities of the Separate Account are shares issued by:
Cova Series Trust, Lord Abbett Series Fund, Inc. and General American Capital
Company, collectively, the Funds.
The Company will vote the shares held in the Separate Account in
accordance with instructions received from persons having a voting interest in
the Separate Account. The Company will vote shares for which it has not
received instructions in the same proportion as it votes shares for which it
has received instructions. The Company will vote shares it owns in the same
proportion as it votes shares for which it has received instructions.
(g) Whether security holders must be given notice of any change in:
(1) the composition of the assets of the trust;
Notice must be given of any such proposed change.
(2) the terms and conditions of the securities issued by the trust;
Notice must be given of any such proposed change.
(3) the provisions of any indenture or agreement of the trust;
Notice must be given of any such proposed change.
(4) the identity of the depositor, trustee or custodian;
There is no provision requiring notice to or consent of Owners with
respect to any change in the identity of the Separate Account's depositor.
The Company's obligations under the Policy, however, cannot be transferred to
any other entity without notice to the Owner.
(h) Whether the consent of the security holders is required in order for
action to be taken concerning any change in:
(1) the composition of the assets of the trust;
Consent of Owners is not required when substituting the underlying
securities of the Separate Account. However, to substitute such securities,
approval of the Securities and Exchange Commission is required in compliance
with Section 26(b) of the Investment Company Act of 1940. The Company may,
however, add additional Sub-Accounts without the consent of Owners. Except as
required by federal or state law or regulation, no action will be taken by the
Company which will adversely affect the rights of Owners without their
consent.
(2) the terms and conditions of the securities issued by the trust;
No change in the terms and conditions of the Policy can be made without
the consent of the Owners except as required by federal or state law or
regulation.
(3) the provisions of any indenture or agreement of the trust;
Not Applicable.
(4) the identity of the depositor, trustee or custodian;
There is no provision requiring notice to or consent of Owners with
respect to any change in the identity of the Separate Account's depositor. The
Company's obligations under the Policy, however, cannot be transferred to any
other entity without compliance with state insurance law, which may under some
circumstances, require the Owner's consent.
(i) Any other principal feature of the securities issued by the trust or any
other principal right, privilege or obligation not covered by subdivisions (a)
to (g) or by any other item in this form.
In return for the payment of premiums, the Policy provides insurance
coverage on the life of the insured.
The Policy provides for the right to borrow from the Company using the
Policy's Cash Value as collateral.
INFORMATION CONCERNING THE SECURITIES UNDERLYING THE TRUST'S SECURITIES.
11. Describe briefly the kind or type of securities comprising the unit of
specified securities in which security holders have an interest.
The securities held in the Separate Account will be shares of Cova Series
Trust, Lord Abbett Series Fund, Inc. and General American Capital Company, all
of which are open-end, management investment companies of the series type.
12. If the trust is the issuer of periodic payment plan certificates and
if any underlying securities were issued by another investment company,
furnish the following information for each such company:
(a) Name of company;
Cova Series Trust
Lord Abbett Series Fund, Inc.
General American Capital Company
(b) Name and principal business address of depositor;
Cova Financial Services Life Insurance Company is the depositor of the Cova
Series Trust. Its address is: One Tower Lane, Suite 3000, Oakbrook Terrace,
IL 60181.
Lord, Abbett & Co. is the depositor of the Lord Abbett Series Fund, Inc. Its
address is: 767 Fifth Avenue, New York, NY 10153.
General American Life Insurance Company is the depositor of the General
American Capital Company. Its address is: 700 Market Street, St. Louis, MO
63101.
(c) Name and principal business address of trustee or custodian;
Investor's Bank & Trust Company is the custodian for the Cova Series Trust.
Its address is: 89 South Street, Boston, MA 02111.
The Bank of New York is the custodian for the Lord Abbett Series Fund, Inc.
Its address is: 40 Wall Street, New York, NY 10286.
The Bank of New York is the custodian for the General American Capital
Company. Its address is: 40 Wall Street, New York, NY 10286.
(d) Name and principal business address of principal underwriter;
Cova Series Trust and Lord Abbett Series Fund, Inc. distribute their own
shares.
Walnut Street Securities Inc, acts as the principal underwriter for General
American Capital Company.
(e) The period during which the securities of such company have been the
underlying securities.
No underlying securities have yet been acquired by the Separate Account.
INFORMATION CONCERNING LOADS, FEES, CHARGES AND EXPENSES.
13. (a)Furnish the following information with respect to each load, fee,
expense or charge to which: (1) principal payments; (2) underlying securities;
(3) distributions; (4) cumulated or reinvested distributions or income; and
(5) redeemed or liquidated assets of the trust's securities are subject; (A)
the nature of such load, fee, expense, or charge; (B) the amount thereof; (C)
the name of the person to whom such amounts are paid and his relationship to
the trust; (D) the nature of the services performed by such person in
consideration for such load, fee, expense or charge.
1. Principal Payments
MORTALITY AND EXPENSE RISK CHARGE. For the first ten years, the Company
deducts a charge equal, on an annual basis, to 0.90% of the Account Value
allocated to the Separate Account. For the eleventh year and after, the
charge is 0.75%. This compensates the Company for assuming the mortality and
expense risks under the Policy.
ADMINISTRATIVE CHARGE. The Company deducts a charge equal, on an annual
basis, to 0.40% of the Account Value. This compensates the Company for
expenses incurred in the operation of the Separate Account and for
administering the Policy.
TAX EXPENSE CHARGE. This deduction is the sum of the Premium Tax Charge and
the Federal Tax Charge. It is deducted monthly for the first ten years. It
is equal, on an annual basis, to .40% (.15% for Federal Tax Charge and .25%
for Premium Tax Charge) of the Account Value. This compensates the Company
for federal and state tax incurred as a result of issuing the Policy.
COST OF INSURANCE CHARGE. Each month the Company deducts a charge for the
cost of insurance which provides the Death Benefit for the following month.
ANNUAL POLICY MAINTENANCE FEE. Every year on the anniversary of the Policy
Date, Cova deducts $30 as a policy maintenance fee. Under some circumstances,
this charge is waived. This, in addition to the Administrative Charge,
compensates the Company for the administrative expenses incurred.
2. Underlying Securities
The Funds are charged management fees by their respective investment adviser
and incur operating expenses.
3. Distributions
Not Applicable.
4. Cumulated or reinvested distributions or income.
All investment income and other distributions are reinvested in Fund shares at
net asset value.
5. Redeemed or liquidated assets.
SURRENDER CHARGE. The surrender charge is taken out of the Account Value
surrendered during the first ten years which is not part of the Annual
Withdrawal Amount. The Surrender Charges, which are equal to a percent of
Premium surrendered are:
<TABLE>
<CAPTION>
<S> <C>
Policy Year Surrender Charge
- ----------- -----------------
1 7.5%
2 7.5%
3 7.5%
4 6.0%
5 5.0%
6 4.0%
7 3.0%
8 2.0%
9 1.0%
10 + 0%
</TABLE>
This compensates the Company for the expenses incurred in distributing the
Policy.
DEFERRED PREMIUM TAX CHARGE. This charge is assessed on premiums surrendered
from the Policy. It is equal to:
<TABLE>
<CAPTION>
<S> <C>
Policy Year Deferred Premium Tax Charge
- ----------- ----------------------------
1 2.25%
2 2.00%
3 1.75%
4 1.50%
5 1.25%
6 1.00%
7 .75%
8 .50%
9 .25%
10 + 0%
</TABLE>
This charge enables the Company to collect that portion of the Premium Tax
Charge it has not collected before the Policy is surrendered.
(b) For each installment payment type of periodic payment plan certificate of
the trust, furnish the following information with respect to sales load and
other deductions from principal payments.
See response to item 13(a)(1).
(c) State the amount of total deductions as a percentage of the net amount
invested for each type of security issued by the trust. State each different
sales charge available as a percentage of the public offering price and as a
percentage of the net amount invested. List any special purchase plans or
methods established by rule or exemptive order that reflect scheduled
variations in, or elimination of, the sales load, and identify each class of
individuals or transactions to which such plans apply.
(1) The amount of sales load as a percentage of the net amount invested is 0%.
(2) There is no charge deducted from premiums.
(d) Explain fully the reasons for any difference in the price at which
securities are offered generally to the public, and the price at which
securities are offered for any class of transactions to any class or group of
individuals, including officers, directors, or employees of the depositor,
trustee, custodian or principal underwriter.
Not Applicable.
(e) Furnish a brief description of any loads, fees, expenses or charges not
covered in Item 13(a) which may be paid by security holders in connection with
the trust or its securities.
None.
(f) State whether the depositor, principal underwriter, custodian or trustee,
or any affiliated person of the foregoing may receive profits or other
benefits not included in answer to Item 13(a) or 13 (d) through the sale or
purchase of the trust's securities or interests in such securities, or
underlying securities or interests in underlying securities, and describe
fully the nature and extent of such profits or benefits.
None.
(g) State the percentage that the aggregate annual charges and deductions for
maintenance and other expenses of the trust bear to the dividend and interest
income from the trust property during the period covered by the financial
statements filed herewith.
Not Applicable
INFORMATION CONCERNING THE OPERATIONS OF THE TRUST.
14. Describe the procedure with respect to applications (if any) and the
issuance and authentication of the trust's securities, and state the substance
of the provisions of any indenture or agreement pertaining thereto.
A person desiring to purchase a Policy must complete an application on a form
provided by the Company. The Company will underwrite the Policy before it is
issued and, if the applicant meets the underwriting standards of the Company,
the Policy will be issued.
15. Describe the procedure with respect to the receipt of payments from
purchasers of the trust's securities and the handling of the proceeds thereof,
and state the substance of the provisions of any indenture or agreement
pertaining thereto.
When a Policy is purchased, the Company will initially invest the premium in
the Money Market Portfolio. After 15 days (or longer in those states where
required) from the Policy Issue Date, the Company will allocate the Account
Value to the Investment Portfolios as requested in the application.
16. Describe the procedure with respect to the acquisition of underlying
securities and the disposition thereof, and state the substance of the
provisions of any indenture or agreement pertaining thereto.
The Company applies premiums to the purchase of Investment Portfolio shares at
their net asset value. Redemption of Investment Portfolio shares may be made
by the Company to permit the payment of benefits or amounts in connection with
requests for surrender or for other purposes contemplated by the Policy.
17. (a) Describe the procedure with respect to withdrawal or redemption by
security holders.
Any surrender by an owner may be made by communication in writing to the
Company at its service office. Upon written receipt of such request, the
Company will cancel accumulation units in the Policy and redeem Investment
Portfolio shares in sufficient amount to meet any requests. See Item 10.
(b) Furnish the names of any persons who may redeem or repurchase, or are
required to redeem or repurchase, the trust's securities or underlying
securities from security holders, and the substance of the provisions of any
indenture or agreement pertaining thereto.
The Company is required to honor surrender requests as described in Items
10(c) and 17(a). With respect to the Separate Account's underlying
securities, the Investment Options are required to redeem their shares at net
asset value and to make payment therefore within 3 business days.
(c) Indicate whether repurchased or redeemed securities will be canceled or
may be resold.
When there is a total withdrawal from a Policy, it is canceled.
18. (a) Describe the procedure with respect to the receipt, custody and
disposition of the income and other distributable funds of the trust and state
the substance of the provisions of any indenture or agreement pertaining
thereto.
All income and other distributable funds of the Separate Account are
reinvested in Investment Option shares and are added to the assets of the
Separate Account.
(b) Describe the procedure, if any, with respect to the reinvestment of
distributions to security holders and state the substance of the provisions of
any indenture or agreement pertaining thereto.
Not Applicable.
(c) If any reserves or special funds are created out of income or principal,
state with respect to each such reserve or fund the purpose and ultimate
disposition thereof, and describe the manner of handling of same.
Not Applicable.
(d) Submit a schedule showing the periodic and special distributions which
have been made to security holders during the three years covered by the
financial statements filed herewith. State for each distribution the
aggregate amount and amount per share. If distributions from sources other
than current income have been made, identify each such other source and
indicate whether such distribution represents the return of principal payments
to security holders. If payments other than cash were made describe the
nature thereof, the account charged and the basis of determining the amount of
such charge.
No distributions have been made.
19. Describe the procedure with respect to the keeping of records and
accounts of the trust, the making of reports and the furnishing of information
to security holders, and the substance of the provisions of any indenture or
agreement pertaining thereto.
The Company provides confirmations with respect to all premiums received, loan
transactions and any surrenders. The Company also provides each Policy owner
with an annual statement which will show the current amount of death benefit
payable under the Policy, the current Account Value, the current Cash
Surrender Value, current Debt and will show all transactions previously
confirmed. The statement will also show all premiums paid and all charges
deducted during the policy year.
20. State the substance of the provisions of any indenture or agreement
concerning the trust with respect to the following:
(a) Amendments to such indenture or agreement;
Not Applicable.
(b) The extension or termination of such indenture or agreement;
Not Applicable.
(c) The removal or resignation of the trustee or custodian, or the failure of
the trustee or custodian to perform its duties, obligations and functions;
Not Applicable.
(d) The appointment of a successor trustee and the procedure if a successor
trustee is not appointed;
The Separate Account has no trustees.
(e) The removal or resignation of the depositor, or the failure of the
depositor to perform its duties, obligations and functions;
There are no provisions relating to the removal or resignation of the
depositor or the failure of the depositor to perform its duties, obligations
and functions.
(f) The appointment of a successor depositor and the procedure if a successor
depositor is not appointed.
There are no provisions relating to the appointment of a successor
depositor or the procedure if a successor depositor is not appointed.
21. (a) State the substance of the provisions of any indenture or
agreement with respect to loans to security holders.
Policy owners may borrow from the Company using the Policy as the sole
security.
(b) Furnish a brief description of any procedure or arrangement by which loans
are made available to security holders by the depositor, principal
underwriter, trustee or custodian, or any affiliated person of the foregoing.
The following items should be covered.
(1) the name of each person who makes such agreements or arrangements with
security holders;
The Company will make a loan to an Owner with the Policy as the sole
security.
(2) the rate of interest payable on such loans;
The interest rate for a Policy loan is 6% per annum.
(3) the period for which loans may be made;
Loans can be made while the Policy is in force.
(4) costs or charges for default in repayment at maturity;
Not applicable.
(5) other material provisions of the agreements or arrangements;
A policy loan will result in accumulation units being redeemed from
the Investment Portfolios and the proceeds being transferred to the Loan
Account. The Company will pay interest on the Loan Account at an annual rate
of 4.0% (unless a Preferred Loan is in effect which earns 6%). An outstanding
loan reduces the amount of death proceeds and the cash surrender value.
(c) If such loans are made, furnish the aggregate amount of loans outstanding
at the end of the last fiscal year, the amount of interest collected during
the last fiscal year allocated to the depositor, principal underwriter,
trustee or custodian or affiliated person of the foregoing and the aggregate
amount of loans in default at the end of the last fiscal year covered by
financial statements filed herewith.
Not Applicable.
22. State the substance of the provisions of any indenture or agreement
with respect to limitations on the liabilities of the depositor, trustee or
custodian, or any other party to such indenture or agreement.
There is no such provision or agreement.
23. Describe any bonding arrangement for officers, directors, partners or
employees of the depositor or principal underwriter of the trust, including
the amount of coverage and the type of bond.
24. State the substance of any other material provisions of any indenture
or agreement concerning the trust or its securities and a description of any
other material functions or duties of the depositor, trustee or custodian not
stated in Item 10 or Items 14 to 23 inclusive.
The Owner may assign his rights under the Policy. The Owner may change owners
during the life time of the Insured while the Policy is in force.
III. ORGANIZATION, PERSONNEL AND AFFILIATED
PERSONS OF DEPOSITOR
ORGANIZATION AND OPERATIONS OF DEPOSITOR.
25. State the form of organization of the depositor of the trust, the name
of the state or other sovereign power under the laws of which the depositor
was organized and the date of organization.
The Company was incorporated in Missouri in 1981 as a stock life insurance
company.
26. (a) Furnish the following information with respect to all fees
received by the depositor of the trust in connection with the exercise of any
functions or duties concerning securities of the trust during the period
covered by the financial statements filed herewith.
Not Applicable.
(b) Furnish the following information with respect to any fee or any
participation in fees received by the depositor from any underlying investment
company or any affiliated person or investment adviser of such company.
See Item 13(a).
27. Describe the general character of the business engaged in by the
depositor including a statement as to any business other than that of
depositor of the trust. If the depositor acts or has acted in any capacity
with respect to any investment company or companies other than the trust,
state the name or names of such company or companies, their relationship, if
any, to the trust, and the nature of the depositor's activities therewith. If
the depositor has ceased to act in such named capacity, state the date of and
circumstances surrounding such cessation.
The company conducts a life insurance business in all states except
California, Maine, New Hampshire, New York and Vermont and the District of
Columbia. It acts as the depositor of Cova Variable Annuity Account One and
the Cova Series Trust. The portfolios of Cova Series Trust represent some of
the Investment Portfolios under the Policies.
OFFICIALS AND AFFILIATED PERSONS OF DEPOSITOR.
28. (a) Furnish as at latest practicable date the following information
with respect to the depositor of the trust, with respect to each officer,
director, or partner of the depositor, and with respect to each natural person
directly or indirectly owning, controlling or holding with power to vote five
percent or more of the outstanding voting securities of the depositor.
See Item 29.
(b) Furnish a brief statement of the business experience during the last five
years of each officer, director or partner of the depositor.
The directors and executive officers of the Company are listed below:
COMPANIES OWNING SECURITIES OF DEPOSITOR.
29. Furnish as at latest practicable date the following information with
respect to each company which directly or indirectly owns, controls or holds
with power to vote five percent or more of the outstanding voting securities
of the depositor.
The Company is a wholly owned subsidiary of General American Life Insurance
Company.
CONTROLLING PERSONS.
30. Furnish as at latest practicable date the following information with
respect to any person, other than those covered by Items 28, 29, and 42 who
directly or indirectly controls the depositor.
None.
COMPENSATION OF OFFICERS AND DIRECTORS OF DEPOSITOR:
COMPENSATION OF OFFICERS OF DEPOSITOR.
31. Furnish the following information with respect to the remuneration for
services paid by the depositor during the last fiscal year covered by
financial statements filed herewith:
(a) Directly to each of the officers or partners of the depositor directly
receiving the three highest amounts of remuneration.
Not Applicable. As of the date hereof, the Separate Account had not yet
commenced operations.
(b) Directly to all officers or partners of the depositor as a group exclusive
of persons whose remuneration is included under Item 31(a), stating separately
the aggregate amount paid by the depositor itself and the aggregate amount
paid by all the subsidiaries.
Not Applicable. As of the date hereof, the Separate Account had not yet
commenced operations.
(c) Indirectly or through subsidiaries to each of the officers or partners of
the depositor.
Not Applicable. As of the date hereof, the Separate Account had not yet
commenced operations.
COMPENSATION OF DIRECTORS
32. Furnish the following information with respect to the remuneration for
services, exclusive of remuneration reported under Item 31, paid by the
depositor during the last fiscal year covered by financial statements filed
herewith:
(a) The aggregate direct remuneration to directors;
Not Applicable. See Item 31.
(b) Indirectly through subsidiaries to directors.
Not Applicable. See Item 31.
COMPENSATION TO EMPLOYEES.
33. (a) Furnish the following information with respect to the aggregate
amount of remuneration for services of all employees of the depositor
(exclusive of persons whose remuneration is reported in Items 31 and 32) who
received remuneration in excess of $10,000 during the last fiscal year covered
by financial statements filed herewith from the depositor and any of its
subsidiaries.
Not Applicable. See Item 31.
(b) Furnish the following information with respect to the remuneration for
services paid directly during the last fiscal year covered by financial
statements filed herewith to the following classes of persons (exclusive of
those person covered by Item 33(a)): (1) sales managers, branch managers,
district managers and other persons supervising the sale of registrant's
securities; (2) salesmen, sales agents, canvassers and other persons making
solicitations but not in a supervisory capacity; (3) administrative and
clerical employees; and (4) others (specify). If a person is employed in more
than one capacity, classify according to predominant type of work.
Not Applicable. See Item 31.
COMPENSATION TO OTHER PERSONS.
34. Furnish the following information with respect to the aggregate amount
of compensation for services paid any person (exclusive of persons whose
remuneration is reported in Items 31, 32, and 33), whose aggregate
compensation in connection with services rendered with respect to the trust in
all capacities exceeded $10,000 during the last fiscal year covered by
financial statements filed herewith from the depositor and any of its
subsidiaries:
Not Applicable. See Item 31.
IV. DISTRIBUTION AND REDEMPTION OF SECURITIES
DISTRIBUTION OF SECURITIES.
35. Furnish the names of the States in which sales of the trust's
securities: (a) are currently being made, (b) are presently proposed to be
made, and (c) have been discontinued, indicating by appropriate letter the
status with respect to each State.
No sales of the Policy have been made or are currently being made. It is
presently proposed to sell the Policy in the states where the Company is
licensed to do business.
36. If sales of the trust's securities have at any time since January 1,
1936 been suspended for more than a month describe briefly the reasons for
such suspension.
Not Applicable.
37. (a) Furnish the following information with respect to each instance
where subsequent to January 1, 1937, any Federal or State governmental
officer, agency, or regulatory body denied authority to distribute securities
of the trust, excluding a denial which was merely a procedural step prior to
any determination by such officer, etc. and which denial was subsequently
rescinded: (1) name of officer, agency or body; (2) date of denial; (3) brief
statement of reason given for denial.
Not Applicable.
(b) Furnish the following information with regard to each instance where,
subsequent to January 1, 1937, the authority to distribute securities of the
trust has been revoked by any Federal or State governmental officer, agency
or regulatory body: (1) name of officer, agency or body; (2) date of
revocation; (3) brief statement of reason given for revocation.
Not Applicable.
38. (a) Furnish a general description of the method of distribution of
securities of the trust.
The Policy issued by the Separate Account will be sold by licensed
insurance agents in those states where the Policy may be lawfully sold. Such
agents will be registered representatives of a broker-dealer registered under
the Securities Exchange Act of 1934 which is a member of the National
Association of Securities Dealers, Inc.
(b) State the substance of any current selling agreement between each
principal underwriter and the trust or the depositor, including a statement as
to the inception and termination dates of the agreement, any renewal and
termination provisions, and any assignment provisions.
The Company intends to execute an agreement with the Principal
Underwriter whereby it will distribute the Policy by executing selling
agreements with other broker-dealers. The agreement will be effective on the
date executed and will remain effective until terminated by either party upon
sixty (60) days notice, and may not be assigned.
(c) State the substance of any current agreements or arrangements of each
principal underwriter with dealers, agents, salesmen, etc. with respect to
commissions and overriding commissions, territories, franchises,
qualifications and revocations. If the trust is the issuer of periodic
payment plan certificates, furnish schedules of commissions and the bases
thereof. In lieu of a statement concerning schedules of commissions, such
schedules of commissions may be filed as Exhibit A(3)(c).
See Exhibit A(3)(c).
INFORMATION CONCERNING PRINCIPAL UNDERWRITER.
39. (a) State the form of organization of each principal underwriter of
securities of the trust, the name of the State or other sovereign power under
the laws of which each underwriter was organized and the date of the
organization.
Cova Life Sales Company is a corporation organized under the laws of
Illinois on 9/25/84.
(b) State whether any principal underwriter currently distributing securities
of the trust is a member of the National Association of Securities Dealers,
Inc.
Cova Life Sales Company is a member of the National Association of
Securities Dealers, Inc.
40. a) Furnish the following information with respect to all fees received
by each principal underwriter of the trust from the sale of securities of the
trust and any other functions in connection therewith exercised by such
underwriter in such capacity or otherwise during the period covered by the
financial statements filed herewith.
Not Applicable.
(b) Furnish the following information with respect to any fee or any
participation in fees received by each principal underwriter from any
underlying investment company or any affiliated person or investment adviser
of such company: (1) the nature of such fee or participation; (2) the name of
the person making payment; (3) the nature of the services rendered in
consideration for such fee or participation; (4) the aggregate amount received
during the last fiscal year covered by the financial statements filed
herewith.
Not Applicable.
41. (a) Describe the general character of the business engaged in by each
principal underwriter, including a statement as to any business other than the
distribution of securities of the trust. If a principal underwriter acts or
has acted in any capacity with respect to any investment company or companies
other than the trust, state the name or names of such company or companies,
their relationship, if any, to the trust and the nature of such activities.
If a principal underwriter has ceased to act in such named capacity, state the
date of and the circumstances surrounding such cessation.
Cova Life Sales Company also acts as the principal underwriter of
variable annuity contracts issued by the Company and its affiliated insurance
companies. Cova Life Sales Company also acts as the principal underwriter for
Cova Series Trust.
(b) Furnish as at latest practicable date the address of each branch office of
each principal underwriter currently selling securities of the trust and
furnish the name and residence address of the person in charge of such office.
Not Applicable.
(c) Furnish the number of individual salesmen of each principal underwriter
through whom any of the securities of the trust were distributed for the last
fiscal year of the trust covered by the financial statements filed herewith
and furnish the aggregate amount of compensation received by such salesmen in
such year.
Not Applicable.
42. Furnish as at latest practicable date the following information with
respect to each principal underwriter currently distributing securities of the
trust and with respect to each of the officers, directors, or partners of such
underwriter.
Not Applicable.
43. Furnish, for the last fiscal year covered by the financial statements
filed herewith, the amount of brokerage commissions received by any principal
underwriter who is a member of a national securities exchange and who is
currently distributing the securities of the trust or effecting transactions
for the trust in the portfolio securities of the trust.
None.
OFFERING PRICE OR ACQUISITION VALUATION OF SECURITIES OF THE TRUST.
44. (a) Furnish the following information with respect to the method of
valuation used by the trust for purposes of determining the offering price to
the public of securities issued by the trust or the valuation of shares or
interests in the underlying securities acquired by the holder of a periodic
payment plan certificate.
Account Values allocated to the Separate Account are invested at net
asset value in the Investment Portfolios in accordance with the selection made
by the owner.
Account Values will fluctuate in accordance with investment results of
the Investment Portfolios selected. In order to determine how these
fluctuations affect Account Value, accumulation units are used. Every
business day the Company determines the value of an accumulation unit for each
of the Investment Portfolios. The value of an accumulation unit for any given
business day is determined by multiplying a factor referred to as the net
investment factor times the value of an Accumulation unit for the previous
business day. The net investment factor is a number that reflects the change
(up or down) in an underlying Investment Portfolio share.
(b) Furnish a specimen schedule showing the components of the offering price
of the trust's securities as at the latest practicable date.
Not Applicable.
(c) If there is any variation in the offering price of the trust's securities
to any person or classes of persons other than underwriters, state the nature
and amount of such variation and indicate the person or classes of persons to
whom such offering is made.
Not Applicable.
45. Furnish the following information with respect to any suspension of
the redemption rights of securities issued by the trust during the three
fiscal years covered by the financial statements filed herewith: (a) by whose
action redemption rights were suspended; (b) the number of days' notice given
to security holders prior to suspension of redemption rights; (c) reason for
suspension; (d) period during which suspension was in effect.
Not Applicable.
REDEMPTION VALUATION OF SECURITIES OF THE TRUST.
46. (a) Furnish the following information with respect to the method of
determining the redemption or withdrawal valuation of securities issued by the
trust:
(1) the source of quotations used to determine the value of portfolio
securities;
The Custodians for the underlying series funds.
(2) whether opening, closing bid, asked or any other price is used;
Net asset value is used.
(3) whether price is as of the day of sale or as of any other time;
As of the next compute price.
(4) a brief description of the methods used by registrant for determining
other assets and liabilities including accrual for expenses and taxes
(including taxes on unrealized appreciation);
See item 13(a).
(5) other items which registrant deducts from the net asset value in
computing redemption value of its securities; and
See item 13(a).
(6) whether adjustments are made for fractions.
Not applicable.
(b) Furnish a specimen schedule showing the components of the redemption price
to the holders of the trust's securities as at the latest practicable date.
Not applicable.
PURCHASE AND SALE OF INTERESTS IN UNDERLYING SECURITIES FROM AND TO SECURITY
HOLDERS.
47. Furnish a statement as to the procedure with respect to the
maintenance of a position in the underlying securities or interests in the
underlying securities, the extent and nature thereof and the person who
maintains such a position. Include a description of the procedure with
respect to the purchase of underlying securities or interest in the underlying
securities from security holders who exercise redemption or withdrawal rights
and the sale of such underlying securities and interests in the underlying
securities to other security holders. State whether the method of valuation
of such underlying securities or interests in the underlying securities
differs from that set forth in Items 44 and 46. If any item of expenditure
included in the determination of the valuation is not or may not actually be
incurred or expended, explain the nature of such item and who may benefit from
the transaction.
The Company will maintain a position in Investment Portfolio shares by
purchasing Investment Portfolio shares at net asset value in connection with
premiums allocated to the Separate Account in accordance with instructions
from the Owners and to redeem Investment Portfolio shares at net asset value
for the purposes of making Policy obligations, or making adjustments in the
reserves held in the Separate Account. There are no procedures for the
purchase of underlying securities or interests therein from Owners who
exercise surrender rights in that Owners have no direct interest therein.
V. INFORMATION CONCERNING THE TRUSTEE
OR CUSTODIAN
48. Furnish the following information as to each trustee or custodian of
the trust:
(a) Name and principal business address;
None.
(b) Form of organization;
Not Applicable.
(c) State or other sovereign power under the laws of which the trustee or
custodian was organized;
Not Applicable.
(d) Name of governmental supervising or examining authority.
Not Applicable.
49. State the basis for payment of fees or expenses of the trustee or
custodian for services rendered with respect to the trust and its securities,
and the aggregate amount thereof for the last fiscal year. Indicate the
person paying such fees or expenses. If any fees or expenses are prepaid,
state the unearned amount.
Not Applicable.
50. State whether the trustee or custodian or any other person has or may
create a lien on the assets of the trust, and if so, give full particulars,
outlining the substance of the provisions of any indenture or agreement with
respect thereto.
Not Applicable.
VI. INFORMATION CONCERNING THE INSURANCE OF
HOLDERS OF SECURITIES
51. Furnish the following information with respect to insurance holders of
securities:
(a) The name and address of the insurance company;
Cova Financial Services Life Insurance Company
One Tower Lane, Suite 3000
Oakbrook Terrace, IL 60181
800-523-1661
(b) The types of policies and whether individual or group policies;
The Policy is an individual modified single premium variable life
insurance policy.
(c) The types of risks insured and excluded;
The Policy provides for a death benefit upon the death of the Insured. Under
some circumstances, a portion of the death benefit will be paid out if the
Insured is terminally ill. The death benefit is the only insurance benefit
offered.
(d) The coverage of the policies;
While the Policy remains in force, it provides for a death benefit on the life
of the Insured.
(e) The beneficiaries of such policies and the uses to which the proceeds of
policies must be put;
The Owner designates one or more persons to be the beneficiaries of the
death benefit. There are no limitations on the use of the proceeds.
(f) The terms and manner of cancellation and of reinstatement;
The Policy will terminate if (1) the owner makes a total surrender of the
Policy, (2) the grace period has ended, or (3) the Insured has died. The
Policy can be reinstated if the owner did not make a total surrender and of
the Insured is still alive within five years after the end of the grace period.
To reinstate the Policy, the Insured must provide evidence of insurability and
either repay any outstanding loan and accrued interest or reinstate the loan
plus interest. A sufficient premium must be paid to (1) cover all deductions
that are due and unpaid and (2) be sufficient to keep the Policy in force for
2 months.
(g) The method of determining the amount of premiums to be paid by holders of
securities;
See Item 13(a) for information on the types of charges and methods of
assessing them.
(h) The amount of aggregate premiums paid to the insurance company during the
last fiscal year;
Not Applicable.
(i) Whether any person other than the insurance company receives any part of
such premiums, the name of each such person and the amounts involved, and the
nature of the services rendered therefor;
The Company may from time to time, enter into reinsurance treaties with
other insurers whereby such insurers may agree to reimburse the Company for
mortality expenses.
(j) The substance of any other material provisions of any indenture or
agreement of the trust relating to insurance.
Not Applicable.
VII. POLICY OF REGISTRANT
52. (a) Furnish the substance of the provisions of any indenture or
agreement with respect to the conditions upon which and the method of
selection by which particular portfolio securities must or may be eliminated
from assets of the trust or must or may be replaced by other portfolio
securities. If an investment adviser or other person is to be employed in
connection with such selection, elimination or substitution, state the name of
such person, the nature of any affiliation to the depositor, trustee or
custodian, any principal underwriter, and the amount of remuneration to be
received for such services. If any particular person is not designated in the
indenture or agreement, describe briefly the method of selection of such
person.
The Company will not substitute another security for the underlying
securities of the trust unless the Securities and Exchange Commission shall
have approved such substitution.
(b) Furnish the following information with respect to each transaction
involving the elimination of any underlying security during the period covered
by the financial statements filed herewith.
Not Applicable.
(c) Describe the policy of the trust with respect to the substitution and
elimination of the underlying securities of the trust with respect to: (1) the
grounds for elimination and substitution; (2) the type of securities which may
be substituted for any underlying security; (3) whether the acquisition of
such substituted security or securities would constitute the concentration of
investment in a particular industry or group of industries or would conform to
a policy of concentration of investment in a particular industry or group of
industries; (4) whether such substituted securities may be the securities of
another investment company; and (5) the substance of the provisions of any
indenture or agreement which authorize or restrict the policy of the
registrant in this regard.
Not Applicable.
(d) Furnish a description of any policy (exclusive of policies covered by
paragraphs (a) and (b) herein) of the trust which is deemed a matter of
fundamental policy and which is elected to be treated as such.
None.
REGULATED INVESTMENT COMPANY.
53. (a) State the taxable status of the trust.
The Company is taxed as a life insurance company under the Internal
Revenue Code. Since the Separate Account is not a separate entity from the
Company and its operations form a part of the company, it will not be taxed
separately as a "regulated investment company" under the Subchapter M of the
Code.
(b) State whether the trust qualified for the last taxable year as a regulated
investment company as defined in Section 851 of the Internal Revenue Code of
1954, and state its present intention with respect to such qualifications
during the current taxable year.
Not Applicable.
VIII. FINANCIAL AND STATISTICAL INFORMATION
54. If the trust is not the issuer of periodic payment plan certificates,
furnish the following information with respect to each class or series of its
securities.
Not Applicable.
55. If the trust is the issuer of periodic payment plan certificates, a
transcript of a hypothetical account shall be filed in approximately the
following form on the basis of the certificate calling for the smallest amount
of payments. The schedule shall cover a certificate of the type currently
being sold assuming that such certificate had been sold at a date
approximately 10 years prior to the date of registration or at the approximate
date of organization of the trust.
Not Applicable.
56. If the trust is the issuer of periodic payment plan certificates,
furnish by years for the period covered by the financial statements filed
herewith in respect of certificates sold during such period, the following
information for each fully paid type and each installment payment type of
periodic payment plan certificate currently being issued by the trust.
Not Applicable.
57. If the trust is the issuer of periodic payment plan certificates,
furnish by years for the period covered by the financial statements filed
herewith the following information for each installment payment type of
periodic payment plan certificate currently being issued by the trust.
Not Applicable.
58. If the trust is the issuer of periodic payment plan certificates,
furnish the following information for each installment payment type of
periodic payment plan certificate outstanding as at the latest practicable
date.
Not Applicable.
59. Financial statements:
Financial Statements of the Trust
The financial statements are filed for the Separate Account. It has not yet
commenced operations, has no assets or liabilities and has received no income
nor incurred any expense.
Financial Statements of the Depositor
The financial statements of the Company will be included in an Amended
Registration Statement on Form S-6 filed by the registrant pursuant to the
Securities Act of 1933.
IX. EXHIBITS
A. (1) Resolution of Board of directors of the Company authorizing the
Separate Account.*
(2) None.
(3) (a) Principal Underwriter's Agreement*
(b) Agents Agreement*
(c) Schedules of sales commissions referred to in Item 38(c)*
(4) None
(5) Modified Single Premium Life Insurance Policy*
(6) (a) Articles of Incorporation of the Company*
(b) Bylaws of the Company*
(7) Not Applicable
(8) Not Applicable
(9) None
(10) Form of application*
* Filed with initial Registration Statement on Form S-6 for the Policy
(which is filed concurrently herewith) and are hereby incorporated
by reference.
B. Furnish copies of each of the following:
(1) Not Applicable
(2) Not Applicable
C. Not Applicable
SIGNATURE
Pursuant to the requirements of the Investment Company Act of 1940 the
depositor of the Registrant has caused this registration statement to be duly
signed on behalf of the Registrant in the City of Oakbrook Terrace and State
of Illinois on the 13th day of December 1996.
[SEAL]
COVA VARIABLE LIFE ACCOUNT ONE
By: COVA FINANCIAL SERVICES LIFE INSURANCE COMPANY
__________________________________________
By: /s/ LORRY J. STENSRUD
______________________________
Lorry J. Stensrud, President
COVA FINANCIAL SERVICES LIFE INSURANCE COMPANY
By: /s/ LORRY J. STENSRUD
______________________________
Lorry J. Stensrud, President
Attest: /s/ JEROME P. DARGA
______________________
(Name)
Assistant Secretary
________________________
(Title)
