Exhibit 4
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Qualified Group Annuity Contract
1-94
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Great-West Life & Annuity Insurance Company
Home Office - Englewood, Colorado
Administrative Offices - Englewood, Colorado
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GROUP
POLICYHOLDER ABC
Hospital
GROUP POLICY
NUMBER 12345GP
GROUP ANNUITY CONTRACT DATE
December X, 19XX
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Group Annuity, Non-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 that the
Group Policyholder has designated.
Signed for Great-West Life & Annuity Insurance Company on the issuance of the
Group Annuity Contract on the Group Annuity Contract Date.
Signed for the Company on the Issue Date.
D.C. Lennox, W.T. McCallum,
Secretary President and Chief Executive Officer
For the Actuary
This Group Annuity Contract is a legal contract between the Group Policyholder
and Great-West Life & Annuity Insurance Company. PLEASE READ THIS ANNUITY
CONTRACT CAREFULLY. IT IS A CONTRACT WHICH MAY PROVIDE FOR PAYMENTS OR VALUES
WHICH ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT MAY INCREASE OR DECREASE
ACCORDING TO THE INVESTMENT EXPERIENCE OF A VARIABLE ANNUITY ACCOUNT.
Qualified Group Fixed and Variable Deferred Annuity Contract
Form No. QGAC 1-94
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TABLE OF CONTENTS
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SECTION 1.
DEFINITIONS...............................................................................Page
6
SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Series
Account....................................................................8
2.2 Ownership of Group Annuity
Contract............................................................8
2.3 Participant Annuity Account
Value..............................................................8
2.4 Transfer and
Assignment........................................................................8
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity
Contract.....................................................................8
3.2 Entire
Contract................................................................................8
3.3 The
Plan.......................................................................................8
3.4
Non-Participating..............................................................................9
3.5 Currency and Payment of
Deposits...............................................................9
3.6 Age 9
3.7 Voting Rights and
Reports......................................................................9
3.8 Notice and
Proof...............................................................................9
3.9 Tax Consequences of
Payments...................................................................9
3.10 Plan
Amendments...............................................................................10
3.11
Gender........................................................................................10
SECTION 4. PURCHASE PROVISIONS
4.1 Commencement and Termination of
Coverage......................................................10
4.2
Deposits......................................................................................10
4.3 Allocation of
Deposits........................................................................10
SECTION 5. CONTRACT VALUE PROVISIONS
5.1 Variable Contract
Value.......................................................................11
5.2 Accumulation
Units............................................................................11
5.3 Accumulation Unit
Value.......................................................................11
5.4 Annuity Unit
Value............................................................................11
5.5 Risk
Charge...................................................................................11
5.6 Net Investment
Factor.........................................................................11
5.7 Guaranteed Account
Value......................................................................12
5.8 Guaranteed Sub-Account
Riders.................................................................12
5.9 Contract Maintenance
Charge...................................................................12
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TABLE OF CONTENTS (Continued)
SECTION 6. TRANSFERS
6.1 Intra-Company
Transfers.......................................................................12
6.2 Transfers out of the Group Annuity
Contract...................................................12
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY
7.1 Death of Participant after Annuity Commencement
Date..........................................13
7.2 Death of Participant before Annuity Commencement
Date.........................................13
7.3 Amount Payable On Death Of
Participant........................................................13
7.4 Requests for
Distributions....................................................................13
SECTION 8. DISTRIBUTIONS TO A PARTICIPANT
8.1 Requests for In Service Withdrawals and
Surrenders............................................14
8.2 In Service
Withdrawal.........................................................................14
8.3 Amount Payable on In Service
Withdrawal.......................................................14
8.4
Surrender.....................................................................................14
8.5 Amount Payable on
Surrender...................................................................14
8.6 Conditions of
Payment.........................................................................14
8.7 Adequate
Proof................................................................................14
8.8 Establishment of Alternate Payee
Account......................................................15
8.9
Loans.........................................................................................15
SECTION 9. CONTINGENT DEFERRED SALES CHARGE
9.1 Transfers To Other
Companies..................................................................15
9.2 Surrenders and In Service
Withdrawals.........................................................15
SECTION 10. PAYMENT OPTIONS
10.1 How to Elect Payment
Options.................................................................16
10.2 Selection of Payment
Options.................................................................16
10.3 Variable Annuity Payment
Options.............................................................16
10.4 Fixed Annuity Payment
Options................................................................17
TABLE OF CONTENTS (Continued)
SECTION 11. PERIODIC PAYMENTS
11.1 Periodic Payment
Option......................................................................18
SECTION 12. CONTRACT MODIFICATION
12.1 Contract
Modification........................................................................19
12.2 Modification of
Tables.......................................................................19
12.3 Modification of Guaranteed Sub-Account Riders, if
Any........................................19
12.4 Modification of Variable and/or Guaranteed Sub-Account
Riders, if
Any...............................................................................19
SECTION 13. CESSATION OF DEPOSITS
13.1 Cessation of
Deposits........................................................................19
13.2 Options on Declaration of Date of Cessation of
Deposits......................................20
TABLE A
.........................................................................................21
TABLE B
.........................................................................................22
TABLE C
.........................................................................................23
TABLE D
.........................................................................................24
TABLE E
.........................................................................................25
GUARANTEED SUB-ACCOUNT RIDERS, IF ANY
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SECTION 1. 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 measure used to determine the Variable
Contract Value before the Annuity Commencement Date.
Administrative Offices - 8515 East Orchard Road, Englewood, Colorado 80111.
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
payment option, which for any Participant is the date required under the Group
Policyholder's Plan.
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 measure used to determine the dollar value of any
Variable Dollar Annuity Payment after the first annuity payment is made.
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.
Employer - the Employer who established and maintains the Plan.
Forfeiture - that portion of the Participant's Annuity Account Value which is
not vested under the terms of the Plan as of the date a distribution is made.
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 or the Plan Trustee that applies for this
Group Annuity Contract.
Guaranteed Account - the portion of this Group Annuity Contract providing
Guaranteed Sub-Accounts, each of which guarantees principal and past interest
credits.
Guaranteed Account Value - the sum of the values of the Guaranteed Sub-Accounts
credited to the Participant under a Participant Annuity Account.
Guaranteed Interest Rate - the minimum interest rate applicable to Guaranteed
Sub-Accounts which is equal to an annual effective rate of 0%.
Guaranteed Sub-Account - a subdivision of the Guaranteed Account having a
Guaranteed Interest Rate. This subdivision is described in greater detail in the
attached Guaranteed Sub-Account Riders, if any.
In Service Withdrawal - a withdrawal of some or all of the Participant's Annuity
Account Value, as allowed by the Plan, during his service with the Employer.
Intra-Company Transfer - amounts moved within and between the currently offered
Variable and Guaranteed Sub-Accounts.
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.
Letter Agreement - a formal written agreement signed by the Company and the
Group Policyholder which is used to clarify or modify certain provisions of the
Contract and will be attached to and form a part of this Group Annuity Contract.
Participant - an employee who has met the eligibility requirements under the
Plan and for whom the Group Policyholder has applied for coverage.
Participant Annuity Account - a separate record in the name of each Participant
which reflects the total value of the Guaranteed and Variable Sub-Accounts.
Participant Annuity Account Value - the sum of the Variable and Guaranteed
Account Values credited to the 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 to receive the value of the Participant Annuity Account.
Plan - a pension or profit sharing plan established and maintained by the
Employer and which is qualified under Section 401(a) or 401(k) of the Internal
Revenue Code of 1986, as amended.
Plan Administrator - the person(s) designated by the Plan to perform all
administrative functions required by the Employee Retirement Income Security Act
of 1974, as amended (ERISA), the Internal Revenue Code, Department of Labor
Regulation and/or any other applicable law.
Premium Tax - the amount of premium tax, if any, charged by a state or other
governmental authority.
Qualified Domestic Relations - a domestic relations order that creates or
recognizes Order (QDRO) the existence of an alternate payee's right to, or
assigns to an alternate payee the right to, receive all or a portion of the
benefits payable with respect to a Participant and that complies with
requirements of the Internal Revenue Code, Treasury Regulations and any other
applicable law.
Request - any request in a form, either written, telephoned or computerized,
satisfactory to the Company and received by the Company at its Administrative
Office, from the Group Policyholder, or the Group Policyholder's designee as
required by any provision of this contract, or as required by the Company.
Series Account - the [FutureFunds Series II Account,] a segregated investment
account established by Great-West Life & Annuity Insurance Company under
Colorado law.
Surrender - a lump-sum payment of the entire Participant Annuity Account Value
as provided for in the Plan other than as an In-Service Withdrawal.
Transaction Date - Deposits and Requests will be processed on the date received
by the Company at its Administrative Offices. Contributions and Requests
received after 4:00 p.m. EST/EDT shall be deemed to have been received on the
next business day. The Variable Account Value is valued on each date that the
New York Stock Exchange is open for trading and on which the Company's
Administrative Offices are open. The New York Stock Exchange is currently closed
on weekends and on the following holidays: New Year's Day, President's Day, Good
Friday, Memorial Day, July Fourth, Labor Day, Thanksgiving Day, and Christmas
Day. The Company's Administrative Offices are normally not open on the following
days: the Monday after New Year's Day, July Fourth, or Christmas Day if any of
these holidays fall on a Sunday; the Friday before New Year's Day, July Fourth,
or Christmas Day if any of these holidays fall on a Saturday; and the Friday
after Thanksgiving.
Transfer to Other Companies - amounts moved from any Variable or Guaranteed
Sub-Account to another company.
Trustee - the person or entity designated by the Plan.
Valuation Date - the date on which the net asset value of each Eligible Fund is
determined.
Valuation Period - the period between successive Valuation Dates.
Variable Account - the account established under this Group Annuity Contract
providing Variable Sub-Accounts, each having its own Accumulation Unit and
Annuity Unit Value. All monies held in the Variable Account are held in the
Series Account.
Variable Account Value - the sum of the values of the Variable Sub-Accounts
credited to the Participant Annuity Account.
Variable Sub-Account - a sub-division of the Variable Account. Each Variable
Sub-Account has its own Accumulation Unit and Annuity Unit Value.
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SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
The portion of the assets of the Series Account equal to the reserves
and other contract liabilities with respect to the Series Account are
not chargeable with liabilities arising out of any other business the
Company may conduct.
2.2 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 for the benefit of the Participants.
Subject to the Plan participation provisions, each employee for whom
Deposits have been made is a Participant for whom a Participant
Annuity Account is kep
2.3 Participant Annuity Account Value
Each Participant for whom
a Participant Annuity Account is established and for whom Deposits have been
received by the Company owns his Participant Annuity Account Value subject to
the vesting provisions of the Plan.
2.4 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.
To the extent permitted
by law, no proceeds or payments under the Group Annuity Contract will be subject
to the claims of creditors of or legal process against the Group Policyholder.
To the extent permitted
by law, no interest of a Participant or Beneficiary in this Group Annuity
Contract may be assigned, charged, attached, anticipated, given as security or
otherwise alienated, and no such interest shall be subject to execution, seizure
or other legal or equitable process. To the extent permitted by law, neither a
Participant nor any Beneficiary may commute or surrender any payment, benefit,
or installment to which the Participant or Beneficiary may become entitled by
the terms of the Group Annuity Contract.
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity Contract
The Group Annuity Contract is issued by the Company to the Group
Policyholder.
3.2 Entire Contract
This Group Annuity Contract, its application, Tables, Guaranteed
Sub-Account Riders and /or Letter Agreements, 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.
Afterissue, 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 (or delegate) of the
Company can modify or waive any provisions of the Group Annuity Contract.
3.3 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. The obligations
of the Company are measured and determined solely by the terms and provisions of
this Group Annuity Contract.
SECTION 3. GENERAL PROVISIONS (continued)
3.4 Non-Participating
This Group Annuity Contract is non-participating, meaning that it is not
eligible to share in the Company's divisible surplus.
3.5 Currency and Payment of Deposits
All amounts to be paid to or by the Company must be in the currency of
the United States of America. All Deposits to this Group Annuity
Contract must be made payable to the Company or its designated agent.
3.6 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.
3.7 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.
3.8 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.
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.
3.9 Tax Consequences of Payments
Subject to the provisions of the Plan, the
Participant, Annuitant, Payee or Beneficiary, as the case may be, must determine
the timing and amount of any benefit payable to him. Nothing contained herein
shall be construed to be tax or legal advice and the Company assumes no
responsibility or liability for any damages or costs, including but not limited
to taxes, penalties, interest or attorney's fees incurred by the Plan, the Group
Policyholder, the Participant, the Alternate Payee, the Beneficiary, or any
other person arising out of any such determination.
SECTION 3. GENERAL PROVISIONS (continued)
3.10 Plan Amendments
The Group Policyholder shall, within thirty (30) days after the adoption
of an amendment to the Plan, send a copy of each such amendment to
the Company at its Administrative Services Offices.
3.11 Gender
Whenever a masculine pronoun is used, it shall be deemed in all instances where
appropriate to mean the feminine pronoun as well.
SECTION 4. PURCHASE PROVISIONS
4.1 Commencement and Termination of Coverage
The Company may accept applications for coverage unless a Date of
Cessation of Deposits has been declared. A person may commence
coverage under the Group Annuity Contract when the Plan's conditions
for participation have been met and the Company has been properly
notified that such person has been designated a Participant. The
responsibility for such designation will rest solely with the Group
Policyholder.
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 or
Participant's total or partial distribution which results in a
Participant Annuity Account Value of $0.
4.2 Deposits
Unless a Date of Cessation of Deposits has been declared, the Group Policyholder
may from time to time pay Deposits in cash in respect of a Participant until the
earlier of his/her death, Annuity Commencement Date, or the termination of the
Participant Annuity Account.
The amount of Deposits 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 Deposits 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 Deposits received, such
Deposits may be returned.
4.3 Allocation of Deposits
After an adequate application on behalf of a Participant has been made,
Deposits, less Premium Tax, if any, will be allocated in the Participant Annuity
Account when received by the Company at its Administrative Offices.
Deposits on behalf of the Participant will be allocated among any number of
currently offered Variable and Guaranteed Sub-Accounts in accordance with the
latest recorded Request.
The allocation of Deposits may be changed at any time upon the Company's receipt
at its Administrative Offices of the Request. A change of allocation will be
effective for Deposits which are received after the Company's receipt and
recording of the change.
SECTION 5. CONTRACT VALUE PROVISIONS
5.1 Variable Contract Value
The Variable Contract Value for a Participant on any date during the
Accumulation Period will be the sum of the values of the Variable
Sub-Accounts held for the Participant.
The value of a Participant's interest in a Variable Sub-Account will be
determined by multiplying the number of Accumulation Units held for
the Participant by the Accumulation Unit Value for that Variable
Sub-Account.
5.2 Accumulation Units
For each Deposit, the number of Accumulation Units credited for the
Participant to a Variable Sub-Account will be determined by dividing
the amount of the Deposit by the accumulation unit value for that
Variable Sub-Account on the applicable Transaction Date.
5.3 Accumulation Unit Value
The initial accumulation unit value of each Variable Sub-Account was
established at $10. The accumulation unit value of a Variable
Sub-Account on a Valuation Date is calculated by multiplying the
accumulation unit value as of the immediately preceding Valuation
Date by the net investment factor as described in the net investment
factor provision below.
The dollar value of an Accumulation Unit will vary in amount depending
upon the investment experience of the Eligible Fund.
5.4 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).
The Annuity Unit Value may increase, decrease or remain unchanged as a
result of the value of the net investment factor.
5.5 Risk Charge
The Company will deduct the risk charge for expense and mortality
guarantees in the calculation of the net investment factor. This
charge will not exceed 1.25% on an annual basis of the daily net
asset value of each Variable Sub-Account. This deduction is made
daily.
5.6 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 an amount representing the risk charge deducted from
each Variable Sub-Account on a daily basis as a percentage 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.
SECTION 5. CONTRACT VALUE PROVISIONS (continued)
5.7 Guaranteed Account Value
A Participant's Guaranteed Account Value on any date during the
Accumulation Period will be the sum of the values of the Guaranteed
Sub-Accounts credited to the Participant Annuity Account.
The Company may offer one or more Guaranteed Sub-Accounts into which
Deposits will be made.
5.8 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.
5.9 Contract Maintenance Charge
On the first day of each calendar year a
contract maintenance charge of not more than $60 annually will be declared
by the Company and deducted from the Participant Annuity Account. If a
Participant Annuity Account is established for a Participant after that
date, the 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 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. The Group Policyholder may elect to pay such expenses to the
Company separately. If such an election has been made, then no charge will
be made against the Variable and Guaranteed Sub-Accounts unless payment is
not received within 30 days.
SECTION 6. TRANSFERS
6.1 Intra-Company Transfers
The Group Policyholder may Request transfers. The following provisions
apply:
(a) All or a portion of the Annuity Account Value may be transferred
within and between the Variable and Guaranteed Sub-Accounts
currently offered by the Company at any time prior to the
Annuity Commencement Date by Request of the Owner. No transfers
are permitted after the Annuity Commencement Date.
(b) If a Transfer is made within 30 days of the Annuity Commencement
Date, the Company may delay the Annuity Commencement Date by 30
days.
(c) A Transfer shall be effective upon the Transaction Date.
(d) A Transfer from Guaranteed Sub-Accounts shall be subject to the terms
of the attached Guaranteed Sub-Account Rider(s), if any.
(e) No Surrender Charge will apply to Intra-Company Transfers.
6.2 Transfers out of the Group Annuity Contract
Transfers out of the Group
Annuity Contract to an account currently offered by another Company under
the terms of the Plan may be made only prior to the Annuity Commencement
Date. The Contingent Deferred Sales Charge in Section 9, if applicable,
will be deducted from each partial or total transfer out of the Group
Annuity Contract.
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY
7.1 Death of Participant after Annuity Commencement Date
If the Participant dies after the Annuity Commencement Date and before
his/her entire interest has been distributed, payments will continue
to the Beneficiary under the Payment Option applicable to the
Participant on the Participant's date of death. Notwithstanding the
preceding sentence, if the Plan allows the Beneficiary to change the
method of distribution, a new Payment Option may be elected by
Request by the Group Policyholder on behalf of the Beneficiary only
so long as payments are made to the Beneficiary not less rapidly than
under the Payment Option effective on the Participant's date of
death. The Contingent Deferred Sales Charge will not apply.
7.2 Death of Participant before Annuity Commencement Date.
a. 5-Year Rule. If the Participant dies before the Annuity
Commencement Date, the entire interest of the Participant must
be distributed within five years after the death of the
Participant. This Rule applies to all non-individual entities.
b. 1-Year Rule. If the Plan provides that any portion of the Participant's
interest is payable to a designated Beneficiary, such portion may be
distributed over the lesser of (1) the life of the "designated
Beneficiary," or (2) over a period not extending beyond the life expectancy
of the designated Beneficiary. Such distributions to a designated
Beneficiary must begin not later than December 31 of the year following the
date of the Participant's death. The Group Policyholder on behalf of the
designated Beneficiary may elect by Request to take distributions either
under the 5-Year Rule or under this 1-Year Rule. If no election is received
by the Company by November 1 of the year following the year of the
Participant's death, distributions will be made pursuant to the 5-Year Rule
described in subsection a. of Section 7.2.
For purposes of this section, a designated Beneficiary is any individual
named as a Beneficiary by the Participant.
c. Special Rule for Surviving Spouse.
If the designated Beneficiary is the surviving spouse of the
Participant, distributions must begin no later than the date on which the
Participant would have attained age 70 1/2. Distributions may be elected at any
time pursuant to Section 10 of this Contract; but in any event must commence on
or before the later of (1) December 31 of the year immediately following the
Participant's death and (2) December 31 of the calendar year in which the
Participant would have attained age 70 1/2.
d. The Contingent Deferred Sales Charge will not apply.
7.3 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 Deposits paid to, less any distributions made under this
Contract 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.
7.4 Requests For Distributions Subject to the 5-Year rule, the 1-Year rule
or the Special Rule for Surviving Spouse, as applicable, set forth in
Section 7.2, an election to receive the amount described in Section 7.3
must be made pursuant to Section 10 of this Contract.
SECTION 8. DISTRIBUTIONS TO A PARTICIPANT
8.1 Requests for In Service Withdrawals and
Surrenders
On the Company's receipt of the Request at least 30 days before the
Annuity Commencement Date, the Group Policyholder on behalf of the
Participant may:
a. Elect or change the Participant's Annuity Commencement Date to
any future date which is not later than April 1 of the calendar
year following the calendar year in which the Participant
attains age 70 1/2. If any Annuity Commencement Date would be
less than 30 days from the date the Request is received, the
Company may delay the Annuity Commencement Date elected by 30
days. Given adequate time to process a Request, any such delay
will not be later than April 1 of the calendar year following
the calendar year in which the Participant attains age 70 1/2.
b. If the Group Policyholder on behalf of a married Participant has
failed to elect a Payment Option within 30 days of the Annuity
Commencement Date, the Company will pay the Group Policyholder
on behalf of the Participant a Variable Joint and One-Half
Survivor Annuity from the Variable Contract Value and a Fixed
Joint and One-Half Survivor Annuity from the Guaranteed Contract
Value.
c. If the Group Policyholder on behalf of an unmarried Participant
has failed to elect a Payment Option within 30 days of the
Annuity Commencement Date, the Company will pay the Group
Policyholder on behalf of the Participant a Variable Life
Annuity with a 10 year Guaranteed Period from the Variable
Contract Value and a Fixed Life Annuity with a 10 year
Guaranteed Period from the Guaranteed Contract Value.
8.2 In Service Withdrawal
By Request, the Group Policyholder may direct the Company to make an In
Service Withdrawal from the Participant Annuity Account payable to
the Participant. The In Service Withdrawal will take effect on the
later of the date elected or the date the Request is received at the
Administrative Offices of the Company.
The Group Policyholder must designate in the Request the Variable or
Guaranteed Sub-Account(s), or a combination of them, from which the
In Service Withdrawal is to be made.
8.3 Amount Payable on In Service Withdrawal
The amount payable on In
Service Withdrawal will be paid in one sum under the In Service withdrawal
provisions equal to: (A) all or any portion of the Participant's Annuity
Account Value as requested by the Group Policyholder, on behalf of the
Participant, in accordance with the terms of the Plan, less (B) Premium
Tax, if any, less (C) Forfeiture, if any, as determined by the Plan
Administrator in accordance with the vesting schedule of the Plan, less (D)
the Contingent Deferred Sales Charge, described in Section 9, if any.
8.4 Surrender By Request, the Group Policyholder may surrender the
Participant Annuity Account on behalf of the Participant. The Surrender
will take effect on the later of the date elected or the date the Request
is received at the Administrative Offices of the Company. Instructions as
to the allocation of any Forfeiture as a result of such surrender must
accompany the Request. The responsibility for determining that such
instructions are in accordance with the provisions of the Plan lies solely
with the Group Policyholder.
8.5 Amount Payable On Surrender
If permitted by the Plan, the amount
payable on Surrender may either be applied under the Methods of Payment
provisions or paid in one sum under the Surrender provisions equal to: (A)
the Participant Annuity Account Value as of the effective date of the
Surrender, less (B) Premium Tax, if any, less (C) Forfeiture, if any, less
(D) the Contingent Deferred Sales Charge, described in Section 9, if any.
8.6 Conditions of Payment
Payment will only be made if then available to
the Payee under the terms and provisions of the Plan as determined by the
Group Policyholder.
8.7 Adequate Proof
The Company may require adequate proof of age,
separation from service or eligibility for another benefit to establish
that a benefit has become payable under the provisions of the Plan prior to
making any payment under this Group Annuity Contract.
SECTION 8. DISTRIBUTIONS TO A PARTICIPANT (continued)
8.8 Establishment of Alternate Payee Account
In the event the Company receives a request for a payment in connection
with a Qualified Domestic Relations Order (QDRO) and the Group
Policyholder notifies the Company that the Plan does not permit
immediate distributions, or in the event the Company is unable to
obtain all necessary information to make a distribution pursuant to
such order, then the Company will establish a separate account on
behalf of the Alternate Payee named in such order. Such Alternate
Payee account will be established and administered in accordance with
the provisions of the Plan.
8.9 Loans
If the Plan permits loans, loans will be available to a Participant in
accordance with the terms set forth in the Plan and the loan application
form.
SECTION 9. CONTINGENT DEFERRED SALES CHARGE
9.1 Transfers To Other Companies
On any total or partial transfer of the Participant Annuity Account to
another company, the Contingent Deferred Sales Charge will be
deducted from the amount transferred. The Contingent Deferred Sales
Charge will be equal to a percentage of the amount transferred based
on the table in 9.2 below.
9.2 Surrenders and In Service Withdrawals
On any Surrenders or In Service
Withdrawals of the Participant Annuity Account permitted under the terms of
the Plan, a Contingent Deferred Sales Charge will be deducted from the
amount distributed. The Contingent Deferred Sales Charge will be equal to a
percentage of the amount distributed based on the table below.
Contingent Deferred Sales Charge Table
Completed Years From Participant Effective Date % of Amount Transferred or
Under this Contract Distributed 0 - 4 5% 5 - 9 4% 10 - 14 3% 15 or more 0%
Notwithstanding anything in this Group Annuity Contract to the contrary, in
no event shall the Contingent
Deferred Sales Charge at any point in time exceed 8.5% of Deposits contributed
by the Participant into this Group Annuity Contract.
SECTION 10. PAYMENT OPTIONS
10.1 How to Elect Payment Options
The Request of the Group Policyholder on behalf of the Participant or
Beneficiary is required to elect, or change the election of, a
payment option and must be received by the Company at least 30 days
prior to the Annuity Commencement Date.
If an option has not been elected within 30 days of the Annuity
Commencement Date, the Company will pay a Variable Joint and One-Half
Survivor Annuity from the Variable Contract Value and a Fixed Joint
and One-Half Survivor Annuity from the Guaranteed Contract Value.
10.2 Selection of Payment Options
(a) A single sum payment may be elected. If it is, the amount to be
paid is the Surrender Value, and will be subject to any
applicable Surrender Charge.
(b) If a variable annuity payment option is elected, the amount to
be applied is the Variable Account Value, as of the Annuity
Commencement Date, less Premium Tax, if any.
(c) If a fixed annuity payment option is elected, the amount to be
applied is the Guaranteed Account Value, as of the Annuity
Commencement Date, less Premium Tax, if any.
(d) The minimum amount that may be withdrawn from the Annuity
Account Value to purchase an annuity payment option is $2,000.
If the amount is less than $2,000, the Company may pay the
amount in a single sum subject to Sections 8.3.
(e) Payments to be made under the annuity payment option selected
must be at least $50. The Company reserves the right to make
the payments using the most frequent payment interval which
produces a payment of not less than $50.
(f) The maximum amount that may be applied under any annuity payment option
is $1,000,000, unless prior approval is obtained from the Company.
10.3 Variable Annuity Payment Options
The guaranteed annuity table is based on mortality from the 1971 female
Group Annuity Mortality Table with a five year setback, a 2% administrative
charge and a guaranteed interest rate of 3 1/2% per year. The Company may
offer a better rate than the guaranteed rate shown.
The following variable annuity payment options are available: (a) Option 1:
Variable Life Annuity with Guaranteed Period Monthly payments for the
guaranteed Annuity Payment Period elected or the lifetime of the
Participant or Payee, whichever is longer. The guaranteed Annuity Payment
Period elected may be 5, 10, 15, or 20 years. Upon death of the Participant
or Payee, the Beneficiary will begin to receive the remaining payments at
the same monthly interval elected by the Participant. See Table A. (b)
Option 2: Variable Life Annuity Monthly payments for the Participant's
lifetime, without a guaranteed period. See Table A. (c) Option 3: Variable
Joint and One-Half Survivor Annuity A Variable Joint and One-Half Survivor
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 continues to a
designated beneficiary, if living, and terminates upon his/her death. Table
B is applicable to this Option. (d) Option 4: Any Other Form Any other form
of variable annuity which is acceptable to the Company.
SECTION 10. PAYMENT OPTIONS (continued)
These variable annuity payment options are subject to the following
provisions:
(1) Amount of First Monthly Payment
The first monthly payment under a variable annuity payment option
will be based on the value of each Variable Sub-Account on the
5th Valuation Date preceding the Annuity Commencement Date. It
will be determined by applying the appropriate rate from Table
A to the amount applied under the payment option.
(2) Annuity Units
The number of Annuity Units paid to the Participant for each
Variable Sub-Account is determined by dividing the amount of
the first monthly payment by the sub-account's annuity unit
value on the 5th Valuation Date preceding the date the first
payment is due. The number of Annuity Units used to calculate
each payment for a Variable Sub-Account remains fixed during
the Annuity Payment Period.
(3) Amount of Monthly Payments after the First
Monthly payments after the first will vary depending upon the
investment experience of the Variable Sub-Accounts. The
subsequent amount paid from each sub-account is determined by
multiplying (a) by (b) where (a) is the number of sub-account
Annuity Units to be paid and (b) is the sub-account annuity
unit value on the 5th Valuation Date preceding the date the
annuity payment is due. The total amount of each variable
annuity payment will be the sum of the variable 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.
10.4 Fixed Annuity Payment Options
The guaranteed annuity table is based on mortality from the 1971 female
Group Annuity Mortality Table with a five year setback, a 2%
administrative charge and a guaranteed interest rate of 3 1/2% per
year. The Company may offer a better rate than the guaranteed rate
shown.
The following fixed annuity payment options are available:
of Specified Amount
An annuity payment
at 12-, 6-, 3-, or 1-month intervals, of an amount elected for an Annuity
Payment Period of not more than 240 months. Upon death of the Participant or
Payee, the Beneficiary will begin to receive the remaining payments at the same
monthly interval. See Table C.
(b) Option 2: Income
for a Specified Period
An annuity payment
at 12-, 6-, 3-, or 1-month intervals, for the number of months elected for an
Annuity Payment Period of not more than 240 months. Upon death of the
Participant, the Beneficiary will begin to receive the remaining payments at the
same monthly interval that was elected by the Group Policyholder. See Table C.
(c) Option 3: Fixed
Life Annuity with Guaranteed Period
Monthly payments
for the guaranteed Annuity Payment Period elected which may be 5, 10, 15 or 20
years or the lifetime of the Annuitant whichever is longer. Upon death of the
Participant, any amounts remaining payable under this payment option will be
paid to the Beneficiary. See Table B.
(d) Option 4: Fixed Life Annuity
Monthly payments
for the Participant's lifetime, without a guaranteed period. See Table B.
(e) Option 5: Joint
and One-Half Fixed Survivor Annuity
A Joint and
One-Half Fixed Survivor 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 continues to a
designated beneficiary, if living, and terminates upon his/her death. Table E is
applicable to this Option.
(f) Option 6: Any
Other Form
Any other form of
annuity which is acceptable to the Company.
SECTION 11. PERIODIC PAYMENTS
11.1 Periodic Payment Option
The Group Policyholder must Request that all or part of the Annuity
Account be applied to a Periodic Payment Option. All outstanding loan
balances must be paid in full before a Participant may apply for a
Periodic Payment Option. While periodic payments are being received:
o the Group Policyholder may continue to exercise all contractual
rights that are available prior to electing a payment option, except
that no Contributions may be made by a Participant;
o Participants may continue to keep their current Guaranteed and Variable
Sub-Accounts; o charges and fees under the Contract, if applicable,
continue to apply, except as noted below; o a Surrender Charge does not
apply to periodic payments; and o if a partial withdrawal is made, a
Surrender Charge, if applicable,
will be deducted. The surrender charge free amount does not apply.
If periodic payments cease, the Participant may resume making
Contributions, at which time the surrender charge free amount will be
in effect.
The Group Policyholder will elect by Request: o the payment frequency of
either 12-, 6-, 3-, or 1-month intervals; o a payment amount; a minimum of
$50 is required; o the calendar day of the month on which payments will be
made; o one payment option; and o the allocation of payments from the
Variable and/or Guaranteed Sub-Account(s) as follows:
1) Prorate the amount to be paid across all Variable and Guaranteed
Sub-Accounts in proportion to the assets in each sub-account; or
2) Select the Investment Division(s) from which payments will
be made. Once the Investment Division(s) have been
depleted, the Company will automatically prorate the
remaining payments unless the Group Policyholder Requests
the selection of another Investment Division(s).
Payments will cease on the earlier of:
o the date the amount
elected to be paid under the option selected has been reduced to zero;
o the Group
Policyholder Requests the payments to stop;
o the death of the
Participant; or
o the Annuity Account
Value is zero.
The Group Policyholder
must elect one of the following 5 payment options:
1) Income for a
Specified Period for at least thirty-six (36) months - The Group Policyholder
elects the duration over which payments will be made. This amount may vary based
on the duration; or
2) Income of a
Specified Amount for at least thirty-six (36) months - The Group Policyholder
elects the dollar amount of the payments. Based on the amount elected, the
duration may vary; or
3) Interest Only - The
payments will be based on the amount of interest credited to the Guaranteed
Sub-Account(s) between each payment. Available only if 100% of the account
value is invested in the Guaranteed Sub-Account; or
4) Minimum Distribution - the Group Policyholder may Request minimum
distributions as specified under Internal Revenue Code 401(a)(9); or 5) Any
other form for a period of at least thirty-six (36) months - Any other form
of periodic payment which is acceptable to the Company.
SECTION 12. CONTRACT MODIFICATION
12.1 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 Deposits
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.
12.2 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 Deposits paid in respect of Participants
prior to the date of such modification.
12.3 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
Deposits paid in respect of Participants prior to the date of such
modification.
12.4 Modification of Variable and/or Guaranteed Sub-Account Riders, If Any
Notwithstanding the other contract modification provisions, the Company may
offer new or cease offering existing Variable or Guaranteed Sub-Accounts.
No such modification shall affect the terms, provisions, or conditions
which are or may be applicable to Deposits previously paid to any Variable
or Guaranteed Sub-Account which is no longer offered by the Company.
Maturing Certificates may be modified at the Certificate Maturity Date by
the Company. The Company may periodically notify the Group Policyholder of
the current offering of Variable or Guaranteed Sub-Accounts.
SECTION 13. CESSATION OF DEPOSITS
13.1 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 Guaranteed and Variable
Sub-Accounts of the Group Annuity Contract. If the Company receives
notice from the Group Policyholder of a Cessation of Deposits and no
Cessation of Deposits Date is stated in the notice, the Date of
Cessation of Deposits will be 60 days from the date the notice was
received by the Company.
If a Date of Cessation of Deposits has been declared for certain Sub-Accounts,
the Group Policyholder in respect of the Participant may by Request make a
change of allocation of his/her new Deposits. When no change of allocations is
received, the Company may return all new Deposits affected by the declaration of
the Date of Cessation of Deposits, or allocate such new Deposits to the
Sub-Account chosen by the Company.
After the Date of Cessation of Deposits declared in respect of all Sub-Accounts,
no new Participant Annuity Account will be established, and all Participant
Annuity Accounts shall become subject to the provisions of Section 13.2 below.
SECTION 13. CESSATION OF DEPOSITS (continued)
13.2 Options on Declaration of Date of Cessation of
Deposits
Upon the declaration of the Date of Cessation of Deposits for all
Sub-Accounts, the Group Policyholder may by 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,
the Company will make the election in its sole discretion. Such
election shall apply to all Participant Annuity Accounts and shall be
binding on the Group Policyholder.
a. Cessation Option (1) Maintenance of Each Participant Annuity Account
Value: The Company will maintain each Participant Annuity Account Value
until it is applied to a Payment Option or paid under the Group Annuity
Contract. After Cessation Option (1) has been elected, Transfers To Other
Companies will be permitted in accordance with Sections 6 and 9 of the
Contract. A Contingent Deferred Sales Charge, if applicable, will apply.
b. Cessation Option
(2) Installment Settlement of Contract Values:
Upon receipt of a
Request from the Group Policyholder and subject to the provisions relating to
Transfers, the Company will pay the sum of the Variable Contract Values in
respect of Participants as of the Date of Cessation of Deposits to the successor
insurer of the Plan or to the Group Policyholder within 7 days of the date the
cessation option is elected.
Upon receipt of a Request from the Group Policyholder, the Company will pay the
sum of the Guaranteed Contract Values in respect of the Participants as of the
Date of Cessation of Deposits to 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 of
Cessation.
After Cessation Option (2) has been elected, no benefits will be paid, no
Transfers will be made, no method of Payment option may be elected by a
Participant or Payee and no Deposits will be accepted.
<PAGE>
<TABLE>
<S> <C> <C> <C> <C> <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 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
TABLE B - Variable Joint and One-Half Survivor 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 3.88 3.91 3.94 3.96
3.97 3.98
55 4.09 4.15 4.19 4.23
4.25 4.27
60 4.34 4.43 4.51 4.58
4.63 4.66
65 4.64 4.77 4.90 5.01
5.10 5.16
70 4.99 5.17 5.36 5.55
5.70 5.83
75 5.40 5.65 5.91 6.19
6.46 6.69
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.
<PAGE>
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 28.61
4 21.82
5 17.75
6 15.04
7 13.10
8 11.66
9 10.54
10 9.63
11 8.90
12 8.30
13 7.78
14 7.34
15 6.96
16 6.63
17 6.34
18 6.08
19 5.85
20 5.64
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.
<PAGE>
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 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
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 3.88 3.91 3.94 3.96
3.97 3.98
55 4.09 4.15 4.19 4.23
4.25 4.27
60 4.34 4.43 4.51 4.58
4.63 4.66
65 4.64 4.77 4.90 5.01
5.10 5.16
70 4.99 5.17 5.36 5.55
5.70 5.83
75 5.40 5.65 5.91 6.19
6.46 6.69
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.
</TABLE>
<PAGE>
DAILY INTEREST GUARANTEE FUND RIDER
A GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY
CONTRACT
The Daily Interest Guarantee Fund is a Guaranteed Sub-Account. Deposits may be
made into the Daily Interest Guarantee Fund at any time. Interest will be earned
on the Daily Interest Guarantee Fund value and compounded daily. The interest
rate credited may change on a calendar quarter basis, but on an annual effective
basis will not be less than the Guaranteed Interest Rate.
The value of the Daily Interest Guarantee Fund in respect of the Participant
will be determined by adding his/her Daily Interest Guarantee Fund Sub-Account's
Deposits and interest and subtracting distributions to a Beneficiary, amounts
distributed or applied under a payment option, transfers, Contract Maintenance
Charge, and Premium Tax.
This Rider, unless and until modified, forms part of the Group Annuity Contract.
<PAGE>
GUARANTEED CERTIFICATE SUB-ACCOUNT FUND RIDER
A 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 Request allocate any Deposit
in respect of the Participant to any one Certificate. Deposits may be allocated
only to those Certificates currently being offered by the Company.
If the Group Policyholder allocates a Participant's Deposits to Certificates not
currently offered by the Company, the Company may return such Deposits, allocate
such Deposits to a currently offered Certificate, or allocate such Deposits to
another currently offered Guaranteed Sub-Account.
DEFINITIONS
Certificate - represents the amount deposited into the Guaranteed 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 duration 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.
Interest Crediting and Selection of Payment Option
The Credited Interest Rate on an annual effective basis will not be less than
the Guaranteed Interest Rate and will be compounded daily. A Deposit to the
Guaranteed Certificate Fund which remains in the Guaranteed Certificate Fund
until the Certificate Maturity Date will earn a Credited Interest Rate for the
Certificate's Interest Guarantee Period.
If the Participant is eligible for a benefit payment in accordance with the
Plan, as determined by the Group Policyholder, amounts deposited into the
Guaranteed Certificate Fund may be applied to a payment option prior to the
Certificate Maturity Date. Amounts applied to a payment option pursuant to
Section 10 of the Group Annuity Contract prior to the Certificate Maturity Date
will receive the Credited Interest Rate from the date of deposit to the date the
amount is applied to the elected payment option.
If the Participant is not eligible for a benefit payment in accordance with the
provisions of the Plan, as determined by the Group Policyholder, amounts
deposited into the Guaranteed Certificate Fund must remain in the Certificate
until the Certificate Maturity Date. Thus, no payment option may be elected, and
no distributions or transfers will be permitted prior to the Maturity Date of
each respective Certificate.
GUARANTEED CERTIFICATE SUB-ACCOUNT FUND RIDER (continued)
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.
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 Credited
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.
Transfers
The terms of Section 6 of the Group Annuity Contract will apply to any transfer
to or from the Guaranteed Certificate Fund.
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 Certificate Fund Sub-Account's
Deposits and interest, and subtracting his/her total or partial distributions,
distributions to a Beneficiary, amounts distributed or applied under a payment
option, transfers, Contract Maintenance Charge, and Premium Tax.
This Rider, unless and until modified, forms part of the Group Annuity Contract.
<PAGE>
GUARANTEED FIXED FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
The Participant, subject to the provisions of the Group Annuity Contract, may
allocate all or a portion of his/her Deposits to the Guaranteed Fixed Fund,
which is a Guaranteed Sub-Account. Deposits allocated to the Guaranteed Fixed
Fund in a calendar quarter shall earn an initial annual effective rate of
interest equal to the rate stated by the Company for that calendar quarter. Each
initial rate shall remain in effect through the end of that calendar year and
shall never be less than 3.5%.* Each year in which Deposits are allocated to the
Guaranteed Fixed Fund shall be known as a deposit year.
All Deposits allocated and interest accrued thereon in a given deposit year
which remain in the Guaranteed Fixed Fund shall constitute a separate portfolio
as of January 1st of the year following the deposit year. Each separate
portfolio shall earn an annual effective rate of interest stated by the Company,
which shall be known as a renewal rate. Each renewal rate shall be effective for
one calendar year and shall never be less than 3.5%.* A different renewal rate
may be declared by the Company for each separate portfolio and for each calendar
year.
The Participant, subject to the provisions of the Group Annuity Contract and
this Guaranteed Sub-Account Rider, may transfer amounts from his/her Guaranteed
Fixed Fund sub-account at any time. The Company may, from time to time,
establish a maximum amount which may be transferred from the Participant's
Guaranteed Fixed Fund sub-account in a calendar year, which shall never be less
than 20% of the Participant's prior year end account balance in the Guaranteed
Fixed Fund. However, if the Participant's Guaranteed Fixed Fund sub-account
balance is $500 or less on the effective date of the transfer, all or a portion
of that balance may be transferred. Amounts transferred shall be debited from
the Participant's Guaranteed Fixed Fund sub-account on a last-in-first-out
basis.
Distributions from the Guaranteed Fixed Fund sub-account shall be governed by
the Group Annuity Contract. Amounts distributed from the Guaranteed Fixed Fund
sub-account shall be debited on a last-in-first-out basis.
*IMPORTANT NOTICE: The Guaranteed Interest Rate defined in the Group Annuity
Contract shall not apply to funds deposited into the Guaranteed Fixed Fund
sub-account.
<PAGE>
Periodic Payment Option Rider
1-98
<PAGE>
PERIODIC PAYMENTS OPTION RIDER - 401(a)/(k) PLANS
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Ability to Elect
In addition to the methods of payment available under Article 9 of the Group
Annuity Contract, a Periodic Payment Option may be elected under the Contract if
also permitted under the provisions of the Plan.
If the Participant is entitled to begin distributions under the Plan, the
Participant, with the Group Policyholder's consent, may, by Written Request,
elect that all or part of the Participant Annuity Account be applied to a
Periodic Payment Option. All outstanding loan balances must be paid in full or
treated as a distribution before a Participant may apply for a Periodic Payment
Option.
Operation of Participant Annuity Account While periodic payments are being
received:
o the Participant may continue to exercise all contractual rights that are
available prior to electing a payment option, except that no Deposits
may be made by a Participant;
o Participants may continue to keep their current Participant Annuity Account; o
charges and fees under the Contract, if applicable, continue to apply.
If periodic payments cease, the Participant may resume making Deposits, if
allowed by the Plan. Additionally, if periodic payments cease, periodic payment
options may not commence again for at least a 36 month period.
Frequency and Amount of Payments
The Participant will elect by Written Request:
o the payment frequency of either 12-, 6-, 3-, or 1-month intervals; o a payment
amount; a minimum of $50 is required; o the month, day and year on which
payments will be made; and o one payment option.
The Participant may elect to change the payment option and/or frequency once
each calendar year.
Payments will cease on the earlier of:
o the date the amount elected to be paid under the option selected has been
reduced to zero; o the date the Participant, by Written Request, chooses that
the payments stop; or o the Annuity Account Value is zero.
Payments to a Beneficiary
Upon the Participant's death, the Beneficiary shall elect a payment option on
the death claim form which complies with the distribution requirements of
Section 401(a)(9) of the Internal Revenue Code.
Payment Options Available
The Participant must elect one of the following 4 payment options: 1) Income
for a Specified Period for at least thirty-six (36) months. The Participant
elects the duration over which payments will be made. This amount may vary
based on the duration; or
2) Income of a Specified Amount for at least thirty-six (36) months. The
Participant elects the dollar amount of the payments. Based on the amount
elected, the duration may vary; or
3) Interest Only. The payments will be based on the amount of interest
credited to the Participant Annuity Account between each payment. Available
only if the Participant is younger than 70 1/2; or
4) Minimum Distribution. The Participant may Request minimum distributions
as specified under Internal Revenue Code Section 401(a)(9).
PERIODIC PAYMENTS OPTION RIDER - 401(a)/(k) PLANS (continued)
Signed for Great-West Life & Annuity Insurance Company on the Issue Date.
[GRAPHIC OMITTED]
W.T. McCallum,
President and Chief Executive Officer
Signed for the Group Policyholder on the day of
, 19 .
Group Policyholder Name
(Signature)
Group Policy Number
<PAGE>
403(b) Employer Sponsored Group Annuity Contract
1-92
<PAGE>
Great-West Life & Annuity Insurance Company
8515 East Orchard Road Englewood, CO 80111
HOME OFFICE - ENGLEWOOD, COLORADO
ADMINISTRATIVE OFFICES
ENGLEWOOD, COLORADO
GROUP POLICYHOLDER
GROUP POLICY NUMBER
GROUP ANNUITY CONTRACT DATE
Group Tax-Deferred Annuity, Non-Participating
Signed for Great-West Life & Annuity Insurance Company on the issuance of the
Group Annuity Contract on the Annuity Contract Date.
[GRAPHIC OMITTED][GRAPHIC OMITTED] [GRAPHIC OMITTED][GRAPHIC OMITTED]
General Counsel and Secretary President and Chief Executive Officer
[GRAPHIC OMITTED][GRAPHIC OMITTED]
For the Actuary
15 Day Free-Look
The Accountholder may return his/her Certificate within 15 days of its mailing
and have all Deposits refunded to him/her if, after examination, the
Accountholder is not satisfied with it for any reason.
PLEASE READ THIS CONTRACT CAREFULLY. IT IS A CONTRACT WHICH MAY PROVIDE FOR
PAYMENTS OR VALUES WHICH ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT MAY
INCREASE OR DECREASE ACCORDING TO THE INVESTMENT EXPERIENCE OF THE VARIABLE
ANNUITY ACCOUNT.
Group Tax-Deferred Annuity
EMPLOYER SPONSORED HOSPITAL AND EDUCATION
GROUP TAX-DEFERRED ANNUITY CONTRACT
TABLE OF CONTENTS
15 DAY FREE-LOOK
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
SECTION 1.
DEFINITIONS.....................................................................................5
SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Group Annuity
Contract.............................................................7
2.2 Ownership of Participant Annuity Account
Value..................................................7
2.3 Transfer and
Assignment.........................................................................7
2.4 Ownership of Series
Account.....................................................................7
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity
Contract......................................................................7
3.2
Certificate.....................................................................................7
3.3 Entire
Contract.................................................................................7
3.4 Contract
Modification...........................................................................7
3.5
Non-Participating...............................................................................8
3.6
Beneficiary.....................................................................................8
3.7 Currency and Payment of
Deposits................................................................8
3.8 Age
............................................................................................8
3.9 Voting
Rights...................................................................................8
3.10
Reports.........................................................................................8
3.11 Notice and
Proof................................................................................8
3.12 Materials Developed by Group
Policyholder.......................................................9
3.13 Tax Consequences of
Payments....................................................................9
3.14
Loans...........................................................................................9
SECTION 4. DEPOSIT PROVISIONS
4.1 Commencement of
Deposits........................................................................9
4.2
Deposits........................................................................................9
4.3 Allocation of
Deposits..........................................................................9
SECTION 5. ACCOUNT VALUE PROVISIONS
5.1 Variable Accounts
..............................................................................9
5.2 Risk
Charge....................................................................................10
5.3 Guaranteed Account
Value.......................................................................10
5.4 Guaranteed Sub-Account
Riders..................................................................10
5.5 Contract Maintenance
Charge....................................................................11
SECTION 6. TRANSFERS AND ROLLOVERS
6.1
Transfers......................................................................................11
6.2 Transfer
Terms.................................................................................11
6.3 Intra-Company
Transfers........................................................................11
6.4 Transfers to Other
Companies...................................................................12
6.5 90-24
Transfers................................................................................12
6.6
Rollovers......................................................................................12
GROUP TAX-DEFERRED ANNUITY CONTRACT
TABLE OF CONTENTS (continued)
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY UPON DEATH
7.1 Death of Accountholder After Annuity Commencement
Date.....................................12
7.2 Death of Accountholder Before Annuity Commencement
Date....................................13
7.3 Amount Payable on Death of
Participant.....................................................13
SECTION 8. QUALIFIED DOMESTIC RELATIONS ORDER (QDRO)
8.1 Effect of Qualified Domestic Relations Order
(QDRO)........................................14
8.2 Total or Partial
Distribution............................................................ 14
8.3 Establishment of Alternate Payee Annuity
Account...........................................14
8.4 Withdrawal from Participant Annuity
Account................................................14
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER
9.1 Requests for
Distributions.................................................................14
9.2 Distribution to Participant Due to
Hardship................................................15
9.3 Adequate
Proof.............................................................................15
SECTION 10. CONTINGENT DEFERRED SALES CHARGE AND LOSS OF INTEREST CHARGE
10.1 Contingent Deferred Sales
Charge...........................................................16
10.2 Contingent Deferred Sales Charge
Amount....................................................16
SECTION 11. PAYMENT OPTIONS
11.1 How to Elect Payment
Options...............................................................16
11.2 Selection of Payment
Options...............................................................16
11.3 Variable Dollar Payment
Options............................................................17
11.4 Fixed Dollar Payment
Options...............................................................18
SECTION 12. DEPOSIT TERMINATION
12.1 Notice of Termination
.....................................................................19
12.2 Administration of Accounts Upon Deposit
Termination........................................19
TABLE A 20
TABLE B 21
TABLE C 22
TABLE D 23
TABLE E 24
GUARANTEED SUB-ACCOUNT RIDERS, IF
ANY..............................................................................
SYSTEMATIC WITHDRAWAL OPTION RIDER, IF
ANY.........................................................................
</TABLE>
<PAGE>
SECTION 1. DEFINITIONS
Accountholder - a Participant with respect to his/her Participant Annuity
Account or an Alternate Payee with respect to his/her Alternate Payee Annuity
Account.
Accumulation Period - the period during which the Accountholder is covered under
this Group Annuity Contract prior to his/her Annuity Commencement Date.
Accumulation Unit - an accounting measure used to determine the Variable Account
Value before the Annuity Commencement Date.
Administrative Offices - 8515 E. Orchard Road
Englewood, Colorado 80111
Alternate Payee - a spouse, former spouse, child or other dependent of a
Participant who is entitled to receive all or a portion of the Participant
Annuity Account pursuant to a Qualified Domestic Relations Order.
Alternate Payee Annuity Account - a separate record in the name of an Alternate
Payee which reflects the value of amounts awarded to the Alternate Payee from a
Participant Annuity Account pursuant to a Qualified Domestic Relations Order.
These amounts may only be allocated to a Guaranteed Sub-account.
Alternate Payee Effective Date - the date on which the appropriate value of the
Participant Annuity Account is transferred to the Alternate Payee Annuity
Account pursuant to a Qualified Domestic Relations Order.
Annuitant - the person upon whose life the payment of an annuity is based.
Annuity Account Value - the sum of the Variable and Guaranteed Sub-Accounts
credited to the Accountholder under his/her annuity account.
Annuity Commencement Date - the date on which annuity payments commence under a
payment option, which for any Accountholder shall be not later than April 1st of
the calendar year following the calendar year in which the Participant attains
age 70 1/2.
Annuity Contract Date - the effective date of this Group Annuity Contract as
agreed upon by the Group Policyholder and the Company.
Annuity Payment Period - the period during which the Payee is receiving annuity
payments under this Group Annuity Contract.
Annuity Unit - an accounting measure used to determine the dollar value of any
Variable Dollar Annuity Payment after the first annuity payment is made.
Beneficiary - the person(s) designated by the Accountholder to receive
distributions, if any, payable upon the Accountholder's death.
Certificate - an individual certificate, including a copy of this Group Annuity
Contract, issued to each Participant and Alternate Payee to evidence his/her
coverage under this Group Annuity Contract.
Company - Great-West Life & Annuity Insurance Company.
Deposit - contributions, Intra-Company Transfers, Transfers from other
companies, and other amounts allocated to a Guaranteed or Variable Sub-Account.
Eligible Employee - an individual performing services for an Eligible Employer.
Eligible Employer - an educational organization described in Section
170(b)(1)(A)(ii) which is a political subdivision of a state or an agency or
instrumentality thereof. An "Eligible Employer" may also include an employer
described in Section 501(c)(3) of Internal Revenue Code of 1986, as amended.
Eligible Fund - a registered management investment company in which the assets
of the Series Account may be invested.
SECTION 1. DEFINITIONS (continued)
Group Policyholder - the Eligible Employer who has applied for and has been
issued this Group Annuity Contract.
Guaranteed Account - the account established under this Group Annuity Contract
providing Guaranteed Sub-Accounts.
Guaranteed Account Value - the sum of the values of the Guaranteed Sub-Accounts
credited to the Accountholder under his/her annuity account.
Guaranteed Interest Rate - a minimum interest rate applicable to Guaranteed
Sub-Accounts with an annual effective rate of 4%.
Guaranteed Sub-Account - a sub-division of the Guaranteed Account described in
the attached Guaranteed Sub-Account Riders, if any.
Intra-Company Transfer - amounts moved within and between any of the Variable
and Guaranteed Sub-Accounts.
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.
Letter Agreement - a formal written agreement signed by the Company and the
Group Policyholder which is used to clarify or modify certain provisions of the
Contract and will be attached to and form a part of this Group Annuity Contract.
Participant - an Eligible Employee of the Group Policyholder for whom an annuity
account has been established under this Group Annuity Contract.
Participant Annuity Account - a separate record established in the name of each
Participant which reflects the total value of the Participant's Guaranteed and
Variable Sub-Accounts.
Participant Effective Date - the date on which the first Deposit is credited to
a Participant Annuity Account.
Payee - any person receiving distributions or annuity payments under this Group
Annuity Contract.
Premium Tax - the amount of tax, if any, charged by a state or other
governmental authority on premiums.
Qualified Domestic Relations Order (QDRO) - a domestic relations order which
creates or recognizes the existence of an Alternate Payee's right to, or assigns
to an Alternate Payee the right to, receive all or a portion of the value of a
Participant Annuity Account which meets the requirements of Internal Revenue
Code Section 414(p).
Series Account - the segregated investment account of Great-West Life & Annuity
Insurance Company called "FUTUREFUNDS Series Account" existing under Colorado
law and registered as a unit investment trust under the Investment Company Act
of 1940, as amended.
Transfer to Other Companies - amounts moved from any Variable or Guaranteed
Sub-Account to another company upon Written Request of the Accountholder.
Valuation Date - the date on which the net asset value of each Eligible Fund is
determined.
Valuation Period - the period between two successive Valuation Dates.
Variable Account - the account established under this Group Annuity Contract
providing Variable Sub-Accounts.
Variable Account Value - the sum of the values of the Variable Sub-Accounts
credited to a Participant under his/her Participant Annuity Account.
Variable Sub-Account - a sub-division of the Variable Account containing the
value credited to a Participant from an Investment Division.
Written Request - any request in written form, satisfactory to the Company and
received by the Company at its Administrative Office, from the Group
Policyholder, the Accountholder, or their designee as required by any provision
of this Group Annuity Contract, and at other times as required by the Company.
SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Group Annuity Contract
The Group Policyholder is the owner of this Group Annuity Contract for
the benefit of its Eligible Employees who become Participants.
2.2 Ownership of Participant Annuity Account Value
Each Eligible Employee for whom a Participant Annuity Account is
established and for whom Deposits have been received by the Company, owns
his/her Participant Annuity Account Value.
2.3 Transfer and Assignment
Except as provided in the Loan application form, if any, the interest of
any Accountholder, or of the Group Policyholder in this Group Annuity
Contract may not be transferred, sold, assigned, pledged, charged,
encumbered or in any way alienated by any of them.
To the extent permitted by law, no proceeds or payments under the Group
Annuity Contract will be subject to the claims of creditors or legal
process.
2.4 Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
The portion of the assets of the Series Account equal to the reserves and
other contract liabilities with respect to the Series Account are not
chargeable with liabilities arising out of any other business the Company
may conduct.
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity Contract
This Group Annuity Contract is issued by the Company to the Group
Policyholder.
3.2 Certificate
The Company will issue to each Accountholder an individual Certificate as
evidence of his/her participation under this Group Annuity Contract.
3.3 Entire Contract
This Group Annuity Contract, its application, tables, and riders, if any,
form the entire contract between the Group Policyholder and the Company
and the entire agreement between the Company and the Accountholder, as
well as any Beneficiary. This contract supersedes all prior
representations, statements, warranties, promises and agreements of any
kind, whether oral or written, relating to the subject matter of this
Group Annuity Contract. All statements in the application, in the absence
of fraud, have been accepted as representations and not as warranties. A
copy of the application is attached to the Group Annuity Contract when
issued to the Group Policyholder.
3.4 Contract Modification
This Group Annuity Contract may be modified only by written agreement
between the Company and the Group Policyholder, and such modifications
shall become part of this Group Annuity Contract.
Upon 60 days advance written notice to the other, the Group Policyholder
or the Company may terminate Deposits into certain Variable and
Guaranteed Sub-Accounts. In that event, the Participant, by Written
Request, may change the allocation of his/her Deposits. Absent such
Written Request on the date the Sub-account(s) is terminated, the value
of such terminated Sub-account(s) will be allocated to the Daily Interest
Guarantee Fund.
Upon 30 days written notice to the Group Policyholder, the Company may at
any time and without the consent of the Group Policyholder or any other
person, modify this Group Annuity Contract as needed to conform to
changes in tax or other law.
ONLY THE PRESIDENT, A VICE-PRESIDENT, OR THE SECRETARY OF THE COMPANY CAN
MODIFY OR WAIVE ANY PROVISION OF THIS GROUP ANNUITY CONTRACT.
SECTION 3. GENERAL PROVISIONS (continued)
3.5 Non-Participating
This Group Annuity Contract is non-participating. It
is not eligible to share in the Company's divisible surplus.
3.6 Beneficiary
The Accountholder may, by Written Request, designate or change a
Beneficiary from time to time. When recorded by the Company, a change of
Beneficiary will take effect as of the date the Written Request was
signed by the Accountholder. If the Accountholder dies before the date
the Written Request was recorded, the change will take effect as of the
date of the Written Request except to the extent that the Company has
made a payment or has otherwise taken action on a designation or change
before receipt or recording of the designation or change of Beneficiary.
Unless otherwise provided in the Beneficiary designation, the following
provisions will apply:
o upon the death of the Accountholder, his/her Annuity Account Value shall
pass to any surviving primary Beneficiary and if more than one, the
Annuity Account Value shall be shared equally among them.
o if a primary Beneficiary dies before the Accountholder, that
Beneficiary's intended share will be shared equally among the surviving
primary beneficiaries.
o if there is no surviving primary Beneficiary, the Annuity Account Value
shall pass to any surviving contingent Beneficiary, and if more than
one, shall be shared equally among them.
o if no Beneficiary has been designated, or no Beneficiary survives the
Accountholder, the Annuity Account Value will pass to the
Accountholder's estate.
3.7 Currency and Payment of Deposits
All Deposits to this Group Annuity Contract must be made payable to the
Company in the currency of the United States of America.
3.8 Age
If the age of an Annuitant has been misstated, the payments established
for him/her 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 result in an annual effective
rate which will not be less than 4% per year, as determined by the
Company.
3.9 Voting Rights
The Company will vote the shares of an Eligible Fund. To the extent
required by law, the Company will vote according to the instructions of
each Participant in proportion to his/her interest in the Variable
Sub-Account. In such event, the Company will send proxy materials and
form(s) to the Participant for his/her reply. If no reply is received by
the date specified in the proxy materials, 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, 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 Participant, and all other provisions concerning Voting Rights will
apply to the Payee of a Variable Dollar Method of Payment Option.
3.10 Reports
The Company will furnish the Accountholder not less frequently than
annually a statement of his/her Annuity Account Value. The Company will
furnish the Accountholder 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.
3.11 Notice and Proof
Any notice or demand by the Company to or upon the Group Policyholder,
the Accountholder, or any other person may be given by mailing it to that
person's last known address as stated in the Company's file.
Any application, report, request, written request, election, direction,
notice or demand by the Group Policyholder, the Accountholder, or any
other person must be made in a form satisfactory to the Company. When
required by the Company an Accountholder or Payee will obtain the
signature of his/her spouse on forms acceptable to the Company.
SECTION 3. GENERAL PROVISIONS (continued)
3.12 Materials Developed By Group Policyholder
Written materials developed by the Group Policyholder to describe this
Group Annuity Contract must be approved in writing by the Company before
the materials may be used.
The Company may require adequate proof of the age or death of any
individual before it admits a claim for or pays any payment. The Company
may require the documentation of facts needed for continued
administration of this Group Annuity Contract.
3.13 Tax Consequences of Payments
The Accountholder, Annuitant, Payee or Beneficiary, as the case may be,
must determine the timing and amount of any benefit payable to him/her.
Nothing contained herein shall be construed to be tax or legal advice and
the Company assumes no responsibility or liability for any damages or
costs, including but not limited to taxes, penalties, interest or
attorney's fees incurred by the plan, the Group Policyholder, the
Participant, the Alternate Payee, the Beneficiary, or any other person
arising out of any such determination.
3.14 Loans
Loans may be available to Accountholders under this Group Annuity
Contract in accordance with the terms set forth in the loan application
form and the Group Policyholder's plan document.
SECTION 4. DEPOSIT PROVISIONS
4.1 Commencement of Deposits
An Eligible Employee who submits an adequate application becomes a
Participant as of the Participant Effective Date. An Alternate Payee who
submits an adequate application becomes an Accountholder as of the
Alternate Payee Effective Date.
4.2 Deposits
Subject to Section 12, the Group Policyholder shall promptly pay Deposits
in cash for all Participants. The amount of Deposits for any Participant
will be the amount elected by the Participant plus employer
contributions, if any.
With each payment of Deposits, the Group Policyholder shall provide a
report acceptable to the Company containing a list of all Participants
and the amount of the Deposits to be allocated to each Participant. The
Group Policyholder's report is conclusive and binding on it and anyone
claiming an interest under this Group Annuity Contract or any
Certificate. When the Group Policyholder's report does not coincide with
the Deposits received, the Company may return the Deposits.
4.3 Allocation of Deposits
Deposits, less Premium Tax, if any, will be allocated in the Participant
Annuity Account among any number of currently offered Variable and
Guaranteed Sub-Accounts in accordance with the latest recorded Written
Request of the Participant. Allocations shall be effective upon the
Company's receipt of both the Deposit and the Group Policyholder report
required under Section 4.2. Deposits and Policyholder reports received
after 4:00 EST/EDT shall be deemed to have been received on the next
business day.
The allocation of Deposits may be changed at any time upon the Company's
receipt at its Administrative Offices of the Written Request of the
Participant. A change of allocation will be effective for Deposits which
are received after the Company's receipt and recording of such Written
Request.
SECTION 5. ACCOUNT VALUE PROVISIONS
5.1 Variable Accounts
a. Variable Account Value
The Variable Account Value for a Participant on any date during the
Accumulation Period will be the sum of the values of the Variable
Sub-Accounts.
The value of a Participant's interest in a Variable Sub-Account will
be determined by multiplying the number of the Participant's
Accumulation Units by the Accumulation Unit Value for that Variable
Sub-Account.
b. Accumulation Units
For each Deposit, the number of Accumulation Units credited for each
Participant to a Variable Sub-Account will be determined by dividing
the amount of such Deposit by the Accumulation Unit Value for that
Variable Sub-Account on the next Valuation Date on which such Deposit
was allocated.
Deposits received at the Administrative Offices of the Company before
4:00 p.m. EST/EDT of a Valuation Date will be allocated as requested
and shall be applied as of that date. All deposits received after
4:00 p.m. EST/EDT shall be applied as of the following Valuation
Date.
c. Accumulation Unit Value
The initial Accumulation Unit Value of each Variable Sub-Account was
established at $10. The Accumulation Unit Value of a Variable
Sub-Account on a Valuation Date is calculated by multiplying the
Accumulation Unit Value as of the immediately preceding Valuation
Date by the net investment factor (as explained in paragraph d. of
Section 5.1).
The dollar value of an Accumulation Unit will vary in amount
depending upon the investment experience of the Eligible Fund.
d. 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 (the date four days before the record date which
determines if the Group Policyholder is eligible to receive
a dividend) 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 an amount representing the risk charge deducted from each
Variable Sub-Account on a daily basis, equal to an annual rate
of 1.25% 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.
5.2 Risk Charge
The risk charge compensates the Company for its assumption of certain
mortality and expense risks. This charge is described in Section 5.1
d(c).
5.3 Guaranteed Account Value
The Guaranteed Account Value on any date during the Accumulation Period
will be the sum of the values of the Guaranteed Sub-Accounts credited to
the Accountholder under his/her annuity account.
5.4 Guaranteed Sub-Account Riders
The computation of the value of a Guaranteed Sub-Account is described in
the attached Guaranteed Sub-Account Riders, if any.
SECTION 5 ACCOUNT VALUE PROVISIONS (continued)
5.5 Contract Maintenance Charge
The following charges are applicable to the Variable and Guaranteed
Account Values. Each year, beginning on the first day of the calendar
quarter following the first anniversary of a Participant Effective Date,
or an Alternate Payee
Effective Date, as applicable, a nonrefundable contract maintenance
charge of not more than $60 annually, will be deducted from the annuity
account. The contract maintenance charge will be deducted proportionately
from the Variable and Guaranteed Sub-Accounts based upon their Variable
and Guaranteed Account Values.
SECTION 6. TRANSFERS AND ROLLOVERS
6.1 Transfers
A Participant may make Intra-Company Transfers or Transfers to Other
Companies by Written Request. For Intra-Company Transfers only, telephone
transfers will be accepted after the appropriate administrative forms are
executed. Alternate Payees and Beneficiaries may make transfers in
limited circumstances as discussed below.
6.2 Transfer Terms
The following provisions apply to both Intra-Company Transfers and
Transfers to Other Companies.
a. 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. For transfers from or into a Variable Sub-Account, a
unit value is calculated by the Company. If such Written Request is
received after 4:00 p.m. EST/EDT, the transfer will take effect based
on the Unit Value on the later of the date elected or the date
following the date the Written Request is received.
b. When required by the Company, the Participant, Alternate Payee or
Beneficiary will execute forms provided by the Company.
c. No transfers are permitted after the Annuity Commencement Date.
d. A transfer from a Guaranteed Sub-Account shall be subject to the terms
of the attached Guaranteed Sub-Account Riders.
6.3 Intra-Company Transfers
The following provisions will apply to Intra-Company Transfers, except
for funds in an unmatured certificate:
a. At any time prior to the Annuity Commencement Date, the Participant,
by Written Request, may transfer all or a portion of the his/her
Annuity Account Value within and between the Variable and Guaranteed
Sub-Accounts currently offered by the Company.
At any time prior to the Annuity Commencement Date, an Alternate
Payee by Written Request, may transfer all or a portion of his/her
Annuity Account Value within and between the Guaranteed Sub-Accounts
currently offered by the Company.
b. A telephone transfer, if permitted by the Company, will take effect
on the later of the date elected or the date the telephone call is
received at the Administrative Office. If such call is received after
4:00 p.m. EST/EDT, the transfer will take effect on the later of the
date elected or the date following the date the call is received.
c. If an Intra-Company Transfer is made within 30 days of the Annuity
Commencement Date, the Company may delay the Annuity Commencement
Date by 30 days.
d. If a Accountholder dies prior to the Annuity Commencement Date, one
Intra-Company Transfer may be made after the death of the
Accountholder by the Beneficiary to effect the election of a payment
option.
e. No contingent deferred sales charge will apply to Intra-Company
Transfers.
SECTION 6. TRANSFERS AND ROLLOVERS (continued)
f. Monies in the Guaranteed Certificate Fund cannot be transferred prior
to Certificate Maturity Date, except in the following situations: (1)
the Participant dies; or (2) the Participant separates from service;
or (3) the Participant suffers a hardship; or (4) the Participant
elects a payment option under Section 11 with a life contingency or
an annuity payment period of at
least (36) thirty-six months.
6.4 Transfers to Other Companies
a. At any time prior to the Annuity Commencement Date, a Participant, by
Written Request, may transfer all or a portion of the Participant
Annuity Account Value to another Company's ss.403(b) account,
pursuant to Revenue Ruling 90-24. Notwithstanding the immediately
preceding sentence, monies in the Guaranteed Certificate Fund cannot
be transferred prior to Certificate Maturity Date.
At any time prior to the Annuity Commencement Date, an Alternate
Payee by Written Request, may transfer all or a portion of the
Alternate Payee Account to another Company's ss.403(b) account,
pursuant to Revenue Ruling 90-24. Notwithstanding the immediately
preceding sentence, monies in the Guaranteed Certificate Fund cannot
be transferred prior to Certificate Maturity Date.
b. The contingent deferred sales charge described in Section 10 shall
apply to any and all Transfers to Other Companies, except those
requested by the Beneficiary after the Participant's death.
6.5 90-24 Transfers
The company to which a Transfer to Other Companies (as described in
Section 6) is made ("Authorized Provider") must be authorized by the
Group Policyholder to accept direct transfers from the Company. Prior to
the transfer, the authorized provider must verify that the amounts
transferred will be invested into another ss.403(b) vehicle and will
continue after the transfer to be subject to distribution requirements at
least as strict as those applicable to such funds before the transfer. If
such written verification is received by the Company at its
administrative offices prior to the direct transfer, such transfer will
not be reported as a taxable distribution to the Accountholder. All other
disbursements, whether or not paid directly to the Accountholder, and
whether or not eligible for rollover, will be reported as taxable
distributions as required by the Internal Revenue Code.
6.6 Rollovers
a. Subject to the provisions of this Group Annuity Contract, a
Participant, Surviving Spouse or Alternate Payee, upon the occurrence
of certain triggering events, may roll over only those distributions
meeting very specific requirements under the Internal Revenue Code of
1986, as amended from time to time.
b. The Company will not determine whether a disbursement or distribution
is eligible for rollover treatment and accepts no responsibility for
the tax consequences of the distribution. All rollover requests are
required to be reported to the IRS as taxable distributions and it is
solely the responsibility of the Participant, Alternate Payee or
Surviving Spouse to determine whether the distribution qualifies for
rollover treatment and to effect a proper rollover.
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY UPON DEATH
7.1 Death of Accountholder After Annuity Commencement Date
If the Accountholder dies after his/her Annuity Commencement Date and
before his/her entire interest has been distributed, payments will
continue to the Beneficiary under the payment option applicable to the
Accountholder on the Accountholder's date of death.
The Beneficiary will not be allowed to change the method of distribution
in effect on the date of the Accountholder's death or to elect a new
payment option.
7.2 Death of Accountholder's Before Annuity Commencement Date
a. 5-Year Rule. If the Accountholder dies before his/her Annuity
Commencement Date, the entire interest of the Accountholder shall be
distributed within five years after the death of the Accountholder.
This rule will always apply to non-individual entities, including,
but not limited to, trusts and estates.
b. Exception to the 5-Year Rule. For purposes of this section, a
designated Beneficiary is any individual named as Beneficiary by the
Accountholder. If any portion of the Accountholder's interest is
payable to a designated Beneficiary, such portion shall be
distributed over the lesser of (1) the life of the designated
Beneficiary, or (2) over a period not extending beyond the life
expectancy of the designated Beneficiary. Such distributions to a
designated Beneficiary shall begin not later than December 31 of the
year following the date of the Accountholder's death. The designated
Beneficiary may elect by Written Request to take distributions either
under the 5-year rule or under this exception to the 5-year rule. If
no election is made, the 5-year rule will apply.
c. Special Rule for Surviving Spouse.
(1) Participant Annuity Account
If the designated Beneficiary is the surviving spouse of a
Participant, the date on which the distributions are required to
begin shall not be later than the date on which the Participant
would have attained age 70 1/2. If no election is made, this
special rule for surviving spouse will apply.
(2) Alternate Payee Annuity Account
There is no special rule for a surviving spouse of an alternate payee. If
the designated beneficiary is the surviving spouse of an Alternate Payee,
distributions are required to begin pursuant to the rules applicable to
other individuals as described in paragraphs a. and b. of this Section 7.2
d. Election of Payment Option
The designated Beneficiary may elect that payment be made under one
or a combination of the payment options described in Section 11.
7.3 Amount Payable on Death of Participant
a. Amount Payable On Death of
Participant Before Annuity Commencement Date
(1) If the Participant dies
before the Annuity Commencement Date, and before his/her 70th birthday, the
amount payable will be the greater of: (i) the Participant Annuity Account
Value as of the date of death, less Premium Tax, if any; and (ii)the sum of
Deposits paid to, less any Partial Distributions from, the Participant
Annuity Account, less Premium Tax, if any.
(2) If the Participant dies before the Annuity Commencement Date,
but after his/her 70th birthday, the amount payable will be the
Participant Annuity Account Value as of the date of death, less
Premium Tax, if any.
b. Amount Payable on Death of Participant After Annuity Commencement Date
If the Participant dies after the Annuity Commencement Date, the amount
payable will be the amount remaining to be paid under the method of
distribution in effect on the date of the Participant's death.
c. Amount Payable on Death of Alternate Payee Before Annuity Commencement
Date If the Alternate Payee dies before the Annuity Commencement Date, the
amount payable will be the Alternate Payee Annuity Account Value as of the
date of death.
d. Amount Payable on Death of Alternate Payee After Annuity Commencement
Date If the Alternate Payee dies after the Annuity Commencement Date, the
amount payable will be the amount remaining to be paid under the method of
distribution in effect on the date of the Alternate Payee's death.
e. For payments made under this Section 7.3, the contingent deferred sales
charge will not apply.
SECTION 8. QUALIFIED DOMESTIC RELATIONS ORDER (QDRO)
8.1 Effect of Qualified Domestic Relations Order (QDRO)
If a domestic relations order which is determined to be "qualified" by
the plan administrator awards all or a portion of a Participant Annuity
Account to an Alternate Payee, the Alternate Payee may elect to take a
total or partial distribution or may elect to establish an Alternate
Payee Annuity Account.
8.2 Total or Partial Distribution
If the Alternate Payee elects to take a total or partial distribution,
the contingent deferred sales charge will be deducted from the amount
awarded to the Alternate Payee unless the Qualified Domestic Relations
Order clearly specifies, in the opinion of the Company, that such charges
be deducted from the Participant Annuity Account.
8.3 Establishment of Alternate Payee Annuity Account
a. An Alternate Payee who elects to establish an Alternate Payee Annuity
Account must submit an adequate application by Written Request
informing the Company of the amount to be allocated to the Alternate
Payee Annuity Account, which amount may be allocated only among the
Guaranteed Sub-Accounts. If an adequate application is not received
by the Company at its Administrative Offices as of the date the
amounts are to be withdrawn from the Participant Annuity Account, the
Alternate Payee will be deemed to have elected that all amounts be
allocated to the Daily Interest Guaranteed Fund.
b. Contingent deferred sales charges incurred on a distribution from the
Participant Annuity Account pursuant to a Qualified Domestic
Relations Order will be deducted from the amount awarded to the
Alternate Payee unless the Qualified Domestic Relations Order clearly
specifies, in the opinion of the Company, that such charges be
deducted from the Participant Annuity Account.
8.4 Withdrawal From Participant Annuity Account
Amounts will be withdrawn from the Participant Annuity Account pursuant
to the terms of the Qualified Domestic Relations Order (QDRO). If the
QDRO awards less than one hundred percent (100%) of the Participant
Annuity Account Value to the Alternate Payee, the amounts awarded will be
withdrawn from the Participant's Variable and Guaranteed Contract Values
as specified in the QDRO. If the QDRO is silent, or ambiguous, in the
opinion of the Company, with respect to which of the Participant's
Variable or Guaranteed Account Values should be used to establish the
Alternate Payee Account, the accounts will be liquidated in the following
sequence:
(1) Money Market Fund
(2) Bond Fund
(3) Growth Fund
(4) Daily Interest Guaranteed Fund
(5) Other Variable Funds
(6) Guaranteed Certificate Fund
(7) Other Guaranteed Funds
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER
9.1 Requests for Distributions
a. Subject to the provisions of Section 11.1, the Accountholder may
obtain a total or partial distribution of any amounts in his/her
annuity account, except for any funds allocated to an unmatured
certificate. The Company shall make the distribution as soon as
practicable after receipt of the Written Request.
b. Distribution of Pre-1989 Account Balance to Participant The pre-1989
account balance consists of those amounts which were in the
Participant Annuity Account as of December 31, 1988. With respect to
Deposits transferred into this Group Annuity Contract from another
403(b) contract after December 31, 1988, it shall be
the Participant's sole responsibility to identify and certify the
portion of such amounts which were originally contributed prior to
January 1, 1989. Upon receipt of documented records acceptable to the
Company, such pre-1989 amounts will be available for total or partial
distribution to a Participant Payee at any time, provided that such
amounts are permitted to be distributed under the terms of the Group
Policyholder's plan document. However, unmatured amounts in
Guaranteed Certificate Funds will not be available until Certificate
Maturity Date. Such distributions may be subject to an IRS premature
withdrawal penalty.
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER (CONTINUED)
c. Distribution of Post-1988 Account Balance to Participant A
Participant may obtain total or partial distributions with respect to
Deposits made to the Participant Annuity Account after December 31,
1988, earnings thereon and earnings on Deposits contributed prior to
January 1, 1989, only if the Participant has attained age 59 1/2, or
has died, separated from service or suffered a hardship.
d. Distribution to Alternate Payees
Post-1988 funds in an Alternate Payee Annuity Account are not
restricted. An Alternate Payee may obtain a total or partial
distribution of his/her account at any time, except for any funds
allocated to an unmatured certificate. The Company shall make the
distribution as soon as practicable after receipt of the Written
Request.
e. Election of Account From Which Partial Distribution is to be Made By
Written Request, the Accountholder must elect the Variable or
Guaranteed Sub-Accounts(s), or a combination of them, from which a
partial distribution is to be made and the amount to be distributed
from each sub-account. If an adequate election is not made, the
Written Request will be returned and no partial distribution will be
processed.
f. Amount of Total Distribution
The Accountholder must elect a payment option under Section 11 for
disbursement of a total distribution. The amount payable is equal to:
(a) The Annuity Account Value as of the effective date of the total
distribution, less (b) the contingent deferred sales charge, if any,
less (c) Premium Tax, if any.
g. Amount of Partial Distribution
Partial distributions will be paid in a single sum only and will be
equal to:
(a) the amount requested as a partial distribution as of the
effective date of the distribution, less (b) the contingent deferred
sales charge, if any, less (c) Premium Tax, if any.
9.2 Distribution to Participant Due to Hardship
If the Participant incurs a hardship, the Participant may by Written
Request take a total or partial distribution from the Participant Annuity
Account. Such request must be accompanied by a form certifying
entitlement to the amount requested by virtue of a genuine hardship. The
distribution will be made as soon as practicable after the later of the
(1) the date elected: or (2) the date the Written Request is received at
the Administrative Offices of the Company. The contingent deferred sales
charge will not apply to any hardship.
9.3 Adequate Proof
The Company may require adequate proof of age, separation from service or
hardship to establish that a benefit has become payable prior to making
any payment under this Group Annuity Contract.
SECTION 10 CONTINGENT DEFERRED SALES CHARGE
10.1 Contingent Deferred Sales Charge
a. Participant Annuity Account
On any total or partial Transfer to Other Companies, distribution or
single sum payment under Section 11 from the Participant Annuity
Account, the contingent deferred sales charge will be deducted except
in the following situations: (1) the Participant dies; or (2) the
Participant separates from service; or (3) the Participant suffers a
hardship; or (4) the Participant elects a payment option under
Section 11 with a life contingency or an annuity payment period of at
least thirty-six (36) months.
b. Alternate Payee Annuity Account
On any total or partial Transfer to Other Companies, distribution or
single sum payment under Section 11 from a Alternate Payee Annuity
Account, the contingent deferred sales charge will be deducted,
except on the death of the Alternate Payee.
10.2 Contingent Deferred Sales Charge Amount
a. Participant Annuity Account
On any amount transferred, distributed, or paid, a contingent
deferred sales charge will be deducted from the amount distributed.
The contingent deferred sales charge will be equal to a percentage of
the amount distributed based on the table below.
Contingent Deferred Sales Charge Table
Completed Years From
Participant Effective Date % of Amount Transferred
Under this Contract Distributed, or Paid
0 - 4 5%
5 - 9 4%
10 - 14 3%
15 or more 0%
Notwithstanding anything in this Group Annuity Contract to the contrary,
in no event shall the contingent deferred sales charge at any point in
time exceed 8.5% of Deposits contributed by the Participant into this
Group Annuity Contract.
b. Alternate Payee Account
On any amount transferred, distributed or paid, a contingent deferred
sales charge will be deducted from the amount distributed. The
contingent deferred sales charge will be equal to a percentage of the
amount distributed based on the table below.
Contingent Deferred Sales Charge Table
Completed Years From
the Alternate Payee % of Amount Transferred
Effective Date or Distributed
0 - 4 5%
5 - 9 4%
10 - 14 3%
15 or more 0%
Notwithstanding anything in this Group Annuity Contract to the contrary,
in no event shall the contingent deferred sales charge at any point in
time exceed 8.5% of Deposits contributed by the Participant into this
Group Annuity Contract.
SECTION 11. PAYMENT OPTIONS
11.1 How to Elect Payment Options
The Written Request of the Accountholder or Payee is required to elect,
or change the election of, a payment option and must be received by the
Company at least 30 days prior to the Annuity Commencement Date, except
for annuities payable in arrears. For annuities payable in arrears, a
Written Request must be received by the Company at least one year prior
to the Annuity Commencement Date. For all payment options, a $1.50 check
charge will be deducted from the amount of each payment.
11.2 Selection of Payment Options
(a) A total or partial single sum payment or one of the variable or fixed
dollar payment options or a combination of them may be elected.
(b) If the Participant or Payee elects to apply any or all of the
Guaranteed Account Value to a variable dollar method of payment
option, or any or all of the Variable Account Value to a fixed dollar
method of payment option, an Intra-Company Transfer must be made
prior to the Annuity Commencement Date pursuant to Section 6.
SECTION 11. PAYMENT OPTIONS (continued)
(c) If a single sum payment is elected, the amount to be paid is the
amount requested less Premium Tax, if any.
(d) If a variable dollar payment option is elected, the amount to be
applied is the Variable Account Value, as of the date the amount of
the first monthly payment is determined, less Premium Tax, if any.
(e) If a fixed dollar method of payment option is elected, the amount to
be applied is the Guaranteed Account Value, as of the Annuity
Commencement Date, less Premium Tax, if any.
(f) Effective the date the first annuity check is cashed, the payment
option elected or deemed to have elected under, shall be irrevocable.
11.3 Variable Dollar Payment Options
The following variable dollar payment options are available:
(a) Option 1: Variable Life Annuity with Guaranteed Period
Monthly payments for the guaranteed Annuity Payment Period elected or
the lifetime of the Payee whichever is longer. The guaranteed Annuity
Payment Period elected may be 5, 10, 15, or 20 years. Upon death of
the Payee, any amounts remaining payable under this payment option
will be paid to the Beneficiary. See Table A.
(b) Option 2: Variable Life Annuity Monthly payments for the Payee's
lifetime, without a guaranteed period. See Table A.
(c) Option 3: Joint and One-Half Survivor Variable Annuity Monthly
payments to an Annuitant for his/her lifetime, with payments based on
one-half of the variable Annuity Units continuing to the survivor for
life. See Table B.
(d) Option 4: Any Other Form
Any other form of Variable Annuity which is acceptable to the
Company.
(e) These variable dollar payment options are subject to the following
provisions:
(1) Amount of First Monthly Payment. The first monthly payment under
a variable dollar payment option will be based on the Variable
Account Value credited on behalf 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 payment option. The first monthly payment will be the
sum of the variable dollar annuity payments for each Variable
Sub-Account.
(2) Annuity Units. The number of Annuity Units paid to the Annuitant
for each Variable Sub-Account is determined by dividing the
amount of the first monthly payment by the Sub-Account's Annuity
Unit Value on the 5th Valuation Date preceding the date the
first payment is due. The number of Annuity Units for a Variable
Sub-Account remains fixed during the Annuity Payment Period.
(3) Amount of Monthly Payments after the First. Monthly payments
after the first will vary depending upon the investment
experience of the Variable Sub-Accounts. The subsequent dollar
amount paid from each Sub-Account is determined by multiplying
(a) by (b) where (a) is the number of Sub-Account Annuity Units
and (b) is 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.
(f) The minimum amount that may be applied under the elected payment
option is $2,000. If the amount is less than $2,000, the Company may
pay it in one sum. If any payment to be made under the elected
payment 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 maximum amount that may be applied under any elected
payment option is $1,000,000. For the application of any greater
amount, the Company's consent is required.
SECTION 11. PAYMENT OPTIONS (CONTINUED)
11.4 Fixed Dollar Payment Options
The following fixed dollar payment options are available:
(a) Option 1: Income of Specified Amount
An income at 12-, 6-, 3-, or 1-month intervals, of an amount elected
by the Payee for an Annuity Payment Period of not more than 240
months. Upon death of the Payee, any amounts remaining payable under
this payment option will be paid to the Beneficiary. See Table C.
(b) Option 2: Income for a Specified Period
An income at 12-, 6-, 3-, or 1-month intervals, for the number of
months elected for an Annuity Payment Period of not more than 240
months. Upon death of the Payee, any amounts remaining payable under
this payment option will be paid to the Beneficiary. See Table C.
(c) Option 3: Fixed Life Annuity with Guaranteed Period Monthly payments
for the guaranteed Annuity Payment Period elected which may be 5, 10,
15 or 20 years or the lifetime of the Payee, whichever is longer.
Upon death of the Payee, any amounts remaining payable under this
payment option will be paid to the Beneficiary. See Table D.
(d) Option 4: Fixed Life Annuity with Installment Refund Period Monthly
payments for the life of the Payee or until the sum of the payments
made equals the amount applied, whichever is longer.
(e) Option 5: Fixed Life Annuity
Monthly payments for the Payee's lifetime, without a guaranteed period. See
Table D.
(f) Option 6: Joint and One-Half Survivor Fixed Annuity Fixed monthly
payments to an Annuitant for his/her lifetime, with one-half of the
fixed payment amount continuing to the survivor for life. See Table E
for the minimum monthly amount.
(g) Option 7: Systematic Withdrawal Option
Monthly, quarterly, semi-annual or annual payments as agreed upon by
the Payee and the Company as described in the attached Systematic
Withdrawal Option are described in greater detail in the attached
Systematic Withdrawal Option Rider, if any.
(h) Option 8: Any Other Form
Any other form of Fixed Annuity which is acceptable to the Company.
Upon death of the Payee, any amounts remaining payable under this
payment option will be paid to the Beneficiary.
(i) These fixed dollar payment options are subject to the following
provisions:
(1) Payments under a fixed dollar 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 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.
(2) The minimum amount that may be applied under the elected payment
option is $2,000. If the amount is less than $2,000, the Company
may pay it in one sum. If any payment to be made under the
elected payment 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 maximum amount that may be applied
under any elected payment option is $1,000,000. For the
application of any greater amount, the Company's consent is
required.
SECTION 12. DEPOSIT TERMINATION
12.1 Notice of Termination
Either the Group Policyholder or the Company may terminate Deposits under
this Group Annuity Contract by giving at least 60 days advance written
notice to the other. Such notice shall be sent certified mail, return
receipt requested. The termination date shall be 60 days after the date
the notice is received.
12.2 Administration of Accounts Upon Deposit Termination
After termination of Deposits, the Company shall continue to administer
all Participant Annuity Accounts and Alternate Payee Annuity Accounts in
accordance with the provisions of this Group Annuity Contract except that
no Deposits will be accepted or allocated by the Company after the 60th
day from the date the termination letter is received. The Company will
maintain each Participant Annuity Account until it is Transferred under
the terms of Section 6 or applied to a payment option. Amounts in the
Guaranteed Certificate Fund must remain with the Company until the
Certificate Maturity Date.
<PAGE>
<TABLE>
<S> <C> <C> <C> <C> <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 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
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 3.88 3.91 3.94 3.96
3.97 3.98
55 4.09 4.15 4.19 4.23
4.25 4.27
60 4.34 4.43 4.51 4.58
4.63 4.66
65 4.64 4.77 4.90 5.01
5.10 5.16
70 4.99 5.17 5.36 5.55
5.70 5.83
75 5.40 5.65 5.91 6.19
6.46 6.69
If payments commence on any other date than the exact age of the Annuitant
or survivor 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.
<PAGE>
TABLE C - Income of Specified Amount
- Income for a Specified Period
Monthly Payment for Each $1,000
of Participant Annuity Account Value
Years Payment
3 28.61
4 21.82
5 17.75
6 15.04
7 13.10
8 11.66
9 10.54
10 9.63
11 8.90
12 8.30
13 7.78
14 7.34
15 6.96
16 6.63
17 6.34
18 6.08
19 5.85
20 5.64
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.
<PAGE>
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 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
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 3.88 3.91 3.94 3.96
3.97 3.98
55 4.09 4.15 4.19 4.23
4.25 4.27
60 4.34 4.43 4.51 4.58
4.63 4.66
65 4.64 4.77 4.90 5.01
5.10 5.16
70 4.99 5.17 5.36 5.55
5.70 5.83
75 5.40 5.65 5.91 6.19
6.46 6.69
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.
</TABLE>
<PAGE>
DAILY INTEREST GUARANTEE FUND RIDER
A GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY
CONTRACT
The Daily Interest Guarantee Fund is a Guaranteed Sub-Account. The value of an
Accountholder's interest in the Daily Interest Guarantee Fund is his/her
Deposits into the fund plus interest less amounts distributed, transferred or
applied to a payment option, less contract maintenance charge, and Premium Tax.
Amounts in the Daily Interest Guarantee Fund shall earn an annual effective rate
to be determined by the Company prior to the last day of each calendar quarter,
effective for deposits in the next calendar quarter and money already in the
account. This annual effective rate will never be less than the Guaranteed
Interest Rate.
<PAGE>
GUARANTEED CERTIFICATE FUND RIDER
A GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY
CONTRACT
The Guaranteed Certificate Fund is a Guaranteed Sub-Account. The Accountholder,
by Written Request, may allocate all or a portion of his/her Deposits to one and
only one of the several certificate periods then offered by the Company. All
Deposits received during a calendar quarter and allocated to a certificate
period shall earn an annual effective rate of interest equal to the rate stated
by the Company for the applicable certificate period from the date of Deposit to
the end of the certificate period. The annual effective rate shall not be less
than the Guaranteed Interest Rate. A Certificate Maturity Date is hereby defined
as the last day of any Certificate period. Certificates which have not reached
the Certificate Maturity Date shall be called unmatured certificate.
The transfer, distribution or application to a payment option prior to the
certificate maturity date of funds in a certificate shall be known as breaking a
certificate. The breaking of a certificate shall only be permitted under the
following circumstances: (1) the Accountholder dies; or (2) the Participant
separates from service; or (3) the Participant suffers a hardship; or (4) the
Accountholder or Beneficiary uses the certificate funds to purchase from the
Company an annuity with life contingencies or an Annuity Payment Period of at
least thirty-six (36) months.
Value of Certificate
Each certificate has its own value, which is an Accountholder's Deposits in that
certificate, plus interest, less amounts distributed, transferred or applied to
a payment option, contract maintenance charges and Premium Tax, as applicable.
The sum of the values of an Accountholder's certificates is the value of the
Accountholder's interest in the Guaranteed Certificate Fund.
Allocation of Matured Certificates
When a certificate matures, the Accountholder may, within 30 days before or
after the Certificate Maturity Date, allocate the value of the certificate among
any of the Variable & Guaranteed Sub-accounts then offered by the Company under
this Group Annuity Contract. This election is effective on the later of the
first day of the calendar quarter immediately following the Maturity Date of the
certificate(s), or the date the Reinvestment Form for Maturity Certificates is
received and recorded by the Company at its Administrative Offices. If the
election is not received by the Company within the 30 day period, the value of
the matured certificate will be allocated to a new certificate with the same
certificate period as the matured certificate.
If the same certificate period is not then offered by the Company under this
Group Annuity Contract, the value of the matured certificate will be allocated
to a new certificate with the shortest certificate period then available.
If the Guaranteed Certificate Fund is not offered by the Company under this
Group Annuity Contract, the value of the matured certificate will be allocated
by the Company to any other Guaranteed Sub-account then available. Amounts from
a matured certificate allocated to a new certificate or other Guaranteed
Sub-account will earn the annual effective rate applicable to that certificate
or Guaranteed Sub-account. This annual effective rate may differ from the annual
effective rate applicable to the matured certificate.
Transfers
Section 6 of this Group Annuity Contract will apply to any transfer to or from
the Guaranteed Certificate Fund.
<PAGE>
SYSTEMATIC WITHDRAWAL PAYMENT OPTION RIDER
ATTACHED TO AND FORMING A PART OF THE GROUP ANNUITY CONTRACT
Ability to Elect
All or a portion of an Accountholder's annuity account may be allocated to the
Systematic Withdrawal Payment Option at any time, subject to any other governing
provision of this Group Annuity Contract. Transfers of amounts held by or for
the benefit of the Accountholder in another 403(b) tax deferred annuity account
with another company may be Deposited or caused to be Deposited by the
Accountholder directly into the Systematic Withdrawal Payment Option.
Election Procedure
The Accountholder must elect the Systematic Withdrawal Payment Option in
accordance with the procedures of this Group Annuity Contract.
Minimum Allocation or Deposit Required
The initial allocation or transfer from another company, whichever occurs first,
must be at least twenty thousand dollars ($20,000.00). All subsequent
allocations and/or transfers from another company must be at least two thousand
dollars ($2,000.00).
Earnings - New Money Yield
All amounts allocated or transferred to the Systematic Withdrawal Payment Option
within a calendar quarter shall earn the annual yield established by the Company
for that quarter, effective from the date of receipt of the application or
transfer from another company through the last day of the next calendar year.
The annual yield shall be established by the Company for each calendar quarter
before the end of the prior calendar quarter and shall not be less than the
Guaranteed Interest Rate. The Company reserves the right to establish different
New Money Yields for different classes of policyholders in compliance with
applicable state laws.
Earnings - Portfolio Yield
On the first day of January of each year, all amounts remaining in the
Systematic Withdrawal Payment Option related to applications or transfers from
another company made prior to the preceding January 1, shall no longer earn the
New Money Yield. These amounts shall earn the Portfolio Yield effective for the
current calendar year.
The Portfolio Yield may be different than the New Money Yield and shall be
established by the Company before the end of each calendar year to be effective
for the next calendar year and may be different every year. The Portfolio Yield
shall not be less than the Guaranteed Interest Rate. The Company reserves the
right to establish different Portfolio Yields for different classes of
policyholders in compliance with applicable state laws.
Designation of Payment Frequency
When the Accountholder elects the Systematic Withdrawal Payment Option, the
Accountholder must designate the frequency of payments. Payments may be made
monthly, quarterly, semi-annually or annually. The Accountholder may change the
frequency of payments only once in a calendar year.
Beginning of Payments
Payments to the Accountholder or his/her designated Payee must begin no later
than one year from the day of the first deposit.
Amount of Payments
Each payment must not be less than the greater of (i) one hundred dollars
($100.00), or (ii) the minimum distribution and minimum incidental death benefit
amount required under the Internal Revenue Code and any regulations issued
thereunder, as amended from time to time. The Company reserves the right to make
a lump sum payment of all of an Accountholder's interest in the Systematic
Withdrawal Payment Option if that interest is less than one hundred dollars
($100.00). The Accountholder may change the amount of the payment only once in a
calendar year.
On a form and in a manner prescribed by the Company, the Accountholder may elect
to receive regular and systematic payments from the Systematic Withdrawal Option
Account on a monthly, quarterly, semi-annual or annual basis. Each payment made
to an Accountholder will be debited from the Systematic Withdrawal Option
Account on a last in, first out (LIFO) basis, except for the interest-only
option as described below. The number of payments received may vary depending
upon the new money yields and/or portfolio yields earned.
SYSTEMATIC WITHDRAWAL PAYMENT OPTION RIDER (continued)
The following payment options will be available under the Systematic Withdrawal
Payment Option:
1. Period Certain
This option allows the Accountholder to choose how long the Accountholder will
receive payments. The Company calculates the Accountholder's amount based on the
Accountholder's current account balance.
2. Payment Certain
This option is similar to the "Period Certain" option above, except that the
Accountholder chooses a payment amount and the Company calculates the length of
time an Accountholder can receive these payments. The Company calculates the
length of time based upon the Accountholder's current account balance.
3. Payments Over Life Expectancy
Under this option, the Company calculates the Accountholder's life expectancy
based upon the Accountholder's current age. This option then works much like the
"Period Certain" option above, under which the Company will calculate the
payments to be made over the Accountholder's expected lifetime.
4. Increasing Payments by Specified Percentage Over Time
Under this option, the Accountholder chooses either the payment amount or the
length of time payments will be made. The Accountholder also elects a percentage
by which the payments will be increased each year.
5. Interest Only
Under this option, the interest credited to the Accountholder's current account
balance will be paid to the Accountholder on a monthly, quarterly, semi-annual
or annual basis, as elected. Each interest only payment made to an Accountholder
will be equal to the entire interest accumulated on all Deposits credited to the
Systematic Withdrawal Option Account since the time of the last interest only
payment. This option will not be available to Accountholder's unable to meet the
minimum distribution requirements under federal law.
Total or Partial Distributions
Total and partial distributions of amounts in the Systematic Withdrawal Payment
Option shall be available to Acountholders under the same principles as
distributions are available under Section 9 of this Group Annuity Contract.
Distributions will be made on a last-in-first-out (LIFO) basis, except for the
interest-only option payment. Distributions shall be effective on the later of
the date the Accountholder elects to have the distribution paid or the date the
Written Request is received by the Company at its Administrative Offices.
Distributions to effect a transfer in accordance with Revenue Ruling 90-24 will
not be permitted from this option once monies are allocated to this Systematic
Withdrawal Option.
Systematic Withdrawal Charges
A charge shall be deducted by the Company from all amounts paid or distributed,
less the Systematic Free Amount. The charge shall be a percentage of the amount
paid or distributed in excess of the Systematic Free Amount and shall be based
on the following table:
Elapsed Years From
Initial Allocation Percentage of
or Transfer Amount Distributed
0 - 5 5%
more than 5 0%
Upon the death of the Accountholder no charge will be assessed against any
payment or distribution made under this Rider.
Systematic Free Amount
The Systematic Free Amount is an amount of the payment or distribution against
which the charge will not be assessed. This free amount is equal to twenty
percent (20%) of the amount in the Accountholder's Systematic Withdrawal Payment
Option as of December 31 of the preceding calendar year, except in the first
year. In the first partial year before any December 31 anniversary, the free
amount will be equal to 20% of the initial deposit made to this option. The free
amount shall be applied to each payment and distribution made in a calendar year
until the free amount is exhausted. A new free amount shall be available for
each calendar year. Any unused free amount from one calendar year is forfeited
and may not be applied to any other year.
<PAGE>
GUARANTEED FIXED FUND
GUARANTEED SUB-ACCOUNT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
The Accountholder, subject to the provisions of the Group Annuity Contract, may
allocate all or a portion of his/her Deposits to the Guaranteed Fixed Fund,
which is a Guaranteed Sub-Account. Deposits allocated to the Guaranteed Fixed
Fund in a calendar quarter shall earn an initial annual effective rate of
interest equal to the rate stated by the Company for that calendar quarter. Each
initial rate shall remain in effect through the end of that calendar year and
shall never be less than 3.5%.* Each year in which deposits are allocated to the
Guaranteed Fixed Fund shall be known as a deposit year.
All Deposits allocated and interest accrued thereon in a given deposit year
which remain in the Guaranteed Fixed Fund shall constitute a separate portfolio
as of January 1st of the year following the deposit year. Each separate
portfolio shall earn an annual effective rate of interest stated by the Company,
which shall be known as a renewal rate. Each renewal rate shall be effective for
one calendar year and shall never be less than 3.5%.* A different renewal rate
may be declared by the Company for each separate portfolio and for each calendar
year.
The Accountholder, subject to the provisions of the Group Annuity Contract and
this Guaranteed Sub-Account Rider, may transfer amounts from his/her Guaranteed
Fixed Fund sub-account at any time. The Company may, from time to time,
establish a maximum amount which may be transferred from the Accountholder's
Guaranteed Fixed Fund sub-account in a calendar year, which shall never be less
than 20% of the Participant's prior year end account balanced in the Guaranteed
Fixed Fund. However, if the Accountholder's Guaranteed Fixed Fund sub-account
balance is $500 or less on the effective date of the transfer, all or a portion
of that balance may be transferred. Amounts transferred shall be debited from
the Accountholder's Guaranteed Fixed Fund sub-account on a last-in-first-out
basis.
Distributions from the Guaranteed Fixed Fund sub-account shall be governed by
the Group Annuity Contract. Amounts distributed from the Guaranteed Fixed Fund
sub-account shall be debited on a last-in-first-out basis.
*IMPORTANT NOTICE: The Guaranteed Interest Rate defined in the Group Annuity
Contract shall not apply to funds deposited into the Guaranteed Fixed Fund
sub-account.
Signed for Great-West Life & Annuity Insurance Company on the Issue date of this
Rider.
[GRAPHIC OMITTED][GRAPHIC OMITTED]
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
LOAN RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Loans are available under the Contract in accordance with the provisions of the
following:
o The Internal Revenue Code and Regulations, as amended from time to time, and o
Department of Labor Regulations, as amended form time to time, including
the Employee Retirement Income Security Act, where applicable, and o Other
applicable federal and state legislation and regulations that may be passed or
promulgated from time to time, and o The provisions of the Truth in Lending
Disclosure and Promissory Notes, as amended from time to time.
Additionally, account reducing loans will be construed to be Partial
Distributions under the provisions of the Distributions To A Beneficiary Upon
Death section of the Contract.
Signed for Great-West Life & Annuity Insurance Company on the Issue date of this
Rider.
[GRAPHIC OMITTED][GRAPHIC OMITTED]
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
PERIODIC PAYMENTS OPTION RIDER
1-95
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
WHEREAS, the Group Policyholder has previously entered into a Tax Deferred
Annuity Contract with Great-West Life & Annuity Insurance Company (hereinafter
referred to as the Company),
AND WHEREAS, the Group Policyholder and the Company desire to make the Periodic
Payment Option available to Accountholders (a Participant or Payee under the
Contract) under the Contract,
NOW THEREFORE, the Group Policyholder and the Company agree that the following
provisions will be added to the Contract as of the date executed below.
Ability To Elect Frequency and Amount of Payments An Accountholder may
elect the Periodic Payment Option if the The Accountholder will elect by
Request: Accountholder is eligible to receive a distribution in accordance
othe payment frequency of either 12-, 6-, 3-, or 1-month with the
Distributions To An Accountholder or Surrender sections intervals; of the
Contract. Notwithstanding the above, the Periodic Payment oa payment
amount; a minimum of $50 is required; Option may not be used to effect
transfers under Revenue Ruling othe month, day and year on which payments
will be made; 90-24. oone payment option; and othe allocation of payments
from the Variable and/or
The Accountholder must Request that all or part of the Annuity Guaranteed
Sub-Account(s) as follows: Account be applied to a Periodic Payment Option. All
outstanding 1) Prorate the amount to be paid across all Variable and loan
balances must be paid in full or treated as a distribution Guaranteed
Sub-Accounts in proportion to the assets before an Accountholder may apply for a
Periodic Payment Option. in each sub-account; or <TABLE> <S> <C>
2) Select the
Investment Division(s) from which payments
Operation of Participant Annuity Account will be made.
Once the Investment Division(s) have
While periodic payments are being received: been
depleted, the Company will automatically prorate
o the Accountholder may continue to exercise all contractual the
remaining payments unless the Accountholder
rights that are available prior to electing a payment Requests
the selection of another Investment
option, except that no Contributions may be made by an Division(s).
Accountholder;
o Accountholders may continue to keep their current Guaranteed The
Accountholder may elect to change the payment option and Variable
Sub-Accounts; and/or frequency once each calendar year.
o charges and fees under the Contract, if applicable, continue
to apply, except as noted below; Payments will cease
on the earlier of:
o a Contingent Deferred Sales Charge does not apply to o the date the amount
elected to be paid under the option periodic payments lasting a minimum of
36 months; and selected has been reduced to zero;
o if a partial withdrawal is made, a Contingent Deferred Sales o the
Accountholder Requests the payments to stop; or
Charge and/or Loss of Interest Charge, if applicable, will o the Annuity
Account Value is zero.
be deducted.
Payments to a
Beneficiary
</TABLE>
If periodic payments cease, the Accountholder may resume making Upon the
Participant's death, the Beneficiary shall elect a Contributions or Deposits.
Additionally, if periodic payments payment option on the death claim form which
complies with cease, periodic payment options may not commence again for at the
distribution requirements of Section 401(a)(9) of the least a 36 month period.
Internal Revenue Code.
PERIODIC PAYMENTS OPTION RIDER (continued)
Payment Options Available
<TABLE>
<S> <C>
<C>
The Accountholder must elect one of the following 4 payment 3) Interest Only.
The payments will be based on the amount
options: of interest
credited to the Guaranteed Sub-Account(s)
1)Income for a Specified Period for at least thirty-six (36) between each
payment. Available only if 100% of the
months. The Accountholder elects the duration over which account value is
invested in the Guaranteed Sub-Account
payments will be made. This amount may vary based on the and Accountholder
is younger than 70 1/2; or
duration; or 4) Minimum
Distribution. The Accountholder may Request
2)Income of a Specified Amount for at least thirty-six (36) minimum
distributions as specified under Internal
months. The Accountholder elects the dollar amount of the Revenue Code
Section 401(a)(9).
payments. Based on the amount elected, the duration may
vary; or
</TABLE>
Signed for Great-West Life & Annuity Insurance Company on the Issue Date.
[GRAPHIC OMITTED][GRAPHIC OMITTED]
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
IRC 403(b) Rider
SBPJA
1-97
<PAGE>
IRC 403(b) RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Due to modifications under the Small Business Job Protection Act of 1996, all
elective deferrals under the Contract will be subject to the provisions noted in
Section 1 below.
1. Each Participant's elective deferrals under the Contract are limited to the
amount permitted under IRC Section 402(g). Should any Participant's
elective deferrals exceed the allowable amount, such Participant must
request that the excess deferrals be distributed from the Contract in
accordance with Internal Revenue Service requirements, as amended from time
to time. If such excess deferral is not timely distributed, the Participant
Annuity Account may lose its ss.403(b) status for tax purposes.
With respect to all monies transferred from a custodial account contract issued
in accordance with the provisions of IRC Section 403(b)(7), including interest
and investment earnings thereon, the following provisions in Sections 2 and 3
below will apply to such monies.
2. No such amounts may be paid or made available to any distributee before: A)
the Participant dies, or B) the Participant attains age 59 1/2, or C) the
Participant separates from service, or D) the Participant becomes disabled
[within the meaning of IRC Section 72(m)(7)], or E) in the case of
contributions made pursuant to a salary reduction
agreement, the Participant encounters financial hardship.
3. The provisions in Section 9.1 of the Contract regarding Distribution of
Pre-1989 Account Balance amounts shall not apply to monies contributed
under a custodial account contract issued under IRC Section 403(b)(7).
Distribution of such custodial account amounts shall be restricted in
accordance with the provisions noted in Section 2 above.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
ENDORSEMENT RIDER ATTACHED TO AND FORMING PART OF
THE GROUP ANNUITY CONTRACT
ISSUED BY
GREAT-WEST LIFE AND ANNUITY INSURANCE COMPANY
Notwithstanding any other provision in this Group Annuity Contract or Guaranteed
Certificate Sub-Account Rider to the contrary, the following provision of this
Rider shall apply:
1. In accordance with the provisions of the Plan funded by this Group
Annuity Contract, there shall be up to five Money Types existing within
the Participant Annuity account under this Contract, which may have
separate contractual requirements in accordance with the provisions of
this Endorsement Rider. These five Money Types are as defined in the
Group Policyholder's Plan.
2. The term "Plan", as used herein, refers to the written tax sheltered
annuity plan document established by the Group Policyholder to make
contributions on behalf of each participant. It shall be the
responsibility of the Group Policyholder to ensure that such Plan meets
all applicable requirements of the Employee Retirement Income Security
Act and the Internal Revenue Code, as amended.
3. The term "Money Type", as used herein, refers to a portion of a
Participant Group Policyholder contribution to the Plan which is
accounted for separately. A separate Money Type shall be established
for each type of contribution that differs from another due to the
source of the money, withdrawal restriction, tax status, or other
pertinent distinction outlined in the Group Policyholder's Plan.
4. In accordance with the provisions of the Plan funded by this Group
Annuity Contract, Benefits payable pursuant to the Retirement
Provisions and the Provisions Relating To Amount Payable on Death,
Partial Surrender and Surrender Sections of the Group Annuity Contract
shall be restricted in accordance with the provisions of this
Endorsement Rider.
5. In accordance with the provisions of the Plan funded by this Group
Annuity Contract, the value of a Participant's Participant Annuity
Account shall only be available to each Participant upon the
Participant's eligibility to receive such Benefits under the
provisions of the Group Policyholder's Plan. Determination as to any
Participant's eligibility to receive Benefits under the Group
Policyholder's Plan shall be the responsibility of the Group
Policyholder.
6. On all requested withdrawals from any Participant Annuity Account, it
is the responsibility of the Group Policyholder to certify to the
Insurance Company, on a form and in a manner prescribed by the
Insurance Company, the status of Participants as to fulfilling certain
Plan requirements. Such certifications shall include who should be
paid, the amount or percentage of Money Type to be debited, and any
other information necessary for the Insurance Company to fulfill its
obligations under this Contract.
7. Notwithstanding the fact that the Insurance Company, may have knowledge
of particular provisions and contribution amounts within the Group
Policyholder's Plan, it is the responsibility of the Group Policyholder
or its delegate, to ensure that all contributions to the Plan are in
compliance with the limitations prescribed under Internal Revenue Code
Sections 403(b) and 415.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
NQDC Rider
1-98
<PAGE>
NQDC 1-98
NONQUALIFIED DEFERRED COMPENSATION RIDER
ATTACHED TO AND FORMING
PART OF THE GROUP ANNUITY CONTRACT
WHEREAS, the Group Policyholder has previously entered into a Tax Deferred
Annuity Contract with Great-West Life & Annuity Insurance Company (hereinafter
referred to as the Company),
WHEREAS, the Group Policyholder desires to make a Nonqualified Deferred
Compensation Arrangement (hereinafter referred to as the NQDC Plan) utilizing
the same investment options offered under the Group Annuity Contract available
to Participants, and
WHEREAS, the Company desires to amend its standard Tax Deferred Annuity Contract
to conform to the provisions of the Group Policyholder's NQDC Plan,
NOW THEREFORE, the Group Policyholder and the Company agree that the Tax
Deferred Annuity Contract to be issued with respect to the NQDC Plan shall
include the following provisions as of the date executed below.
Nonqualified Deferred Compensation Arrangement (NQDC)
The Group Policyholder has established a Nonqualified Deferred Compensation
Arrangement (NQDC). The details of this NQDC Plan are described in greater
detail under the provisions of the NQDC Plan document and is an unfunded plan
for purposes of Title I of the Employee Retirement Income Security Act of 1974
and for purposes of the Internal Revenue Code. All assets in the NQDC Plan are
owned by the Employer and are subject to the claims of the general creditors of
the employer. Participants and their beneficiaries have the status of general
unsecured creditors of their Employer under this arrangement.
NQDC Deposits
NQDC Plan Deposits will be accepted into the Group Annuity Contract and
allocated to Guaranteed and/or Variable Sub-Accounts in accordance with the
Written Request received from the Group Policyholder. It is entirely the Group
Policyholder's responsibility to ensure that all Deposits forwarded to the
Company are in compliance with the provisions of the NQDC Plan.
NQDC Account
The Participant Annuity Account established as a recordkeeping account for each
Participant under the Group Annuity contract shall be called the NQDC Account.
For recordkeeping purposes, all Deposits made on behalf of a Participant, as
well as interest, gains and/or losses on the amounts deposited with respect to
the NQDC Plan will be allocated to that Participant's NQDC Account. Neither the
Participants nor their Beneficiaries shall have any property interest in the
NQDC Account. A Participant's right to assets under the NQDC Account are not
subject in any manner to anticipation, alienation, sale, transfer, assignment,
pledge, encumbrance, attachment or garnishment by creditors of the Participant
or the Participant's beneficiaries.
Distributions
Distributions of any type from a NQDC Account shall be subject to the provisions
of the NQDC Plan and this Group Annuity Contract. Any benefits paid out of the
NQDC Account will be made in a lump sum or in substantially equal monthly
payments over a fixed period of time as defined by the NQDC Plan.
General Provision
This Rider is intended to amend the Group Annuity Contract to conform to the
requirements of the NQDC Plan. Any contract reference or provision inconsistent
with the provisions of the Group Policyholder's NQDC Plan and the Internal
Revenue Code provisions applicable to NQDC Plans is hereby rendered void.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
[OBJECT OMITTED]
W.T. McCallum,
President and Chief Executive Officer
Signed and accepted by the Group Policyholder and attached to the Group
Annuity Contract on , 20 .
By:
Title:
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403(b) Voluntary Group Annuity Contract
1-92
<PAGE>
Great-West Life & Annuity Insurance Company
8515 East Orchard Road Englewood, CO 80111
HOME OFFICE - ENGLEWOOD, COLORADO
ADMINISTRATIVE OFFICES
ENGLEWOOD, COLORADO
GROUP POLICYHOLDER ABC School District
GROUP POLICY NUMBER 12345 GP
GROUP ANNUITY CONTRACT DATE December X, 19XX
Group Tax-Deferred Annuity, Non-Participating
Signed for Great-West Life & Annuity Insurance Company on the issuance of the
Group Annuity Contract on the Annuity Contract Date.
D.C. Lennox, W.T. McCallum,
Secretary President and Chief Executive Officer
For the Actuary
15 Day Free-Look
The Accountholder may return his/her Certificate within 15 days of its mailing
and have all Deposits refunded to him/her if, after examination, the
Accountholder is not satisfied with it for any reason.
PLEASE READ THIS CONTRACT CAREFULLY. IT IS A CONTRACT WHICH MAY PROVIDE FOR
PAYMENTS OR VALUES WHICH ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT MAY
INCREASE OR DECREASE ACCORDING TO THE INVESTMENT EXPERIENCE OF THE VARIABLE
ANNUITY ACCOUNT.
Group Tax-Deferred Annuity
VOLUNTARY HOSPITAL AND EDUCATION
<PAGE>
GROUP TAX-DEFERRED ANNUITY CONTRACT
TABLE OF CONTENTS
15 DAY FREE-LOOK
<TABLE>
<S>
<C>
<C>
SECTION 1.
DEFINITIONS.....................................................................................5
SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Group Annuity
Contract.............................................................7
2.2 Ownership of Participant Annuity Account
Value..................................................7
2.3 Transfer and
Assignment.........................................................................7
2.4 Ownership of Series
Account.....................................................................7
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity
Contract......................................................................7
3.2
Certificate.....................................................................................7
3.3 Entire
Contract.................................................................................7
3.4 Contract
Modification...........................................................................7
3.5
Non-Participating...............................................................................8
3.6
Beneficiary.....................................................................................8
3.7 Currency and Payment of
Deposits................................................................8
3.8 Age
............................................................................................8
3.9 Voting
Rights...................................................................................8
3.10
Reports.........................................................................................8
3.11 Notice and
Proof................................................................................8
3.12 Materials Developed by Group
Policyholder.......................................................9
3.13 Tax Consequences of
Payments....................................................................9
3.14
Loans...........................................................................................9
SECTION 4. DEPOSIT PROVISIONS
4.1 Commencement of
Deposits........................................................................9
4.2
Deposits........................................................................................9
4.3 Allocation of
Deposits..........................................................................9
SECTION 5. ACCOUNT VALUE PROVISIONS
5.1 Variable Accounts
..............................................................................9
5.2 Risk
Charge....................................................................................10
5.3 Guaranteed Account
Value.......................................................................10
5.4 Guaranteed Sub-Account
Riders..................................................................10
5.5 Contract Maintenance
Charge....................................................................10
SECTION 6. TRANSFERS AND ROLLOVERS
6.1
Transfers......................................................................................11
6.2 Transfer
Terms.................................................................................11
6.3 Intra-Company
Transfers........................................................................11
6.4 Transfers to Other
Companies...................................................................12
6.5 90-24
Transfers................................................................................12
6.6
Rollovers......................................................................................12
GROUP TAX-DEFERRED ANNUITY CONTRACT
TABLE OF CONTENTS (continued)
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY UPON DEATH
7.1 Death of Accountholder After Annuity Commencement
Date.....................................12
7.2 Death of Accountholder Before Annuity Commencement
Date....................................13
7.3 Amount Payable on Death of
Participant.....................................................13
SECTION 8. QUALIFIED DOMESTIC RELATIONS ORDER (QDRO)
8.1 Effect of Qualified Domestic Relations Order
(QDRO)........................................14
8.2 Total or Partial
Distribution..............................................................14
8.3 Establishment of Alternate Payee Annuity
Account...........................................14
8.4 Withdrawal from Participant Annuity
Account................................................14
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER
9.1 Requests for
Distributions.................................................................14
9.2 Distribution to Participant Due to
Hardship................................................15
9.3 Adequate
Proof.............................................................................15
SECTION 10. CONTINGENT DEFERRED SALES CHARGE AND LOSS OF INTEREST CHARGE
10.1 Contingent Deferred Sales
Charge...........................................................16
10.2 Contingent Deferred Sales Charge
Amount....................................................16
10.3 Contingent Deferred Sales Charge "Free
Amount".............................................16
10.4 Loss of Interest
Charge....................................................................16
SECTION 11. PAYMENT OPTIONS
11.1 How to Elect Payment
Options...............................................................17
11.2 Selection of Payment
Options...............................................................17
11.3 Variable Dollar Payment
Options............................................................17
11.4 Fixed Dollar Payment
Options...............................................................18
SECTION 12. DEPOSIT TERMINATION
12.1 Notice of
Termination......................................................................19
12.2 Administration of Accounts Upon Deposit
Termination........................................19
TABLE A 20
TABLE B 21
TABLE C 22
TABLE D 23
TABLE E 24
GUARANTEED SUB-ACCOUNT RIDERS, IF
ANY..............................................................................
SYSTEMATIC WITHDRAWAL OPTION RIDER, IF
ANY.........................................................................
</TABLE>
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SECTION 1. DEFINITIONS
Accountholder - a Participant with respect to his/her Participant Annuity
Account or an Alternate Payee with respect to his/her Alternate Payee Annuity
Account.
Accumulation Period - the period during which the Accountholder is covered under
this Group Annuity Contract prior to his/her Annuity Commencement Date.
Accumulation Unit - an accounting measure used to determine the Variable Account
Value before the Annuity Commencement Date.
Administrative Offices - 8515 E. Orchard Road
Englewood, Colorado 80111
Alternate Payee - a spouse, former spouse, child or other dependent of a
Participant who is entitled to receive all or a portion of the Participant
Annuity Account pursuant to a Qualified Domestic Relations Order.
Alternate Payee Annuity Account - a separate record in the name of an Alternate
Payee which reflects the value of amounts awarded to the Alternate Payee from a
Participant Annuity Account pursuant to a Qualified Domestic Relations Order.
These amounts may only be allocated to a Guaranteed Sub-account.
Alternate Payee Effective Date - the date on which the appropriate value of the
Participant Annuity Account is transferred to the Alternate Payee Annuity
Account pursuant to a Qualified Domestic Relations Order.
Annuitant - the person upon whose life the payment of an annuity is based.
Annuity Account Value - the sum of the Variable and Guaranteed Sub-Accounts
credited to the Accountholder under his/her annuity account.
Annuity Commencement Date - the date on which annuity payments commence under a
payment option, which for any Accountholder shall be not later than April 1st of
the calendar year following the calendar year in which the Participant attains
age 70 1/2.
Annuity Contract Date - the effective date of this Group Annuity Contract as
agreed upon by the Group Policyholder and the Company.
Annuity Payment Period - the period during which the Payee is receiving annuity
payments under this Group Annuity Contract.
Annuity Unit - an accounting measure used to determine the dollar value of any
Variable Dollar Annuity Payment after the first annuity payment is made.
Beneficiary - the person(s) designated by the Accountholder to receive
distributions, if any, payable upon the Accountholder's death.
Certificate - an individual certificate, including a copy of this Group Annuity
Contract, issued to each Participant and Alternate Payee to evidence his/her
coverage under this Group Annuity Contract.
Company - Great-West Life & Annuity Insurance Company.
Deposit - contributions, Intra-Company Transfers, Transfers from other
companies, and other amounts allocated to a Guaranteed or Variable Sub-Account.
Eligible Employee - an individual performing services for an Eligible Employer.
Eligible Employer - an educational organization described in Section
170(b)(1)(A)(ii) which is a political subdivision of a state or an agency or
instrumentality thereof. An "Eligible Employer" may also include an employer
described in Section 501(c)(3) of Internal Revenue Code of 1986, as amended.
Eligible Fund - a registered management investment company in which the assets
of the Series Account may be invested.
Group Policyholder - the Eligible Employer who has applied for and has been
issued this Group Annuity Contract.
Guaranteed Account - the account established under this Group Annuity Contract
providing Guaranteed Sub-Accounts.
Guaranteed Account Value - the sum of the values of the Guaranteed Sub-Accounts
credited to the Accountholder under his/her annuity account.
Guaranteed Interest Rate - a minimum interest rate applicable to Guaranteed
Sub-Accounts with an annual effective rate of 4%.
Guaranteed Sub-Account - a sub-division of the Guaranteed Account described in
the attached Guaranteed Sub-Account Riders, if any.
SECTION 1. DEFINITIONS (continued)
Intra-Company Transfer - amounts moved within and between any of the Variable
and Guaranteed Sub-Accounts.
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.
Letter Agreement - a formal written agreement signed by the Company and the
Group Policyholder which is used to clarify or modify certain provisions of the
Contract and will be attached to and form a part of this Group Annuity Contract.
Loss of Interest Charge - a charge which may be applied whenever amounts
deposited into the guaranteed certificate fund are transferred as described in
Section 6.1 prior to the certificate maturity date. The Loss of Interest Charge
is calculated by reducing the credited rate of interest on the affected
certificates to the effective rate shown in the table below:
Age of Certificate Credited
When Charge Is Applied Rate
0-3 Years 4.00%
3-5 Years 5.25%
Participant - an Eligible Employee of the Group Policyholder for whom an annuity
account has been established under this Group Annuity Contract.
Participant Annuity Account - a separate record established in the name of each
Participant which reflects the total value of the Participant's Guaranteed and
Variable Sub-Accounts.
Participant Effective Date - the date on which the first Deposit is credited to
a Participant Annuity Account.
Payee - any person receiving distributions or annuity payments under this Group
Annuity Contract.
Premium Tax - the amount of tax, if any, charged by a state or other
governmental authority on premiums.
Qualified Domestic Relations Order (QDRO) - a domestic relations order which
creates or recognizes the existence of an Alternate Payee's right to, or assigns
to an Alternate Payee the right to, receive all or a portion of the value of a
Participant Annuity Account which meets the requirements of Internal Revenue
Code Section 414(p).
Series Account - the segregated investment account of Great-West Life & Annuity
Insurance Company called "FUTUREFUNDS Series Account" existing under Colorado
law and registered as a unit investment trust under the Investment Company Act
of 1940, as amended.
Transfer to Other Companies - amounts moved from any Variable or Guaranteed
Sub-Account to another company upon Written Request of the Accountholder.
Valuation Date - the date on which the net asset value of each Eligible Fund is
determined.
Valuation Period - the period between two successive Valuation Dates.
Variable Account - the account established under this Group Annuity Contract
providing Variable Sub-Accounts.
Variable Account Value - the sum of the values of the Variable Sub-Accounts
credited to a Participant under his/her Participant Annuity Account.
Variable Sub-Account - a sub-division of the Variable Account containing the
value credited to a Participant from an Investment Division.
Written Request - any request in written form, satisfactory to the Company and
received by the Company at its Administrative Office, from the Group
Policyholder, the Accountholder, or their designee as required by any provision
of this Group Annuity Contract, and at other times as required by the Company.
SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of Group Annuity Contract
The Group Policyholder is the owner of this Group Annuity Contract for the
benefit of its Eligible Employees who become Participants.
2.2 Ownership of Participant Annuity Account Value
Each Eligible Employee for whom a Participant Annuity Account is
established and for whom Deposits have been received by the Company, owns
his/her Participant Annuity Account Value.
2.3 Transfer and Assignment
Except as provided in the Loan application form, if any, the interest of
any Accountholder, or of the
Group Policyholder in this Group Annuity Contract may not be transferred,
sold, assigned, pledged, charged, encumbered or in any way alienated by
any of them.
To the extent permitted by law, no proceeds or payments under the Group
Annuity Contract will be subject to the claims of creditors or legal
process.
2.4 Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
The portion of the assets of the Series Account equal to the reserves and
other contract liabilities with respect to the Series Account are not
chargeable with liabilities arising out of any other business the Company
may conduct.
SECTION 3. GENERAL PROVISIONS
3.1 The Group Annuity Contract
This Group Annuity Contract is issued by the Company to the Group
Policyholder.
3.2 Certificate
The Company will issue to each Accountholder an individual Certificate as
evidence of his/her participation under this Group Annuity Contract.
3.3 Entire Contract
This Group Annuity Contract, its application, tables, and riders, if any,
form the entire contract between the Group Policyholder and the Company
and the entire agreement between the Company and the Accountholder, as
well as any Beneficiary. This contract supersedes all prior
representations, statements, warranties, promises and agreements of any
kind, whether oral or written, relating to the subject matter of this
Group Annuity Contract. All statements in the application, in the absence
of fraud, have been accepted as representations and not as warranties. A
copy of the application is attached to the Group Annuity Contract when
issued to the Group Policyholder.
3.4 Contract Modification
This Group Annuity Contract may be modified only by written agreement
between the Company and the Group Policyholder, and such modifications
shall become part of this Group Annuity Contract.
Upon 60 days advance written notice to the other, the Group Policyholder
or the Company may terminate Deposits into certain Variable and Guaranteed
Sub-Accounts. In that event, the Participant, by Written Request, may
change the allocation of his/her Deposits. Absent such Written Request on
the date the Sub-account(s) is terminated, the value of such terminated
Sub-account(s) will be allocated to the Daily Interest Guarantee Fund.
Upon 30 days written notice to the Group Policyholder, the Company may at
any time and without the consent of the Group Policyholder or any other
person, modify this Group Annuity Contract as needed to conform to changes
in tax or other law.
ONLY THE PRESIDENT, A VICE-PRESIDENT, OR THE SECRETARY OF THE COMPANY CAN
MODIFY OR WAIVE ANY PROVISION OF THIS GROUP ANNUITY CONTRACT.
SECTION 3. GENERAL PROVISIONS (continued)
3.5 Non-Participating
This Group Annuity Contract is non-participating. It is not eligible to
share in the Company's divisible surplus.
3.6 Beneficiary
The Accountholder may, by Written Request, designate or change a
Beneficiary from time to time. When recorded by the Company, a change of
Beneficiary will take effect as of the date the Written Request was signed
by the Accountholder. If the Accountholder dies before the date the
Written Request was recorded, the change will take effect as of the date
of the Written Request except the extent that the Company has made a
payment or has otherwise taken action on a designation or change before
receipt or recording of the designation or change of Beneficiary.
Unless otherwise provided in the Beneficiary designation, the following
provisions will apply: o upon the death of the Accountholder, his/her
Annuity Account Value shall pass to any surviving primary
Beneficiary and if more than one, the Annuity Account Value shall be
shared equally among them. o if a primary Beneficiary dies before the
Accountholder, that Beneficiary's intended share will be shared
equally among the surviving primary beneficiaries.
o if there is no surviving primary Beneficiary, the Annuity Account
Value shall pass to any surviving contingent Beneficiary, and if more
than one, shall be shared equally among them.
o if no Beneficiary has been designated, or no Beneficiary survives the
Accountholder, the Annuity Account Value will pass to the
Accountholder's estate.
3.7 Currency and Payment of Deposits
All Deposits to this Group Annuity Contract must be made payable to the
Company in the currency of the United States of America.
3.8 Age
If the age of an Annuitant has been misstated, the payments established
for him/her 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 result in an
annual effective rate which will not be less than 4% per year, as
determined by the Company.
3.9 Voting Rights
The Company will vote the shares of an Eligible Fund. To the extent
required by law, the Company will vote according to the instructions of
each Participant in proportion to his/her interest in the Variable
Sub-Account. In such event, the Company will send proxy materials and
form(s) to the Participant for his/her reply. If no reply is received by
the date specified in the proxy materials, 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, 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 Participant, and all other provisions concerning Voting Rights will
apply to the Payee of a Variable Dollar Method of Payment Option.
3.10 Reports
The Company will furnish the Accountholder not less frequently than
annually a statement of his/her Annuity Account Value. The Company will
furnish the Accountholder 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.
3.11 Notice and Proof
Any notice or demand by the Company to or upon the Group Policyholder, the
Accountholder, or any other person may be given by mailing it to that
person's last known address as stated in the Company's file.
Any application, report, request, written request, election, direction,
notice or demand by the Group Policyholder, the Accountholder, or any
other person must be made in a form satisfactory to the Company. When
required by the Company an Accountholder or Payee will obtain the
signature of his/her spouse on forms acceptable to the Company.
SECTION 3. GENERAL PROVISIONS (continued)
3.12 Materials Developed By Group Policyholder
Written materials developed by the Group Policyholder to describe this
Group Annuity Contract must be approved in writing by the Company before
the materials may be used.
The Company may require adequate proof of the age or death of any
individual before it admits a claim for or pays any payment. The Company
may require the documentation of facts needed for continued administration
of this Group Annuity Contract.
3.13 Tax Consequences of Payments
The Accountholder, Annuitant, Payee or Beneficiary, as the case may be,
must determine the timing and amount of any benefit payable to him/her.
Nothing contained herein shall be construed to be tax or legal advice and
the Company assumes no responsibility or liability for any damages or
costs, including but not limited to taxes, penalties, interest or
attorney's fees incurred by the plan, the Group Policyholder, the
Participant, the Alternate Payee, the Beneficiary, or any other person
arising out of any such determination.
3.14 Loans
Loans may be available to Accountholders under this Group Annuity Contract
in accordance with the terms set forth in the loan application form.
SECTION 4. DEPOSIT PROVISIONS
4.1 Commencement of Deposits
An Eligible Employee who submits an adequate application becomes a
Participant as of the Participant Effective Date. An Alternate Payee who
submits an adequate application becomes an Accountholder as of the
Alternate Payee Effective Date.
4.2 Deposits
Subject to Section 12, the Group Policyholder shall promptly pay Deposits
in cash for all Participants. The amount of Deposits for any Participant
will be the amount elected by the Participant plus employer contributions,
if any.
With each payment of Deposits, the Group Policyholder shall provide a
report acceptable to the Company containing a list of all Participants and
the amount of the Deposits to be allocated to each Participant. The Group
Policyholder's report is conclusive and binding on it and anyone claiming
an interest under this Group Annuity Contract or any Certificate. When the
Group Policyholder's report does not coincide with the Deposits received,
the Company may return the Deposits.
4.3 Allocation of Deposits
Deposits, less Premium Tax, if any, will be allocated in the Participant
Annuity Account among any number of currently offered Variable and
Guaranteed Sub-Accounts in accordance with the latest recorded Written
Request of the Participant. Allocations shall be effective upon the
Company's receipt of both the Deposit and the Group Policyholder report
required under Section 4.2. Deposits and Policyholder reports received
after 4:00 EST/EDT shall be deemed to have been received on the next
business day.
The allocation of Deposits may be changed at any time upon the Company's
receipt at its Administrative Offices of the Written Request of the
Participant. A change of allocation will be effective for Deposits which
are received after the Company's receipt and recording of such Written
Request.
SECTION 5. ACCOUNT VALUE PROVISIONS
5.1 Variable Accounts
a. Variable Account Value
The Variable Account Value for a Participant on any date during the
Accumulation Period will be the sum of the values of the Variable Sub-
Accounts.
The value of a Participant's interest in a Variable Sub-Account will be
determined by multiplying the number of the Participant's Accumulation
Units by
SECTION 5. ACCOUNT VALUE PROVISIONS (continued)
the Accumulation Unit Value for that Variable Sub-Account.
b. Accumulation Units
For each Deposit, the number of Accumulation Units credited for each
Participant to a Variable Sub-Account will be determined by dividing the
amount of such Deposit by the Accumulation Unit Value for that Variable
Sub-Account on the next Valuation Date on which such Deposit was
allocated.
Deposits received at the Administrative Offices of the Company before 4:00
p.m. EST/EDT of a Valuation Date will be allocated as requested and shall
be applied as of that date. All deposits received after 4:00 p.m. EST/EDT
shall be applied as of the following Valuation Date.
c. Accumulation Unit Value
The initial Accumulation Unit Value of each Variable Sub-Account was
established at $10. The Accumulation Unit Value of a Variable Sub-Account
on a Valuation Date is calculated by multiplying the Accumulation Unit
Value as of the immediately preceding Valuation Date by the net investment
factor (as explained in paragraph d. of Section 5.1).
The dollar value of an Accumulation Unit will vary in amount depending
upon the investment experience of the Eligible Fund.
d. 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 (the
date four days before the record date which determines if the
Group Policyholder is eligible to receive a dividend) 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 an amount representing the risk charge deducted from each Variable
Sub-Account on a daily basis, equal to an annual rate of 1.25% 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.
5.2 Risk Charge
The risk charge compensates the Company for its assumption of certain
mortality and expense risks. This charge is described in Section 5.1 d(c).
5.3 Guaranteed Account Value
The Guaranteed Account Value on any date during the Accumulation Period
will be the sum of the values of the Guaranteed Sub-Accounts credited to
the Accountholder under his/her annuity account.
5.4 Guaranteed Sub-Account Riders
The computation of the value of a Guaranteed Sub-Account is described in
the attached Guaranteed Sub-Account Riders, if any.
5.5 Contract Maintenance Charge
The following charges are applicable to the
SECTION 5. ACCOUNT VALUE PROVISIONS (continued)
Variable and Guaranteed Account Values. Each year, beginning on the first
day of the calendar quarter following the first anniversary of a
Participant Effective Date, or an Alternate Payee Effective Date, as
applicable, a nonrefundable
contract maintenance charge of not more than $60 annually, will be deducted
from the annuity account. The contract maintenance charge will be deducted
proportionately from the Variable and Guaranteed Sub-Accounts based upon
their Variable and Guaranteed Account Values.
SECTION 6. TRANSFERS AND ROLLOVERS
6.1 Transfers
A Participant may make Intra-Company Transfers or Transfers to Other
Companies by Written Request. For Intra-Company Transfers only, telephone
transfers will be accepted after the appropriate administrative forms are
executed. Alternate Payees and Beneficiaries may make transfers in limited
circumstances as discussed below.
6.2 Transfer Terms
The following provisions apply to both Intra-Company Transfers and
Transfers to Other Companies.
a. 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. For transfers from or into a Variable Sub-Account, a
unit value is calculated by the Company. If such Written Request is
received after 4:00 p.m. EST/EDT, the transfer will take effect based
on the Unit Value on the later of the date elected or the date
following the date the Written Request is received.
b. When required by the Company, the Participant, Alternate Payee or
Beneficiary will execute forms provided by the Company.
c. No transfers are permitted after the Annuity Commencement Date.
d. A transfer from a Guaranteed Sub-Account shall be subject to the terms
of the attached Guaranteed Sub-Account Riders.
6.3 Intra-Company Transfers
The following provisions will apply to Intra-Company Transfers, except for
funds in an unmatured certificate:
a. At any time prior to the Annuity Commencement Date, the Participant, by
Written Request, may transfer all or a portion of the his/her Annuity
Account Value within and between the Variable and Guaranteed
Sub-Accounts currently offered by the Company.
At any time prior to the Annuity Commencement Date, an Alternate
Payee by Written Request, may transfer all or a portion of his/her
Annuity Account Value within and between the Guaranteed Sub-Accounts
currently offered by the Company.
b. A telephone transfer, if permitted by the Company, will take effect
on the later of the date elected or the date the telephone call is
received at the Administrative Office. If such call is received after
4:00 p.m. EST/EDT, the transfer will take effect on the later of the
date elected or the date following the date the call is received and
for Intra-Company Transfers from or into a Variable Sub-Account, a
unit value is calculated by the Company.
c. If an Intra-Company Transfer is made within 30 days of the Annuity
Commencement Date, the Company may delay the Annuity Commencement
Date by 30 days.
d. If a Accountholder dies prior to the Annuity Commencement Date, one
Intra-Company Transfer may be made after the death of the
Accountholder by the Beneficiary to effect the election of a payment
option.
e. No contingent deferred sales charge will apply to Intra-Company
Transfers.
SECTION 6. TRANSFERS AND ROLLOVERS (continued)
f. Monies in the Guaranteed Certificate Fund cannot be transferred prior to
Certificate Maturity Date, except in the following situations:
(1) the Participant dies; or
(2) the Participant separates from service; or
(3) the Participant suffers a hardship; or
(4) the Participant elects a payment option under Section 11 with a life
contingency or an annuity payment period of at least (36) thirty-six
months.
6.4 Transfers to Other Companies
a. At any time prior to the Annuity Commencement Date, a Participant, by
Written Request, may transfer all or a portion of the Participant
Annuity Account Value to another Company's ss.403(b) account,
pursuant to Revenue Ruling 90-24. Notwithstanding the immediately
preceding sentence, monies in the Guaranteed Certificate Fund cannot
be transferred prior to Certificate Maturity Date.
At any time prior to the Annuity Commencement Date, an Alternate
Payee by Written Request, may transfer all or a portion of the
Alternate Payee Account to another Company's ss.403(b) account,
pursuant to Revenue Ruling 90-24. Monies in the Guaranteed
Certificate Fund may be subject to a Loss of Interest Charge and/or a
contingent deferred sales charge.
b. Transfers to Other Companies of Guaranteed Certificate Fund Values will
be subject to Loss of Interest Charges described in Section 10.
c. The contingent deferred sales charge described in Section 10 shall
apply to any and all Transfers to Other Companies, except those
requested by the Beneficiary after the Participant's death.
6.5 90-24 Transfers
The company to which a Transfer to Other Companies (as described in
Section 6) is made ("Authorized Provider") must be authorized by the Group
Policyholder to accept direct transfers from the Company. Prior to the
transfer, the authorized provider must verify that the amounts transferred
will be invested into another ss.403(b) vehicle and will continue after
the transfer to be subject to distribution requirements at least as strict
as those applicable to such funds before the transfer. If such written
verification is received by the Company at its administrative offices
prior to the direct transfer, such transfer will not be reported as a
taxable distribution to the Accountholder. All other disbursements,
whether or not paid directly to the Accountholder, and whether or not
eligible for rollover, will be reported as taxable distributions as
required by the Internal Revenue Code.
6.6 Rollovers
a. Subject to the provisions of this Group Annuity Contract, a
Participant, Surviving Spouse or Alternate Payee, upon the occurrence
of certain triggering events, may roll over only those distributions
meeting very specific requirements under the Internal Revenue Code of
1986, as amended from time to time.
b. The Company will not determine whether a disbursement or distribution
is eligible for rollover treatment and accepts no responsibility for
the tax consequences of the distribution. All rollover requests are
required to be reported to the IRS as taxable distributions and it is
solely the responsibility of the Participant, Alternate Payee or
Surviving Spouse to determine whether the distribution qualifies for
rollover treatment and to effect a proper rollover.
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY UPON
DEATH
7.1 Death of Accountholder After Annuity
Commencement Date
If the Accountholder dies after his/her Annuity Commencement Date and
before his/her entire interest has been distributed, payments will
continue to the Beneficiary under the payment option applicable to the
Accountholder on the Accountholder's date of death. The Beneficiary will not
be allowed to change the method of distribution in effect on the date of the
Accountholder's death or to elect a new payment option.
SECTION 7. DISTRIBUTIONS TO A BENEFICIARY UPON
DEATH (continued)
7.2 Death of Accountholder Before Annuity
Commencement Date
a. 5-Year Rule. If the Accountholder dies before his/her Annuity
Commencement Date, the entire interest of the Accountholder shall be
distributed within five years after the death of the Accountholder.
This rule will always apply to non-individual entities, including,
but not limited to, trusts and estates.
b. Exception to the 5-Year Rule. For purposes of this section, a
designated Beneficiary is any individual named as Beneficiary by the
Accountholder. If any portion of the Accountholder's interest is
payable to a designated Beneficiary, such portion shall be
distributed over the lesser of (1) the life of the designated
Beneficiary, or (2) over a period not extending beyond the life
expectancy of the designated Beneficiary. Such distributions to a
designated Beneficiary shall begin not later than December 31 of the
year following the date of the Accountholder's death. The designated
Beneficiary may elect by Written Request to take distributions either
under the 5-year rule or under this exception to the 5-year rule. If
no election is made, the 5-year rule will apply.
c. Special Rule for Surviving Spouse.
(1) Participant Annuity Account
If the designated Beneficiary is the surviving spouse of a
Participant, the date on which the distributions are required to
begin shall not be later than the date on which the Participant would
have attained age 70 1/2. If no election is made, this special rule
for surviving spouse will apply.
(2) Alternate Payee Annuity Account
There is no special rule for a surviving spouse of an alternate payee. If
the designated beneficiary is the surviving spouse of an Alternate Payee,
distributions are required to begin pursuant to the rules applicable to
other individuals as described in paragraphs a. and b. of this Section 7.2
d. Election of Payment Option
The designated Beneficiary may elect that payment be made under one
or a combination of the payment options described in Section 11.
7.3 Amount Payable on Death of Participant
a. Amount Payable On Death of Participant Before Annuity Commencement Date
(1) If the Participant dies before the Annuity Commencement Date, and
before his/her 70th birthday, the amount payable will be the greater
of: (i) the Participant Annuity Account Value as of the date of
death, less Premium Tax, if any; and (ii) the sum of Deposits paid
to, less any Partial Distributions from, the Participant Annuity
Account,
less Premium Tax, if any.
(2) If the Participant dies before the Annuity Commencement Date, but
after his/her 70th birthday, the amount payable will be the
Participant Annuity Account Value as of the date of death, less
Premium Tax, if any.
b. Amount Payable on Death of Participant
After Annuity Commencement Date
If the Participant dies after the Annuity Commencement Date, the
amount payable will be the amount remaining to be paid under the
method of distribution in effect on the date of the Participant's
death.
c. Amount Payable on Death of Alternate
Payee Before Annuity Commencement Date
If the Alternate Payee dies before the Annuity Commencement Date, the
amount payable will be the Alternate Payee Annuity Account Value as
of the date of death.
d. Amount Payable on Death of Alternate
Payee After Annuity Commencement Date
If the Alternate Payee dies after the Annuity Commencement Date, the
amount payable will be the amount remaining to be paid under the
method of distribution in effect on the date of the Alternate Payee's
death.
e. For payments made under this Section 7.3, neither the contingent
deferred sales charge nor the Loss of Interest charge will apply.
SECTION 8. QUALIFIED DOMESTIC RELATIONS ORDER
(QDRO)
8.1 Effect of Qualified Domestic Relations Order
(QDRO)
If a domestic relations order which is determined to be "qualified" by the
plan administrator awards all or a portion of a Participant Annuity
Account to an Alternate Payee, the Alternate Payee may elect to take a
total or partial distribution or may elect to establish an Alternate Payee
Annuity Account.
8.2 Total or Partial Distribution
If the Alternate Payee elects to take a total or partial distribution, the
contingent deferred sales charge and Loss of Interest Charge will be
deducted from the amount awarded to the Alternate Payee unless the
Qualified Domestic Relations Order clearly specifies, in the opinion of
the Company, that such charges be deducted from the Participant Annuity
Account.
8.3 Establishment of Alternate Payee Annuity Account
a. An Alternate Payee who elects to establish an Alternate Payee Annuity
Account must submit an adequate application by Written Request informing
the Company of the amount to be allocated to the Alternate Payee Annuity
Account, which amount may be allocated only among the Guaranteed
Sub-Accounts. If an adequate application is not received by the Company at
its Administrative Offices as of the date the amounts are to be withdrawn
from the Participant Annuity Account, the Alternate Payee will be deemed to
have elected that all amounts be allocated to the Daily Interest Guaranteed
Fund. Any amounts withdrawn from a Participant's unmatured certificates
will be subject to the Loss of Interest Charge, unless such amounts are
allocated to a new certificate under the Alternate Payee Annuity Account.
b. Contingent deferred sales charges and Loss of Interest Charges
incurred on a distribution from the Participant Annuity Account
pursuant to a Qualified Domestic Relations Order will be deducted
from the amount awarded to the Alternate Payee unless the Qualified
Domestic Relations Order clearly specifies, in the opinion of the
Company, that such charges be deducted from the Participant Annuity
Account.
8.4 Withdrawal From Participant Annuity Account
Amounts will be withdrawn from the Participant Annuity Account pursuant to
the terms of the Qualified Domestic Relations Order (QDRO). If the QDRO
awards less than one hundred percent (100%) of the Participant Annuity
Account Value to the Alternate Payee, the amounts awarded will be
withdrawn from the Participant's Variable and Guaranteed Contract Values
as specified in the QDRO. If the QDRO is silent, or ambiguous, in the
opinion of the Company, with respect to which of the Participant's
Variable or Guaranteed Account Values should be used to establish the
Alternate Payee Account, the accounts will be liquidated in the following
sequence: (1) Money Market Fund (2) Bond Fund (3) Growth Fund (4) Daily
Interest Guaranteed Fund (5) Other Variable Funds (6) Guaranteed
Certificate Fund (7) Other Guaranteed Funds
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER
9.1 Requests for Distributions
a. Subject to the provisions of Section 11.1, the Accountholder may
obtain a total or partial distribution of any amounts in his/her
annuity account, except for any funds allocated to an unmatured
certificate. The Company shall make the distribution as soon as
practicable after receipt of the Written Request.
b. Distribution of Pre-1989 Account Balance to Participant The pre-1989
account balance consists of those amounts which were in the
Participant Annuity Account as of December 31, 1988. With respect to
Deposits transferred into this Group Annuity Contract from another
403(b) contract after December 31, 1988, it shall be the
Participant's sole responsibility to identify and certify the portion
of such amounts which were originally contributed prior to January 1,
SECTION 9. DISTRIBUTIONS TO AN ACCOUNTHOLDER
(continued)
1989. Upon receipt of documented records acceptable to the Company, such
pre-1989 amounts will be available for total or partial distribution to a
Participant Payee at any time. Such distributions may be subject to an IRS
premature withdrawal penalty.
c. Distribution of Post-1988 Account Balance to Participant A
Participant may obtain total or partial distributions with respect to
Deposits made to the Participant Annuity Account after December 31,
1988, earnings thereon and earnings on Deposits contributed prior to
January 1, 1989, only if the Participant has attained age 59 1/2, or
has died, separated from service or suffered a hardship.
d. Distribution to Alternate Payees
Post-1988 funds in an Alternate Payee Annuity Account are not
restricted. An Alternate Payee may obtain a total or partial
distribution of his/her account at any time, except for any funds
allocated to an unmatured certificate. The Company shall make the
distribution as soon as practicable after receipt of the Written
Request.
e. Election of Account From Which Partial
Distribution is to be Made
By Written Request, the Accountholder must elect the Variable or
Guaranteed Sub-Accounts(s), or a combination of them, from which a
partial distribution is to be made and the amount to be distributed
from each sub-account. If an adequate election is not made, the
Written Request will be returned and no partial distribution will be
processed.
f. Amount of Total Distribution
The Accountholder must elect a payment option under Section II for
disbursement of a total distribution. The amount payable is equal to:
(a) the Annuity Account Value as of the effective date of the total
distribution, less;
(b) the contingent deferred sales charge, if any, less;
(c) Loss of Interest Charge on unmatured certificates, if any, less;
(d) Premium Tax, if any.
g. Amount of Partial Distribution
Partial distributions will be paid in a single sum only and will be
equal to:
(a) the amount requested as a partial distribution as of the effective date
of the distribution, less;
(b) the contingent deferred sales charge, if any, less;
(c) Loss of Interest Charge on unmatured certificates, if any, less;
(d) Premium Tax, if any.
9.2 Distribution to Participant Due to Hardship
If the Participant incurs a hardship, the Participant may by Written
Request take a total or partial distribution from the Participant Annuity
Account. Such request must be accompanied by a form certifying entitlement
to the amount requested by virtue of a genuine hardship. The distribution
will be made as soon as practicable after the later of the (1) the date
elected: or (2) the date the Written Request is received at the
Administrative Offices of the Company. Neither the Loss of
Interest Charge on unmatured certificates nor the contingent deferred
sales charge will apply to any hardship.
9.3 Adequate Proof
The Company may require adequate proof of age, separation from service or
hardship to establish that a benefit has become payable prior to making
any payment under this Group Annuity Contract.
SECTION 10. CONTINGENT DEFERRED SALES CHARGE
AND LOSS OF INTEREST CHARGE
10.1 Contingent Deferred Sales Charge
a. Participant Annuity Account
On any total or partial Transfer to Other Companies, distribution or
single sum payment under Section 11 from the Participant Annuity Account,
the contingent deferred sales charge will be deducted except in the
following situations:
(1) the Participant dies; or
(2) the Participant elects a payment option under Section 11 with a life
contingency or an annuity payment period of at least thirty-six (36)
months.
b. Alternate Payee Annuity Account
On any total or partial Transfer to Other Companies, distribution or
single sum payment under Section 11 from a Alternate Payee Annuity
Account, the contingent deferred sales charge will be deducted, except on
the death of the Alternate Payee.
10.2 Contingent Deferred Sales Charge Amount
a. Participant Annuity Account
The contingent deferred sales charge will be 6% of the amount transferred,
distributed, or paid in excess of the contingent deferred sales charge
free amount, if any. This charge is limited so that the cumulative total
of all contingent deferred sales charges deducted from the Participant
Annuity Account will not exceed 6% of the Deposits made to his/her
Participant Annuity Account within 72 months prior to the effective date
of the transfer, distribution, or payment. In no event shall the
contingent deferred sales charge at any point in time exceed 8.5% of
Deposits contributed by the Participant into this Group Annuity Contract.
A contingent deferred sales charge will not be charged to any Participant
who has completed 15 or more years in this Group Annuity Contract, as
measured from the Participant Effective Date.
b. Alternate Payee Account
The contingent deferred sales charge will be 6% of the amount transferred,
distributed or paid in excess of the contingent deferred sales charge free
amount, if any. A contingent deferred sales charge will not be charged to
any Alternate Payee who has completed 15 or more years in this Group
Annuity Contract, as measured from the Alternate Payee Effective Date.
10.3 Contingent Deferred Sales Charge "Free Amount"
The contingent deferred sales charge "free amount" is an amount against
which the contingent deferred sales charge will not be assessed. The
contingent deferred sales charge "free amount" shall not exceed 10% of an
Accountholder's Annuity Account Value at December 31 of the previous
calendar year, and will be applied on the first transfer, distribution, or
payments made under the Accountholder's annuity account in that year. All
additional transfers, distributions, or payments during that calendar year
will be subject to a contingent deferred sales charge without the
application of any free amount.
10.4 Loss of Interest Charge
On any total or partial Transfer to Other Company distribution or payment
from a Participant Annuity Account or an Alternate Payee Account, the Loss
of Interest Charge will be deducted from amounts distributed from any
Guaranteed Certificate Fund prior to the Certificate Maturity Date except
in the following situations: (1) the Participant dies; or (2) the
Participant separates from service; or (3) the Participant suffers a
hardship; or (4) the Participant elects a payment option under Section 11
with a life contingency or an annuity payment
period of at least (36) thirty-six months.
SECTION 11. PAYMENT OPTIONS
11.1 How to Elect Payment Options
The Written Request of the Accountholder or Payee is required to elect,
or change the election of, a payment option and must be received by the
Company at least 30 days prior to the Annuity Commencement Date, except
for annuities payable in arrears. For annuities payable in arrears, a
Written Request must be received by the Company at least one year prior
to the Annuity Commencement Date. For all payment options, a $1.50 check
charge will be deducted from the amount of each payment.
11.2 Selection of Payment Options
(a) A total or partial single sum payment or one of the variable or fixed
dollar payment options or a combination of them may be elected.
(b) If the Participant or Payee elects to apply any or all of the
Guaranteed Account Value to a variable dollar method of payment
option, or any or all of the Variable Account Value to a fixed dollar
method of payment option, an Intra-Company Transfer must be made
prior to the Annuity Commencement Date pursuant to Section 6.
(c) If a single sum payment is elected, the amount to be paid is the
amount requested less Premium Tax, if any.
(d) If a variable dollar payment option is elected, the amount to be
applied is the Variable Account Value, as of the date the amount of
the first monthly payment is determined, less Premium Tax, if any.
(e) If a fixed dollar method of payment option is elected, the amount to
be applied is the Guaranteed Account Value, as of the Annuity
Commencement Date, less Premium Tax, if any.
(f) Effective the date the first annuity check is cashed, the payment
option elected or deemed to have elected under, shall be irrevocable.
11.3 Variable Dollar Payment Options
The following variable dollar payment options are available:
(a) Option 1: Variable Life Annuity with Guaranteed Period
Monthly payments for the guaranteed Annuity Payment Period elected or
the lifetime of the Payee whichever is longer. The guaranteed Annuity
Payment Period elected may be 5, 10,
15, or 20 years. Upon death of the Payee, any amounts remaining payable
under this payment option will be paid to the Beneficiary. See Table A.
(b) Option 2: Variable Life Annuity
Monthly payments for the Payee's lifetime, without a guaranteed period. See
Table A.
(c) Option 3: Joint and One-Half Survivor
Variable Annuity
Monthly payments to an Annuitant for his/her lifetime, with payments
based on one-half of the variable Annuity Units continuing to the
survivor for life. See Table B.
(d) Option 4: Any Other Form
Any other form of Variable Annuity which is acceptable to the
Company.
(e) These variable dollar payment options are subject to the following
provisions:
(1) Amount of First Monthly Payment. The first monthly payment
under a variable dollar payment option will be based on the
Variable Account Value credited on behalf 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 payment option. The first monthly payment
will be the sum of the variable dollar annuity payments for
each Variable Sub-Account.
(2) Annuity Units. The number of Annuity Units paid to the
Annuitant for each Variable Sub-Account is determined by
dividing the amount of the first monthly payment by the
Sub-Account's Annuity Unit Value on the 5th Valuation Date
preceding the date the first payment is due. The number of
Annuity Units for a Variable Sub-Account remains fixed during
the Annuity Payment Period.
(3) Amount of Monthly Payments after the First. Monthly payments
after the first will vary depending upon the investment
experience of the Variable Sub-Accounts. The subsequent dollar
amount paid from each Sub-Account is determined by multiplying
(a) by (b) where (a) is the number of Sub-Account Annuity Units
SECTION 11. PAYMENT OPTIONS (continued)
and (b) is 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.
(f) The minimum amount that may be applied under the elected payment
option is $2,000. If the amount is less than $2,000, the Company may
pay it in one sum. If any payment to be made under the elected
payment 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 maximum amount that may be applied under any elected
payment option is $1,000,000. For the application of any greater
amount, the Company's consent is required.
11.4 Fixed Dollar Payment Options
The following fixed dollar payment options are available:
(a) Option 1: Income of Specified Amount
An income at 12-, 6-, 3-, or 1-month intervals, of an amount elected
by the Payee for an Annuity Payment Period of not more than 240
months. Upon death of the Payee, any amounts remaining payable under
this payment option will be paid to the Beneficiary. See Table C.
(b) Option 2: Income for a Specified Period
An income at 12-, 6-, 3-, or 1-month intervals, for the number of
months elected for an Annuity Payment Period of not more than 240
months. Upon death of the Payee, any amounts remaining payable under
this payment option will be paid to the Beneficiary. See Table C.
(c) Option 3: Fixed Life Annuity with Guaranteed Period Monthly payments
for the guaranteed Annuity Payment Period elected which may be 5, 10,
15 or 20 years or the lifetime of the Payee, whichever is longer.
Upon death of the Payee, any amounts remaining payable under this
payment option will be paid to the Beneficiary. See Table D.
(d) Option 4: Fixed Life Annuity with Installment Refund Period Monthly
payments for the life of the Payee or until the sum of the payments
made equals the amount applied, whichever is longer.
(e) Option 5: Fixed Life Annuity
Monthly payments for the Payee's lifetime, without a guaranteed period. See
Table D.
(f) Option 6: Joint and One-Half Survivor Fixed Annuity Fixed monthly
payments to an Annuitant for his/her lifetime, with one-half of the
fixed payment amount continuing to the survivor for life. See Table E
for the minimum monthly amount.
(g) Option 7: Systematic Withdrawal Option
Monthly, quarterly, semi-annual or annual payments as agreed upon by
the Payee and the Company as described in the attached Systematic
Withdrawal Option are described in greater detail in the attached
Systematic Withdrawal Option Rider, if any.
(h) Option 8: Any Other Form
Any other form of Fixed Annuity which is acceptable to the Company.
Upon death of the Payee, any amounts remaining payable under this
payment option will be paid to the Beneficiary.
(i) These fixed dollar payment options are subject to the following
provisions:
(1) Payments under a fixed dollar 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 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.
(2) The minimum amount that may be applied under the elected payment option
is $2,000. If the amount is less than $2,000, the Company may pay it in one
sum. If
SECTION 11. PAYMENT OPTIONS (continued)
any payment to be made under the elected payment 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 maximum amount that may be applied under any
elected payment option is $1,000,000. For the application of any greater amount,
the Company's consent is required.
<PAGE>
SECTION 12. DEPOSIT TERMINATION
12.1 Notice of Termination
Either the Group Policyholder or the Company may terminate Deposits under
this Group Annuity Contract by giving at least 60 days advance written
notice to the other. Such notice shall be sent certified mail, return
receipt requested. The termination date shall be 60 days after the date
the notice is received.
12.2 Administration of Accounts Upon Deposit
Termination
After termination of Deposits, the Company shall continue to administer
all Participant Annuity Accounts and Alternate Payee Annuity Accounts in
accordance with the provisions of this Group Annuity Contract except that
no Deposits will be accepted or allocated by the Company after the 60th
day from the date the termination letter is received. The Company will
maintain each Participant Annuity Account until it is Transferred under
the terms of Section 6 or applied to a payment option. Amounts in the
Guaranteed Certificate Fund must remain with the Company until the
Certificate Maturity Date.
<PAGE>
TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
Age of Without With Guaranteed Period
Payee Guaranteed Period 5 Years 10 Years 15
Years 20 Years
50 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
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 3.88 3.91 3.94
3.96 3.97 3.98
55 4.09 4.15 4.19
4.23 4.25 4.27
60 4.34 4.43 4.51
4.58 4.63 4.66
65 4.64 4.77 4.90
5.01 5.10 5.16
70 4.99 5.17 5.36
5.55 5.70 5.83
75 5.40 5.65 5.91
6.19 6.46 6.69
If payments commence on any other date than the exact age of the
Annuitant or survivor 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.
<PAGE>
TABLE C - Income of Specified Amount
- Income for a Specified Period
Monthly Payment for Each $1,000
of Participant Annuity Account Value
Years Payment
3 28.61
4 21.82
5 17.75
6 15.04
7 13.10
8 11.66
9 10.54
10 9.63
11 8.90
12 8.30
13 7.78
14 7.34
15 6.96
16 6.63
17 6.34
18 6.08
19 5.85
20 5.64
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.
<PAGE>
Page 25
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 3.99 3.99 3.98
3.96 3.94
55 4.31 4.30 4.27
4.24 4.19
60 4.71 4.70 4.67
4.60 4.49
65 5.28 5.25 5.18
5.05 4.84
70 6.07 6.02 5.85
5.56 5.15
75 7.22 7.09 6.68
6.07 5.41
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.
<PAGE>
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 3.88 3.91 3.94
3.96 3.97 3.98
55 4.09 4.15 4.19
4.23 4.25 4.27
60 4.34 4.43 4.51
4.58 4.63 4.66
65 4.64 4.77 4.90
5.01 5.10 5.16
70 4.99 5.17 5.36
5.55 5.70 5.83
75 5.40 5.65 5.91
6.19 6.46 6.69
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.
</TABLE>
<PAGE>
DAILY INTEREST GUARANTEE FUND RIDER
A GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY
CONTRACT
The Daily Interest Guarantee Fund is a Guaranteed Sub-Account. The value of an
Accountholder's interest in the Daily Interest Guarantee Fund is his/her
Deposits into the fund plus interest less amounts distributed, transferred or
applied to a payment option, less contract maintenance charge, and Premium Tax.
Amounts in the Daily Interest Guarantee Fund shall earn an annual
effective rate to be determined by the Company prior to the last
day of each calendar quarter, effective for deposits in the next
calendar quarter and money already in the account. This annual
effective rate will never be less than the Guaranteed Interest
Rate.
<PAGE>
GUARANTEED CERTIFICATE FUND RIDER
A GUARANTEED SUB-ACCOUNT RIDER ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY
CONTRACT
The Guaranteed Certificate Fund is a Guaranteed Sub-Account. The Accountholder,
by Written Request, may allocate all or a portion of his/her Deposits to one and
only one of the several certificate periods then offered by the Company. All
Deposits received during a calendar quarter and allocated to a certificate
period shall earn an annual effective rate of interest equal to the rate stated
by the Company for the applicable certificate period from the date of Deposit to
the end of the certificate period. The annual effective rate shall not be less
than the Guaranteed Interest Rate. A Certificate Maturity Date is hereby defined
as the last day of any Certificate period. Certificates which have not reached
the Certificate Maturity Date shall be called unmatured certificate.
The transfer, distribution or application to a payment option prior to the
certificate maturity date of funds in a certificate shall be known as breaking a
certificate. If a certificate is broken, a Loss of Interest Charge may be
assessed, as defined in the definition section of the contract and in Section
10. However, the Loss of Interest charge will not apply if a certificate is
broken when:
(1) the Accountholder dies; or
(2) the Participant separates from service; or
(3) the Participant suffers a hardship; or
(4) the Accountholder or Beneficiary uses the certificate funds to
purchase from the Company an annuity with life contingencies or an
Annuity Payment Period of at least thirty-six (36) months.
Value of Certificate
Each certificate has its own value, which is an Accountholder's Deposits in that
certificate, plus interest, less amounts distributed, transferred or applied to
a payment option, contract maintenance charges and Premium Tax, as applicable.
When a certificate is broken, a contingent deferred sales charge and/or a Loss
of Interest Charge may apply.
The sum of the values of an Accountholder's certificates is the value of the
Accountholder's interest in the Guaranteed Certificate Fund.
Allocation of Matured Certificates
When a certificate matures, the Accountholder may, within 30 days before or
after the Certificate Maturity Date, allocate the value of the certificate among
any of the Variable & Guaranteed Sub-accounts then offered by the Company under
this Group Annuity Contract. This election is effective on the later of the
first day of the calendar quarter immediately following the Maturity Date of the
certificate(s), or the date the Reinvestment Form for Maturity Certificates is
received and recorded by the Company at its Administrative Offices. If the
election is not received by the Company within the 30 day period, the value of
the matured certificate will be allocated to a new certificate with the same
certificate period as the matured certificate.
If the same certificate period is not then offered by the Company under this
Group Annuity Contract, the value of the matured certificate will be allocated
to a new certificate with the shortest certificate period then available.
If the Guaranteed Certificate Fund is not offered by the Company under this
Group Annuity Contract, the value of the matured certificate will be allocated
by the Company to any other Guaranteed Sub-account then available. Amounts from
a matured certificate allocated to a new certificate or other Guaranteed
Sub-account will earn the annual effective rate applicable to that certificate
or Guaranteed Sub-account. This annual effective rate may differ from the annual
effective rate applicable to the matured certificate.
Transfers
Section 6 of this Group Annuity Contract will apply to any transfer to or from
the Guaranteed Certificate Fund.
<PAGE>
SYSTEMATIC WITHDRAWAL PAYMENT OPTION RIDER
ATTACHED TO AND FORMING A PART OF THE GROUP ANNUITY CONTRACT
Ability to Elect
All or a portion of an Accountholder's annuity account may be allocated to the
Systematic Withdrawal Payment Option at any time, subject to any other governing
provision of this Group Annuity Contract. Transfers of amounts held by or for
the benefit of the Accountholder in another 403(b) tax deferred annuity account
with another company may be Deposited or caused to be Deposited by the
Accountholder directly into the Systematic Withdrawal Payment Option.
Election Procedure
The Accountholder must elect the Systematic Withdrawal Payment Option in
accordance with the procedures of this Group Annuity Contract.
Minimum Allocation or Deposit Required
The initial allocation or transfer from another company, whichever occurs first,
must be at least twenty thousand dollars ($20,000.00). All subsequent
allocations and/or transfers from another company must be at least two thousand
dollars ($2,000.00).
Earnings - New Money Yield
All amounts allocated or transferred to the Systematic Withdrawal Payment Option
within a calendar quarter shall earn the annual yield established by the Company
for that quarter, effective from the date of receipt of the application or
transfer from another company through the last day of the next calendar year.
The annual yield shall be established by the Company for each calendar quarter
before the end of the prior calendar quarter and shall not be less than the
Guaranteed Interest Rate. The Company reserves the right to establish different
New Money Yields for different classes of policyholders in compliance with
applicable state laws.
Earnings - Portfolio Yield
On the first day of January of each year, all amounts remaining in the
Systematic Withdrawal Payment Option related to applications or transfers from
another company made prior to the preceding January 1, shall no longer earn the
New Money Yield. These amounts shall earn the Portfolio Yield effective for the
current calendar year. The Portfolio Yield may be different than the New Money
Yield and shall be established by the Company before the end of each calendar
year to be effective for the next calendar year and may be different every year.
The Portfolio Yield shall not be less than the Guaranteed Interest Rate. The
Company reserves the right to establish different Portfolio Yields for different
classes of policyholders in compliance with applicable state laws.
Designation of Payment Frequency
When the Accountholder elects the Systematic Withdrawal Payment Option, the
Accountholder must designate the frequency of payments. Payments may be made
monthly, quarterly, semi-annually or annually. The Accountholder may change the
frequency of payments only once in a calendar year.
Beginning of Payments
Payments to the Accountholder or his/her designated Payee must begin no later
than one year from the day of the first deposit.
Amount of Payments
Each payment must not be less than the greater of (i) one hundred dollars
($100.00), or (ii) the minimum distribution and minimum incidental death benefit
amount required under the Internal Revenue Code and any regulations issued
thereunder, as amended from time to time. The Company reserves the right to make
a lump sum payment of all of an Accountholder's interest in the Systematic
Withdrawal Payment Option if that interest is less than one hundred dollars
($100.00). The Accountholder may change the amount of the payment only once in a
calendar year.
On a form and in a manner prescribed by the Company, the Accountholder may elect
to receive regular and systematic payments from the Systematic Withdrawal Option
Account on a monthly, quarterly, semi-annual or annual basis. Each payment made
to an Accountholder will be debited from the Systematic Withdrawal Option
Account on a last in, first out (LIFO) basis, except for the interest-only
option as described below. The number of payments received may vary depending
upon the new money yields and/or portfolio yields earned.
Systematic Withdrawal Payment Option Rider - Vol
SYSTEMATIC WITHDRAWAL PAYMENT OPTION RIDER
The following payment options will be available under the Systematic Withdrawal
Payment Option: 1. Period Certain This option allows the Accountholder to choose
how long the Accountholder will receive payments. The Company calculates the
Accountholder's amount based on the Accountholder's current account balance.
2. Payment Certain
This option is similar to the "Period Certain" option above, except that the
Accountholder chooses a payment amount and the Company calculates the length of
time an Accountholder can receive these payments. The Company calculates the
length of time based upon the Accountholder's current account balance.
3. Payments Over Life Expectancy
Under this option, the Company calculates the Accountholder's life expectancy
based upon the Accountholder's current age. This option then works much like the
"Period Certain" option above, under which the Company will calculate the
payments to be made over the Accountholder's expected lifetime.
4. Increasing Payments by Specified Percentage Over Time
Under this option, the Accountholder chooses either the payment amount or the
length of time payments will be made. The Accountholder also elects a percentage
by which the payments will be increased each year.
5. Interest Only
Under this option, the interest credited to the Accountholder's current account
balance will be paid to the Accountholder on a monthly, quarterly, semi-annual
or annual basis, as elected. Each interest only payment made to an Accountholder
will be equal to the entire interest accumulated on all Deposits credited to the
Systematic Withdrawal Option Account since the time of the last interest only
payment. This option will not be available to Accountholder's unable to meet the
minimum distribution requirements under federal law.
Total or Partial Distributions
Total and partial distributions of amounts in the Systematic Withdrawal Payment
Option shall be available to Acountholders under the same principles as
distributions are available under Section 9 of this Group Annuity Contract.
Distributions will be made on a last-in-first-out (LIFO) basis, except for the
interest-only option payment. Distributions shall be effective on the later of
the date the Accountholder elects to have the distribution paid or the date the
Written Request is received by the Company at its Administrative Offices.
Distributions to effect a transfer in accordance with Revenue Ruling 90-24 will
not be permitted from this option once monies are allocated to this Systematic
Withdrawal Option.
Systematic Withdrawal Charges
A charge shall be deducted by the Company from all amounts paid or distributed,
less the Systematic Free Amount. The charge shall be a percentage of the amount
paid or distributed in excess of the Systematic Free Amount and shall be based
on the following table:
Elapsed Years From
Initial Allocation Percentage of
or Transfer Amount Distributed
0 - 5 5%
more than 5 0%
Upon the death of the Accountholder no charge will be assessed against any
payment or distribution made under this Rider.
Systematic Free Amount
The Systematic Free Amount is an amount of the payment or distribution against
which the charge will not be assessed. This free amount is equal to twenty
percent (20%) of the amount in the Accountholder's Systematic Withdrawal Payment
Option as of December 31 of the preceding calendar year, except in the first
year. In the first partial year before any December 31 anniversary, the free
amount will be equal to 20% of the initial deposit made to this option. The free
amount shall be applied to each payment and distribution made in a calendar year
until the free amount is exhausted. A new free amount shall be available for
each calendar year. Any unused free amount from one calendar year is forfeited
and may not be applied to any other year.
<PAGE>
IRC 403(b) Rider
SBJPA
1-97
<PAGE>
IRC 403(b) RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Due to modifications under the Small Business Job Protection Act of 1996, all
elective deferrals under the Contract will be subject to the provisions noted in
Section 1 below.
1. Each Participant's elective deferrals under the Contract are limited to the
amount permitted under IRC Section 402(g). Should any Participant's
elective deferrals exceed the allowable amount, such Participant must
request that the excess deferrals be distributed from the Contract in
accordance with Internal Revenue Service requirements, as amended from time
to time. If such excess deferral is not timely distributed, the Participant
Annuity Account may lose its ss.403(b) status for tax purposes.
With respect to all monies transferred from a custodial account contract issued
in accordance with the provisions of IRC Section 403(b)(7), including interest
and investment earnings thereon, the following provisions in Sections 2 and 3
below will apply to such monies.
2. No such amounts may be paid or made available to any distributee before: A)
the Participant dies, or B) the Participant attains age 59 1/2, or C) the
Participant separates from service, or D) the Participant becomes disabled
[within the meaning of IRC Section 72(m)(7)], or E) in the case of
contributions made pursuant to a salary reduction
agreement, the Participant encounters financial hardship.
3. The provisions in Section 9.1 of the Contract regarding Distribution of
Pre-1989 Account Balance amounts shall not apply to monies contributed
under a custodial account contract issued under IRC Section 403(b)(7).
Distribution of such custodial account amounts shall be restricted in
accordance with the provisions noted in Section 2 above.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
W.T. McCallum,
President and Chief Executive Officer
Signed and accepted by the Group Policyholder and attached to the Group
Annuity Contract on ,
200 .
By:
Title:
<PAGE>
Qualified Governmental Group Pension
Group Contract
685
<PAGE>
HOME OFFICE -.WICHITA, KANSAS
ADMINISTRATIVE OFFICES
DENVER, COLORADO
GROUP CONTRACTHOLDER
GROUP CONTRACT NUMBER
GROUP ANNUITY CONTRACT DATE
Non-Participating
The provisions on the following pages, together with the application for this
Group Annuity Contract, are part of this Group Annuity Contract.
Signed for the Great-West Life & Annuity Insurance Company on the issuance of
the Group-Annuity Contract on the Annuity Contract Date.
Secretary President
For the Actuary
This Group Annuity Contract is the legal contract between the Group
Contractholder, for the benefit of the Participants, and the Great-West Life &
Annuity Insurance Company. PLEASE READ THIS CONTRACT CAREFULLY. IT IS A CONTRACT
WHICH MAY PROVIDE FOR PAYMENTS OR VALUES WHICH ARE NOT GUARANTEED AS TO
FIXED-DOLLAR AMOUNT BUT MAY VARY ACCORDING TO THE INVESTMENT EXPERIENCE OF A
VARIABLE ANNUITY ACCOUNT.
Qualified Governmental Plan - Group Annuity Contract
Contract No.
Form No. QGP 685 - 1
TABLE OF CONTENTS
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
ARTICLE I DEFINITIONS
ARTICLE Il OWNERSHIP PROVISIONS
2.1 Ownership of Series Account
2.2 Ownership of Group Annuity Contract and Participant Annuity Account Value
2.3 Transfer and Assignment
ARTICLE III GENERAL PROVISIONS
3.1 The Group Annuity Contract
3.2 Entire Contract
3.3 Non-Participating
3.4 Beneficiary
3.5 Currency and Payment of Contributions
3.6 Age
3.7 Proof
3.8 Plan Amendments and Changes in Procedure
3.9 Gender
3.10 Assignment
3.11 Representations
3.12 Notice
3.13 Voting Rights and Reports
ARTICLE IV PURCHASE PROVISIONS
4.1 Commencement and Termination of Coverage
4.2 Contributions
4.3 Allocation of Contributions
ARTICLE V CONTRACT VALUE PROVISIONS
5.1 Variable Contract Value
5.2 Accumulation Unit
5.3 Accumulation Unit Value
5.4 Annuity Unit Value
5.5 Net Investment Factor
5.6 Risk Charge
5.7 Guaranteed Contract Value
5.8 Guaranteed Sub-Account Riders
5.9 Asset Management Fee - Guaranteed Contract
5.10 Variable and Guaranteed Contract Value Provisions
Contract Maintenance Charge
Transfers Among Sub-Accounts
Transfers Outside the Contract
Contract No. 12345GP
Form No. QGP 685 - 2
TABLE OF CONTENTS (continued)
ARTICLE VI TRANSFERS
6.1 Right to Transfer
6.2 Transfer Provisions
6.3 No Receipt of Transferred Amounts
ARTICLE VII RETIREMENT
7.1 Retirement Provisions
7.2 Payment On Retirement
ARTICLE VIII PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, IN SERVICE WITHDRAWAL AND
SURRENDER
8.1 Amount Payable On Death of Participant
8.2 In Service Withdrawal
8.3 Amount Payable on In Service Withdrawal
8.4 Surrender
8.5 Amount Payable on Surrender
8.6 Payment on Death, In Service Withdrawal and Surrender
8.7 Contingent Deferred Sales Charge
8.8 Contingent Deferred Sales Charge Free Amount
ARTICLE IX METHOD OF PAYMENT
9.1 Method of Payment Provisions
9.2 Amount To Be Applied
9.3 Variable Dollar Method of Payment
Amount of First Monthly Payment
Annuity Units
Amount of Monthly Payments After the First
Variable Dollar Method of Payment Options
9.4 Fixed Dollar Method of Payment
Amount of Payment
Fixed Dollar Method of Payment Options
9.5 How to Elect Method of Payment Option
9.6 Availability of Options
9.7 Settlement
ARTICLE X MODIFICATIONS
10.1 Contract Modification
10.2 Modification of Tables
10.3 Modification of Guaranteed Sub-Account Riders, If Any
10.4 Modification of Offering of Guaranteed Sub-Accounts
10.5 Modification of Interest Guarantee Period
Contract No. 12345GP
Form No. QGP 685 - 3
ARTICLE XI CESSATION OF DEPOSITS
11.1 By the Company
11.2 By the Group Contractholder
11.3 Change of Allocation Due to Cessation of Deposit
ARTICLE XII CONTRACT TERMINATION
12.1 Contract Termination Date
12.2 Procedures at Contract Termination Date
TABLE A
TABLE B
TABLE C
TABLE D
TABLE E
GUARANTEED SUB-ACCOUNT RIDERS AND LOAN RIDER, IF ANY
Contract No. 12345GP
Form No. QGP 685 - 4
ARTICLE I
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 as provided for in the
Plan, and elected by the
Participant.
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.
Beneficiary - the person(s) entitled to
receive (a) the amount payable
on death when the Participant
has died before the Annuity
Commencement Date, or (b) the
amount, if any, payable under a
method of payment option when
the Participant has died after
the Annuity Commencement Date.
Company - the Great-West Life & Annuity Insurance
Company.
Deposit - includes contributions,
Transfers and other amounts
deposited into Guaranteed or
Variable Sub-Accounts.
Employer - the employer applying for this Group
Annuity Contract.
Eligible Fund - a registered management
investment company in which the
assets of the Series Account
may be invested.
Employer Contributions - contributions made by the Employer
pursuant to the Plan.
Contract No. 12345GP
Form No. QGP 685 - 5
ARTICLE I (continued)
Forfeiture - That portion of the
Participant's Annuity Account
Value which is not vested under
the terms of the Plan as of the
date of Surrender.
Group Annuity Contract - this
Qualified Governmental Plan
Group Annuity Contract which is
a binding agreement between the
Group Contractholder and the
Company.
Group Annuity Contract Date - the
effective date indicated by the
Group Contractholder on the
application for this Group
Annuity Contract, or such other
date which is acceptable to the
Company.
Group Contractholder - the Employer,
or the employee benefit plan
applying 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
Participant under his
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 sub-division 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.
In Service Withdrawal - a
withdrawal of some or all of,
the Participant's Annuity
Account Value during his
service with the Employer.
Contract No. 12345GO
Form No. QGP 685 - 6
ARTICLE I (continued)
Participant - a person in the employ of the
Employer who has met the
requirements for participation
in the Plan and has elected to
make contributions to the Plan
(if required), or who has
elected to have a portion of
his salary contributed to the
plan on his behalf by his
Employer.
Participant Annuity Account - a separate
record established in the name
of each Participant which
reflects the total of the
Guaranteed and Variable
Contract Values. The value of
any outstanding loan balance is
not considered to be part of
the Participant Annuity
Account.
Participant Annuity Account Value - the sum
of the Variable and Guaranteed
Contract Values credited to the
Participant under his
Participant Annuity Account.
Participant Effective Date - the date on
which the first Deposit is
credited to a Participant
Annuity Account.
Payee - Participant, or Beneficiary
if the Participant is not
living or the designated Payee
of a qualified joint and
survivor annuity, a qualified
pre-retirement survivor annuity
or any alternate payee under a
qualified domestic relations
order as defined by the
Internal Revenue Code.
Plan - Plan refers to a
profit-sharing plan of the
Employer which has been
qualified under Section 401(a)
of the Internal Revenue Code as
amended.
Plan Year - The 12 month period
established by the Plan for the
Plan's reporting, disclosure
and funding.
Premium Tax - the amount of premium
tax, if any, charged by a state
or other government authority.
Series Account - the "FutureFunds"
Account, a segregated
investment 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.
Contract No. 12345GP
Form No. QGP 685 - 7
ARTICLE I (continued)
Surrender - A lump-sum payment or the
actuarial equivalent thereof,
if a method of payment option
has been elected, of the entire
Participant Annuity Account
Value as provided for in the
Plan other than as an
In-Service Withdrawal.
Transfer - amounts moved from any
Sub-Account to another
Sub-Account or outside this
Group Annuity Contract, in
accordance with Plan provisions
and the provisions of this
contract.
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 Account - the portion of this
Group Annuity Contract
providing Variable Sub-Accounts
each having its own
Accumulation Unit and Annuity
Unit Value.
Variable Contract Value - the sum of the
values of the Variable
Sub-Accounts credited to a
Participant under his
Participant Annuity Account.
Variable Sub-Account - a sub-division of the Variable Account.
Each Variable Sub-Account has
its own Accumulation Unit and Annuity Unit
Value.
Contract No. 12345GP
Form No. QGP 685 - 8
ARTICLE I (continued)
Written Request - the request required in the Allocation of
Contributions, Beneficiary,
Transfers, Surrender, In Service
Withdrawal, 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 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.
</TABLE>
ARTICLE II
OWNERSHIP PROVISIONS
2.1 Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
2.2 Ownership of Group Annuity Contract and Participant Annuity Account
Value
Upon the Group Contractholder's application for this Group Annuity
Contract, the Group Contractholder becomes the owner of the Group
Annuity Contract for the benefit of its participating employees.
Each employee for whom Deposits have been made participates in this
Group Annuity Contract and is a Participant for whom a Participant
Annuity Account is established.
2.3 Transfer and Assignment
The interest of any Participant or of the Group Contractholder in this
Group Annuity Contract may not be transferred, sold, assigned, pledged,
charged, encumbered or in any way alienated by either of them.
To the extent permitted by law, no proceeds or payments under the Group
Annuity Contract will be subject to the claims of creditors or legal
process.
Contract No. 12345GP
Form No. QGP 685 - 10
ARTICLE III
GENERAL PROVISIONS
3.1 The Group Annuity Contract
The Group Annuity Contract is issued by the Company to the Group
Contractholder.
3.2 Entire Contract
This Group Annuity Contract, its application, tables, and Guaranteed
Sub-Account Riders, if any, form the entire contract between the Group
Contractholder and the Company. A copy of the application is attached
to the Group Annuity Contract when issued to the Group Contractholder.
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 terms and provisions of the Plan shall not for any purpose be
deemed to form part of this Group Annuity Contract and shall not be
binding upon the Company. Notwithstanding the fact that the Company may
have knowledge of the terms of the Plan, the obligations of the Company
shall be measured and determined solely by the terms and provisions of
this Group Annuity Contract.
3.3 Non-Participating
This Group Annuity Contract is non-participating. It is not eligible to
share in the Company's divisible surplus.
3.4 Beneficiary
While the Participant is living, he may by Written Request designate or
change a Beneficiary from time to time in accordance with Plan
provisions. When recorded, a change of Beneficiary will take effect as
of the date the writing was signed. If the Participant dies between the
date the writing was signed and the date it was recorded, the change
will take effect unless the Company has made a payment or has otherwise
taken action on a designation before receipt or recording of the change
of Beneficiary.
Contract No. 12345GP
Form No. QGP 685 - 11
ARTICLE III (Continued)
Unless otherwise provided in the designation of Beneficiary, the
following provisions will apply to the designation:
(1) if a Beneficiary dies before the Participant, the Beneficiary's
interest will pass to any designated surviving Beneficiary.
(2) if there is more than one designated surviving Beneficiary,
the Participant Annuity Account will be shared equally among
them.
(3) if there is no designated surviving Beneficiary, the Participant
Annuity Account will pass to the Participant's estate.
(4) if the Designation of Beneficiary is not adequately made, the
Participant Annuity Account will pass to the Participant's estate.
3.5 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.
3.6 Age
If the age of the Participant or Payee has been misstated, the payments
established for him will be made on the basis of his 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.
3.7 Proof
The Company reserves the right to require satisfactory proof to
establish the age, continued life or death of any person, the happening
of any event or contingency provided for under the Plan, or the
designation of any beneficiary before making any payment on the
direction of the Group Contractholder.
Contract No. 12345GF
Form No. QGP 685 - 12
ARTICLE III (Continued)
3.8 Plan Amendments and Changes in Procedure
The Group Contractholder shall, within thirty (30) days after the
adoption of a Plan Amendment, send a copy of each such amendment to the
Insurance Company at its administrative offices in Denver, Colorado.
If the Group Contractholder adopts an amendment to the Plan which
causes the level of Deposits, In Service Withdrawals, Surrenders,
Transfers or loans to Participants to be materially different from that
originally underwritten by the Company, or if the Employer adopts any
change in its administrative procedures or policies relating to loans
to Participants which causes the level of Deposits, In Service
Withdrawals, Surrenders or loans to Participants to be materially
different than that originally underwritten by the Company, the Company
reserves the right to:
(A) adjust the interest rates credited on the Guaranteed
Certificate Fund Sub-Account Rider both retrospectively and
prospectively to a level mutually agreed upon by the Company
and the Group Contractholder, or
(B) if the Company and the Group Contractholder fail to agree on a
new interest rate then the Group Annuity Contract will be
terminated in accordance with Article XII of this Group
Annuity Contract.
3.9 Gender
Whenever a masculine pronoun is used it shall be deemed in all
instances where appropriate to mean the feminine pronoun as well.
3.10 Assignment
The interest of a Participant or Beneficiary in this Group Annuity
Contract or in any benefit, payment or installment provided hereunder
may not be assigned, charged, attached, anticipated, given as security
or otherwise alienated, and no such interest shall be subject to
execution, seizure or other legal or equitable process. Neither a
Participant nor any Beneficiary may commute or surrender any payment,
benefit, or installment to which he may be or become entitled by the
terms of this Group Annuity Contract.
3.11 Representations
The Company shall be entitled to rely and act solely an the reports,
directions, proofs, notices, elections and other information furnished
it by the Group Contractholder or its agent, and such acts shall be
conclusive and binding as to all Participants and other persons or
corporations claiming interest hereunder.
Contract No. 12345GP
Form No. QGP 685 - 13
ARTICLE III (Continued)
3.12 Notice
Whenever any application, report, direction, request or election is
made or notice or proof given to the Company, it must be in writing and
received by the Company at its administrative offices in Denver,
Colorado. An election shall be in a form satisfactory to the Company
and if made and accepted shall not be subject to change or further
election unless with the consent of the Company.
3.13 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 Contractholder 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 Contractholder 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 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
Contractholder, 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 Contractholder 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 Contractholder, who shall promptly deliver them to
each Participant or Payee of a Variable Dollar Method of Payment
Option. The Company will furnish the Group Contractholder not less
frequently than annually a statement, for each Participant, of the
Participant Annuity Account Value, which the Group Contractholder will
promptly deliver to the Participant. The Group Contractholder may
direct the Company to deliver these reports and statements to the
Participants.
Contract No. 12345GP
Form No. QGP 685 - 14
ARTICLE IV
PURCHASE PROVISIONS
4.1 Commencement and Termination of Coverage
Any employee of the Employer may commence coverage under this Group
Annuity Contract when the Plan's conditions for eligibility have been
met.
An employee becomes covered as a Participant as of the Participant
Effective Date. Coverage of a Participant terminates upon his Surrender
which results in a Participant Annuity Account Value of nil, or
selection of a method of payment option.
4.2 Contributions
Unless a Date of Cessation of Deposits has been declared, the Employer
will pay contributions in cash for all Participants, and will make all
required Employer Contributions as well. Such contributions will cease
upon the Participant's death, Annuity Commencement Date, Surrender of
the Participant Annuity Account, or election to cease making
contributions to the Plan.
The amount of contributions to be paid by the Group Contractholder for
any Participant will be determined by the Participant's election and
the terms of the Plan.
The Employer will report the amount paid as contributions on forms
acceptable to the Company. The Employer's report is conclusive and
binding on it and anyone claiming an interest under the Group Annuity
Contract. When the Employer's report does not coincide with the
contributions received, the Employer must reconcile and correct them.
4.3 Allocation of Contributions
After a Participant's Effective Date, contributions, less Premium Tax,
if any, will be allocated in the Participant Annuity Account effective
as of the date received by the Company at its Administrative Offices.
Contributions for 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 Employer on behalf of
the Participant.
The allocation of contributions may be changed at any time permitted
under the terms of the Plan upon the Company's receipt at its
administrative offices of the Written Request of the Employer on behalf
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.
Contract No. 12345GP
Form No. QGP 685 - 15
ARTICLE V
CONTRACT VALUE PROVISIONS
5.1 Variable Contract Value
The Variable Contract Value for a 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 for the Participant.
The value of a Participant's interest in a Variable Sub-Account will be
determined by multiplying the number of Accumulation Units held for the
Participant for that Variable Sub-Account by the Accumulation Unit
Value for that Variable Sub-Account.
5.2 Accumulation Unit
Contributions and Transfers received at the administrative offices of
the Company before the close of a Valuation Period will be allocated as
requested and applied as of that date based upon the Accumulation Unit
Value for that Variable Sub-Account as of the Valuation Date next
preceding receipt of the funds, to provide Accumulation Units of the
selected Variable Sub-Accounts of the Series Account.
The number of Accumulation Units credited for 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.
5.3 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.
Contract No. 12345GP
Form No. QGP 685 - 16
ARTICLE V (Continued)
5.4 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).
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.
5.5 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:
(1) 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
(2) 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
(3) 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:
(1) 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,
(2) 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.
Contract No. 12345GP
Form No. QGP 685 - 17
ARTICLE V (Continued)
(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)(2)
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.
5.6 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.
5.7 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
Participant.
5.8 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.
5.9 Asset Management Fee - Guaranteed Contract
On the first day of each calendar year an Asset Management Fee to be
assessed against the [Guaranteed Contract Value] [each Guaranteed
Sub-Account] will be declared by the Company. The amount to be deducted
from the Guaranteed Contract Value will be determined and applied by
the Company on the first day of each calendar quarter based on the
balance at the end of the previous calendar quarter. The Employer may
elect to pay these expenses separately. If such an election is made,
then no charge will be made against the Guaranteed Contract Value
unless payment is not received within [ ] days.
Contract No. 12345GP
Form No. QGP 685 - 18
ARTICLE V (Continued)
5.10 Variable and Guaranteed Contract Value Provisions
The following charges are applicable to the Variable and Guaranteed
Contract Values:
(A) Contract Maintenance Charge
On the first day of each calendar year a contract maintenance
charge will be declared by the Company and deducted from the
Participant Annuity Account. If a Participant Annuity Account
is established for a Participant after that date, the 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 Contract 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. The Employer may elect to pay such expenses to
the Company separately. If such an election has been made,
then no charge will be made against the Variable and
Guaranteed Sub-Accounts unless payment is not received within
[ ] days.
(B) Transfers Among Sub-Accounts
With the exception of the first four Transfers among
Sub-Accounts, in a calendar year, a Transfer Charge of [$10]
per such Transfer will be deducted from the Participant
Annuity Account after the Transfer.
(C) Transfers Outside the Contract
Any Transfer outside this Group Annuity Contract will be
assessed a charge of [$0] for each such transfer and such
charge will be deducted from the Participant Annuity Account
at the time of the Transfer.
Contract No. 12345GP
Form No. QGP 685 - 19
ARTICLE VI
TRANSFERS
6.1 Right to Transfer
The Employer on behalf of the Participant may by Written Request
transfer amounts among the currently offered Variable and Guaranteed
Sub-Accounts or outside this Group Annuity Contract, providing such
request is in accordance with the terms of the Plan, and this Group
Annuity Contract.
6.2 Transfer Provisions
The following provisions will apply to any Transfer:
(A) 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;
(B) if a Transfer is made within 30 days of the Annuity
Commencement Date, the Company may delay the Annuity
Commencement Date by 30 days;
(C) if a Participant dies prior to the Annuity Commencement Date,
one Transfer may be made after the death of the Participant by
the Beneficiary to effect the election of the Method of
Payment Option;
(D) when the Company requires it, the Participant or Payee and the
Group Contractholder will execute forms provided by the
Company as necessary to effect the requested Transfer;
(E) no Transfers are permitted after the Annuity Commencement Date;
(F) a Transfer will be subject to terms described in greater detail In the
attached Guaranteed Sub-Account Riders, if any;
(G) all Transfer charges provided for in Article V, if any, will be
deducted;
(H) a contingent deferred sales charge, if applicable, will be
deducted.
6.3 No Receipt of Transferred Amounts
No Transfer made within these transfer provisions will result In the
Participant's receipt of the transferred amounts. If the Transfer is
among Sub-Accounts, these amounts shall continue to be held under the
Participant Annuity Account.
Contract No. 12345GP
Form No. QGP 685 - 20
ARTICLE VII
RETIREMENT
7.1 Retirement Provisions
If the Group Contractholder reports that a Participant has become
eligible for a retirement benefit in accordance with the provisions of
the Plan, the Company shall pay such benefit in accordance with the
provisions of this section.
On the Company's receipt of a Written Request from the Employer, on
behalf of the Participant, at least thirty (30) days, prior to the
Annuity Commencement Date the Company will acknowledge a Written
Request to:
(A) elect to receive payment in one sum, if such payment is permitted by
the Plan;
(B) elect or change a method of payment option;
(C) make payment under a method of payment option;
(D) elect or change the Participant's Annuity Commencement Date to
any future date which is not later than allowed 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 Participant has failed to elect a method of payment option
within 30 days of his Annuity Commencement Date, the Company will pay
him in accordance with the provisions of the Plan.
7.2 Payment On Retirement
Payment under the retirement provisions will only commence on the order
of the Employer, on behalf of the Participant, as directed in the
Written Request.
Contract No. 12345GP
Form No. QGP 685 - 21
ARTICLE VIII
PROVISIONS RELATING TO AMOUNT PAYABLE ON
DEATH, IN SERVICE WITHDRAWAL, AND SURRENDER
8.1 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:
(1) the Participant Annuity Account Value, less Premium Tax, if any,
(2) the sum of Contributions paid to the Participant
Annuity Account, less any In Service Withdrawals made
from such 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 Beneficiary of an amount payable on death may elect that payment be
made under the methods of payment provisions, a combination of the
Surrender and methods of payment provisions, or under the Surrender
provisions if permitted by the Plan. The election of the Beneficiary
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,
payment will be made to the Beneficiary, under the terms of the Plan.
8.2 In Service Withdrawal
By Written Request the Employer may direct the Company to make an In
Service Withdrawal from the Participant Annuity Account payable to the
Participant. The In Service Withdrawal 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.
The Employer must designate in the Written Request the Variable or
Guaranteed Sub-Account(s), or a combination of them, from which the In
Service Withdrawal is to be made.
8.3 Amount Payable On In Service Withdrawal
The amount payable on In Service Withdrawal will be paid in one sum
under the In Service Withdrawal provisions equal to:
(A) the amount requested by the Employer, on behalf of the Participant, in
accordance with the terms of the Plan, less
(B) the contingent deferred sales charge, if any, less
(C) Premium Tax, if any.
Contract No. 12345GP
Form No. QGP 685 - 22
ARTICLE VIII (Continued)
8.4 Surrender
By written request the Employer may surrender the Participant Annuity
Account on behalf of the Participant. 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. Any Forfeiture
as a result of such Surrender shall-be allocated in accordance with the
terms and provisions of the Plan.
8.5 Amount Payable On Surrender
The amount payable on surrender may be applied under the methods of
payment provisions if permitted by the Plan or will be paid in one sum
under the Surrender provisions equal to:
(A) the Participant Annuity Account Value as of the effective date of
the Surrender, less (B) Premium Tax, if any, less (C) Forfeiture, if
any, less (D) the contingent deferred sales charge, if applicable.
8.6 Payment On Death, In Service Withdrawal and-Surrender
Payment under any of the provisions relating to amount payable on
death, In Service Withdrawal, and Surrender will only be made to the
order of the Employer on behalf of the Participant as directed in the
Written Request.
8.7 Loans
Loans to Participants, if permitted by the Plan, will be made only in
accordance with the terms and provisions of the Plan and the attached
Loan Rider.
8.8 Contingent Deferred Sales Charge
The contingent deferred sales charge applicable to any In Service
Withdrawal, Surrender or Transfer 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 to the Participant, under his Participant Annuity Account, to
exceed 6% of the contributions made to his Participant Annuity Account
within 72 months prior to the effective date of the In Service
Withdrawal, Surrender or Transfer.
The contingent deferred sales charge will not be applied under the
following circumstances:
(A) death of the Participant prior to Annuity Commencement Date;
Contract No. 12345GP
Form No. QGP 685 - 23
(B) if the Participant purchases an annuity involving life contingencies; (C) if
the Participant purchases any annuity certain with a term of 36 months or more.
8.9 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 an In Service Withdrawal takes
place.
The contingent deferred sales charge free amount will be applied to the
first In-Service Withdrawal due to financial hardship, as defined in
the Plan, made in each calendar year.
Contract No. 12345GP
Form No. QGP 685 - 24
ARTICLE IX
METHODS OF PAYMENT
9.1 Methods of Payment Provisions
One of the variable or fixed dollar method of payment options or a
combination of them may be elected under the methods of payment
provisions, providing the options are provided for by the Plan.
9.2 Amount To Be Applied
The amount to be applied under the methods of payment provisions is the
Participant Annuity Account Value, less Premium Tax, Forfeitures and
contingent deferred sales charge, if any.
If a variable dollar method of payment option is elected, the amount to
be applied is the Variable Contract Value less any Premium Tax,
Forfeitures or contingent deferred sales charge, if any, 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 less any Premium Tax,
Forfeitures, or contingent deferred sales charge, if any as of the
Annuity Commencement Date.
If the Participant or Beneficiary 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.
9.3 Variable Dollar Method of Payment
(A) 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 to the Participant Annuity Account on the [5th]
Valuation Date preceding the Annuity Commencement Date and
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.
(B) Annuity Units
The number of Annuity Units for each Variable Sub-Account to
be credited to the Participant Annuity Account will be
determined by dividing the portion of 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.
Contract No. 12345GP
Form No. QGP 685 - 25
ARTICLE IX (Continued)
(C) 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.
(D) 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 lifetime;
thereafter, and upon receipt by the Company of adequate proof
of the Annuitant's death, one-half of the variable payment
continues to a designated Payee, if living, and terminates
upon his death. Table B is applicable to this option.
Contract No. 12345GP
Form No. QGP 685 - 26
ARTICLE IX (Continued)
Option 4: Any Other Form
The Company will pay any other form of variable annuity which
is acceptable to it, and provided for in the Plan.
9.4 Fixed Dollar Method of Payment
(A) 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. Those current
rates will not be less than the rate obtained from the table which is
applicable to the elected option.
(B) 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 the 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.
Contract No. 12345GP
Form No. QGP 685 - 27
ARTICLE IX (Continued)
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 lifetime; thereafter,
and upon receipt by the Company of adequate proof of the
Annuitant's death, one-half of the fixed payment continues to
a designated Payee, if living, and terminates upon his 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, and provided for in the Plan.
9.5 How to Elect Method of Payment Option
The Written Request of the Employer on behalf 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.
9.6 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 $3,500. If the amount is less than $3,500,
the Company may pay it in one sum, if such a payment is permitted by
the Plan.
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.
9.7 Settlement
If the Payee has received payments or was to receive payments which had
not yet commenced under variable dollar method of payment option 1, or
under fixed dollar method of payment options 1, 2, or 3, any remaining
amounts payable under the option elected will be paid to the
Beneficiary or designated Payee.
Contract No. 12345GP
Form No. QGP 685 - 28
ARTICLE X
MODIFICATIONS
10.1 Contract Modification
This Group Annuity Contract may be modified at any time by written
agreement between the Company and the Group Contractholder. No such
modification will, without the written consent of the affected
Participants, affect the terms, provisions, or conditions of this Group
Annuity Contract which are or may be applicable to contributions paid
for Participants prior to the date of such modification.
However, the Company may at any time and without the consent of the
Group Contractholder or any Participant or other person, but upon 30
days written notice to the Group Contractholder, modify this Group
Annuity Contract in any respect to conform it to changes in tax or
other law, including applicable regulations or rulings.
10.2 Modification of Tables
The Company may at any time and without the consent of the Group
Contractholder or any Participant or other person, but upon 30 days
written notice to the Group Contractholder, modify Tables A, B, C, D,
and E, or any of them. However, no such modification will affect the
terms, provisions or conditions of this Group Annuity Contract which
are or may be applicable to contributions paid for Participants prior
to the date of such modification.
10.3 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 Contractholder. No such
modification will, without the written consent of affected
Participants, affect the terms, provisions, or conditions of the riders
which are or may be applicable to contributions paid for Participants
prior to the date of such modification.
10.4 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
upon 30 days written notice to the Group Contractholder. 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 Participants of the current
offering of Variable and Guaranteed Sub-Accounts.
Contract No. 12345GP
Form No. QGP 685 - 29
ARTICLE X (Cont'd)
10.5 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.]
Contract No. 12345GP
Form No. QGP 685 - 30
ARTICLE XI
CESSATION OF DEPOSITS
11.1 By the Company
Upon 60 days written notice to the Group Contractholder, the Company
may declare that, as from the date stated in such notice, (that date
being called a Date of Cessation of Deposits) no further deposits shall
be accepted by the Company for allocation to certain or all
Sub-Accounts of this Group Annuity Contract.
11.2 By the Group Contractholder
Upon 60 days written notice to the Company, the Group Contractholder
may declare that as from the date stated in such notice, (that date
being called a Date of Cessation of Deposits) no further deposits shall
be made by the Group Contractholder for allocation to certain or all
Sub-Accounts of this Group Annuity Contract.
11.3 Change of Allocation Due to Cessation of Deposits
If a Date of Cessation of Deposits has been declared for certain
Sub-Accounts, the Participant may by Written Request make a change of
allocation of his contributions. When no change of allocation is
received, the Company will allocate such Contributions to a Guaranteed
Sub-Account which is shorter and closest in duration, or if no
Guaranteed Sub-Account shorter in duration is available, to the
Guaranteed Sub-Account next closest in duration to the account to which
deposits have ceased.
After the Date of Cessation of Deposits declared in respect of all
Sub-Accounts, no new Participant Annuity Account will be established.
Contract No. 12345GF
Form No. QGP 685 - 31
ARTICLE XII
CONTRACT TERMINATION
12.1 Contract Termination Date
The Insurance Company reserves the right upon thirty (30) days written
notice to the Group Contractholder to declare a "Contract Termination
Date", which shall be any date on or after the expiration of the thirty
(30) day notification period.
A Contract Termination Date may only be declared if:
(A) the Group Contractholder adopts an amendment to the Plan which causes
the level of Deposits, In Service Withdrawals, Surrenders, Transfers, or
loans to Participants to be materially different than that originally
underwritten by the Company or if the Group Contractholder adopts any
change in its administrative procedures or policies relating to loans to
Participants which causes the level of Deposits, In Service Withdrawals,
Surrenders, Transfers or loans to Participants to be materially different
than that originally underwritten by the Company and no interest rate has
been agreed upon between the Group Contractholder and the Company under the
provisions of Section 3.8 of this Group Annuity Contract;
(B) the Group Contractholder fails to comply with any provision contained
in this Group Annuity Contract; or
(C) the Plan fails to qualify or becomes disqualified under Internal
Revenue Code Section 401(a).
12.2 Procedures at Contract Termination Date
After a contract termination date has been declared, no benefit shall
become payable, no transfers shall be made, no method of payment option
shall be elected, and no contributions shall be accepted under the
provisions of this Group Annuity Contract.
If a contract termination date has been declared and there are
outstanding expense charges as set forth in Articles V and VIII of this
Group Annuity Contract, the Company shall on the contract termination
date debit each Sub-Account with its share of the amount of outstanding
expenses.
In the event of termination the Company shall pay to a person,
corporation, or other entity named by the Group Contractholder:
(a) the value of all monies held in the Variable Sub-Account, in one lump
sum; and
(b) in twenty (20) equal quarterly installments of principal and
interest, the balance of the Guaranteed Sub-Accounts relating
to this Group Annuity Contract.
Contract No. 12-345GP
Form No. QGP 685 - 32
The first payment shall be no later than thirty (30) days after the
Contract Termination Date. Interest shall be at least four percent (4%)
on the balance of the Guaranteed Sub-Accounts.
Contract No. 12345GP
Form No. QGP 685 - 33
<PAGE>
TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
--------------------------------------------------------------------------------
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.
Contract No. 12345GP
Form No. QGP 685 - 34
<PAGE>
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 6.42
--------------------- ------------- -------------- -------------- ---------------
----------------- ----------------
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.
Contract No. 12345GP
Form No. QGP 685 - 35
<PAGE>
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.
Contract No. 12345GP
Form No. QGP 685 - 36
<PAGE>
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 Year
50 3.83 3.83 3.82
3.80 3.78
55 4.13 4.1.2 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.
Contract No. 12345GP
Form No. QGP 685 - 37
<PAGE>
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.
</TABLE>
Contract No. 12345GP
Form No. QGP 685 - 38
<PAGE>
Group Deferred Compensation Annuity
1-84
<PAGE>
HOME OFFICE - WICHITA, KANSAS
ADMINISTRATIVE OFFICES
DENVER, COLORADO
GROUP POLICYHOLDER
GROUP POLICY NUMBER
GROUP ANNUITY CONTRACT DATE
Group Deferred Compensation Annuity, Non-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
Signed for the Great-West Life & Annuity Insurance Company on the issuance of
the Group Annuity Contract on the Annuity Contract Date.
[GRAPHIC OMITTED][GRAPHIC OMITTED]
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 ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT MAY VARY ACCORDING TO THE
INVESTMENT EXPERIENCE OF A VARIABLE ANNUITY ACCOUNT.
Group Deferred Compensation Annuity
GDOMF 184
<PAGE>
TABLE OF CONTENTS
<TABLE>
<S>
<C>
DEFINITIONS
Page 4
OWNERSHIP 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 Plan
.....................................................................................................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
TRANSFERS
Transfer Terms
..............................................................................................15
No Receipt of Transferred Amounts
...........................................................................15
RETIREMENT PROVISIONS
Adequate Proof
..............................................................................................16
Payment On Retirement
.......................................................................................16
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
Now 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
<PAGE>
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.
DEFINITIONS (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
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.
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.
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 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.
</TABLE>
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.
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.
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.
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
$1 on the date a Deposit was first made under a Variable Annuity Method of
Payment to the Variable Sub-Account(s).
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.
(iii) 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.
CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Net Investment Factor (continued)
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.
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.
CONTRACT 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.
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:
o 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.
o if a Transfer is made within 30 days of the Annuity Commencement Date,
the Company may delay the Annuity Commencement Date by 30 days.
o 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.
o with the exception of the first two Transfers in a calendar year, a
Transfer Charge of $10 will be deducted.
o 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.
o no Transfers are permitted after the Annuity Commencement Date.
o 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.
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.
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.
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.
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.
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.
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 6 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.
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.
METHODS 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 $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 $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.
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.
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 (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.
<PAGE>
TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
----------------------------------------------------------------------------------------------------------------
Age of Payee Without With Guaranteed Period
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.
<PAGE>
TABLE B - Joint and One-Half Survivor Variable Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
--------------------
-------------------------------------------------------------------------------------
Age of Annuitant If Designated Payee Is Age
-------------------------------------------------------------------------------------
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 small be
determined by the Company on the actuarial basis used by it in determining the
above amounts.
<PAGE>
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.
<PAGE>
TABLE D - Fixed Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
--------------------------------------------------------------------------------------------------------------
Age of Payee Without With Guaranteed Period
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.
<PAGE>
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 I be
determined by the Company on the actuarial basis used by it in determining the
above amounts.
</TABLE>
<PAGE>
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 Guaranteed Fund Rider - 1
<PAGE>
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 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 - I
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
If the Guaranteed Certificate Fund is offered, the value of the Certificate or
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:
o 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.
o 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.
o 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.
o 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, and Premium Tax.
This Rider, unless and until Modified, forms part of the Group Annuity Contract.
Guaranteed Certificate Fund Rider - 3
<PAGE>
Periodic Payment Option Rider
1-94
<PAGE>
PERIODIC PAYMENTS OPTION RIDER - 457 PLANS
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
WHEREAS, the Group Policyholder has previously entered into a Group Annuity
Contract ("Contract") with Great-West Life & Annuity Insurance Company
(hereinafter referred to as "the Company"),
AND WHEREAS, the Group Policyholder and the Company desire to make the Periodic
Payment Option available under the Contract,
NOW THEREFORE, the Group Policyholder and the Company agree that the following
provisions will be added to the Contract as of the date executed below.
Election of Periodic Payment Option
If the Participant has separated from service with the Group Policyholder or has
attained age 70 1/2, the Group Policyholder, on behalf of a Participant, may
elect to apply all or a portion of the Participant Annuity Account to a Periodic
Payment Option. The entire Participant Annuity Account must be applied to a
Payment Option under which substantially equal payments are made as required by
Sections 457(d) and 401(a)(9) of the Internal Revenue Code. Once payments have
begun, they cannot be changed or stopped.
If the Participant wishes to take a partial withdrawal, such withdrawal must be
taken prior to the selection of a Periodic Payment Option and will be subject to
any applicable charges.
Payments to a Beneficiary
If the Participant is receiving Periodic Payments, any Periodic Payments
remaining to be paid as of the Participant's date of death will be paid to the
Participant's beneficiary. The Beneficiary will receive payments remaining under
the payment option in effect as of the date of the Participant's death unless a
lump sum is elected on the death claim.
If the Participant dies prior to the time payments have commenced, the Group
Policyholder may elect to apply the entire Participant Annuity Account to a
Periodic Payment Option for the Beneficiary. All payments to a Beneficiary must
comply with the distribution requirements of Sections 457(d) and 401(a)(9) of
the Internal Revenue Code.
Periodic Payment Options Available
The Group Policyholder, on behalf of a Participant, must elect one of the three
payment options listed below. If the Participant dies prior to the time any
payments have been made, the Group Policyholder, on behalf of the Beneficiary,
must elect one of the first two payment options listed below. (Minimum
Distribution Payments are not available to Beneficiaries.) Payments must be
elected over a period of at least 36 months.
1. Payments for a Specified Period. The period over which payments will be
made is elected. The amount of each payment will be substantially equal
but may vary slightly depending upon investment performance. The
duration period may not be changed and must result in a dollar amount
which meets the minimum distribution requirements.
2. Payments of a Specified Amount. The dollar amount of each payment is
elected. The dollar amount may not be changed and must meet the minimum
distribution requirements. Based on the amount elected, the duration of the
payments may vary.
3. Minimum Distribution Payments. Payments will be made as required to meet
the minimum distribution requirements of Internal Revenue Code section
401(a)(9).
Payments will cease when the Annuity Account Value is zero.
Frequency and Amount of Payments
The Request must specify:
1. the payment frequency of either 12-, 6-, 3-, or 1-month intervals;
2. the payment amount; a minimum of $50 is required;
3. the month, day and year on which payments are to begin; and
4. the payment option.
The amount of each payment will be prorated across all Variable and Guaranteed
Sub-Accounts in proportion to the assets in each sub-account unless the fund
from which the periodic payments are to be made is designated. Once a selected
fund has been depleted, any amounts remaining to be paid by the Company will be
prorated across all sub-accounts as described above, unless another fund has
been selected.
Operation of Participant Annuity Account
While periodic payments are being received:
1. no contributions may be made;
2. no partial withdrawals may be made except in the event of an
Unforeseeable Emergency;
3. current Guaranteed and Variable Sub-Accounts may be continued or changes
as allowed under the contract; and
4. charges and fees under the Contract, if applicable, continue to apply,
except that the Contingent Deferred Sales Charge does not apply to a
Periodic Payment Option of a minimum of 36 months.
PPO 1-94-DC
<PAGE>
Periodic Payment Option Rider
1-95
<PAGE>
PPO Rider-DC
PERIODIC PAYMENTS OPTION RIDER - 457 PLANS
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Election of Periodic Payment Option
If the Participant has separated from service with the Group Policyholder or has
attained age 70 1/2, the Group Policyholder, on behalf of a Participant, may
elect to apply all or a portion of the Participant Annuity Account to a Periodic
Payment Option. The entire Participant Annuity Account must be applied to a
Payment Option under which substantially equal payments are made as required by
Sections 457(d) and 401(a)(9) of the Internal Revenue Code. Once payments have
begun, they cannot be changed or stopped.
If the Participant wishes to take a partial withdrawal, such withdrawal must be
taken prior to the selection of a Periodic Payment Option and will be subject to
any applicable charges.
Payments to a Beneficiary
If the Participant is receiving Periodic Payments, any Periodic Payments
remaining to be paid as of the Participant's date of death will be paid to the
Participant's beneficiary. The Beneficiary will receive payments remaining under
the payment option in effect as of the date of the Participant's death unless a
lump sum is elected on the death claim.
If the Participant dies prior to the time payments have commenced, the Group
Policyholder may elect to apply the entire Participant Annuity Account to a
Periodic Payment Option for the Beneficiary. All payments to a Beneficiary must
comply with the distribution requirements of Sections 457(d) and 401(a)(9) of
the Internal Revenue Code.
Periodic Payment Options Available
The Group Policyholder, on behalf of a Participant, must elect one of the three
payment options listed below. If the Participant dies prior to the time any
payments have been made, the Group Policyholder, on behalf of the Beneficiary,
must elect one of the first two payment options listed below. (Minimum
Distribution Payments are not available to Beneficiaries.) Payments must be
elected over a period of at least 36 months.
1. Payments for a Specified Period. The period over which payments will be
made is elected. The amount of each payment will be substantially equal
but may vary slightly depending upon investment performance. The
duration period may not be changed and must result in a dollar amount
which meets the minimum distribution requirements.
2. Payments of a Specified Amount. The dollar amount of each payment is
elected. The dollar amount may not be changed and must meet the minimum
distribution requirements. Based on the amount elected, the duration of the
payments may vary.
3. Minimum Distribution Payments. Payments will be made as required to meet
the minimum distribution requirements of Internal Revenue Code section
401(a)(9).
Payments will cease when the Annuity Account Value is zero.
Frequency and Amount of Payments
The Request must specify:
1. the payment frequency of either 12-, 6-, 3-, or 1-month intervals;
2. the payment amount; a minimum of $50 is required;
3. the month, day and year on which payments are to begin; and
4. the payment option.
Deductions From Participant Annuity Account
The amount of each payment made under this Periodic Payment Option on behalf of
each Participant will be deducted from the Participant Annuity Account of the
Participant.
Operation of Participant Annuity Account While periodic payments are being
received:
1. no contributions may be made;
2. no partial withdrawals may be made except in the event of an
Unforeseeable Emergency;
3. charges and fees under the Contract, if applicable, continue to apply.
<PAGE>
SBJPA Rider
1-96C
<PAGE>
Form No. 1-96C (457-FF 1984)
AMENDMENT NO. 1-96C ATTACHED TO AND FORMING PART OF
THE GROUP DEFERRED COMPENSATION ANNUITY CONTRACT
WHEREAS, the Group Policyholder has entered into a Group Deferred Compensation
Annuity Contract ( the "Group Annuity Contract") and Application for Group
Deferred Compensation Annuity Contract (the "Application") with Great-West Life
& Annuity Insurance Company,
AND WHEREAS, the above noted Group Annuity Contract and Application require
amendments to conform to recent changes made to the Internal Revenue Code of
1986, as amended (hereinafter referred to as the "Code"),
AND WHEREAS, immediately upon the Group Policyholder's amendment of the Plan
document to place all assets in trust, the trust provisions described below will
become effective,
AND WHEREAS, in order to maintain eligibility under Code Section 457, the Plan
will continue to hold Plan assets in trust,
NOW THEREFORE, pursuant to the "Contract Modification" section of the Group
Annuity Contract, the following amendments will be made to the Group Annuity
Contract and Application.
1. The following sentence will be added to the Application:
"Notwithstanding any provision in this Application to the contrary, in no
event shall the assets under the Group Annuity Contract be subject to the
claims of general creditors of the employer after the Plan is amended to
place plan assets in trust."
2. In the "Definitions" section of the Group Annuity Contract, the definition
following the term "Group Policyholder" is hereby deleted. In place
thereof, the following definition of Group Policyholder will be added:
"the named trustee, or the governmental employer sponsoring the Plan, as
trustee, and the applicant for this Group Annuity Contract."
3. The "Ownership of Group Annuity Contract" section of the Group Annuity
Contract is hereby deleted. In place thereof, the following Section will be
added:
Ownership of the 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.
Effective the earlier of January 1, 1999 or the date the Plan is amended to
meet the trust requirement, the Group Policyholder, as the trustee of the
Plan, may exercise all rights hereunder for the exclusive benefit of Plan
Participants and beneficiaries. There is no contractual relationship
between the Company and the Participants.
The Group Policyholder, as owner of the contract, is deemed to be the
trustee of the assets invested in the Group Annuity Contract, and such
contract is intended to satisfy the trust requirements of Code Sections
457(g) and 401(f).
4. The "Transfer and Assignment" section of the Group Annuity Contract is
hereby deleted. In place thereof, the following Section will be added:
Transfer and Assignment
No portion of the Plan's assets and the earnings thereon may be used for,
or diverted to, any purpose other than for the exclusive benefit of plan
participants and beneficiaries prior to the satisfaction of all liabilities
with respect to employees and their beneficiaries.
5. A new sub-section will be added to the "Ownership Provisions" section of the
Group Annuity Contract and shall read as follows:
Trustee of the Group Annuity Contract and Plan Assets
Notwithstanding any provision of this Group Annuity Contract or the
Application to the contrary, the Group Policyholder, as owner of the Group
Annuity Contract, is the trustee with respect to all Plan assets deposited
into the Group Annuity Contract, and the earnings thereon, and shall hold
all such assets for the exclusive benefit of Plan Participants and
Beneficiaries. The Group Annuity Contract shall be treated as a trust for
purposes of Code Sections 457(g) and 401(f), and no portion of the amount
deposited in the Group Annuity Contract, or the earnings thereon, may be
used for, or diverted to, any purpose other than for the exclusive benefit
of Plan Participants and Beneficiaries prior to the satisfaction of all
liabilities with respect to employees and their Beneficiaries.
6. A new first sentence will be added to both the "Partial Surrender" and
"Surrender" sections of the Group Annuity Contract, and shall read as
follows:
Except as provided in the "Amount Payable on Death of Participant" section
of the Group Annuity Contract, no distributions will be allowed prior to
the Participant's attainment of age 70 1/2, unforeseeable emergency, or
separation from service, as determined by the Group Policyholder, unless,
for years after December 31, 1996, the Plan provides for a cash out of a
Participant Annuity Account which does not exceed $3,500 and meets all of
the other requirements of Code Section 457(e)(9)(A).
Signed for Great-West Life & Annuity Insurance Company on the Issue Date.
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
Group Deferred Tax Sheltered Annuity
1-84
<PAGE>
HOME OFFICE - WICHITA, KANSAS
ADMINISTRATIVE OFFICES
DENVER, COLORADO
GROUP POLICYHOLDER
GROUP POLICY NUMBER
GROUP ANNUITY CONTRACT DATE
Group Deferred Tax-Sheltered Annuity, Non Participating
The provisions on the following pages, together with the Application for this
Group Annuity Contract, are part of this Group Annuity Contract.
Signed for the Great-West Life & Annuity Insurance Company on the issuance of
the Group Annuity Contract on the Annuity Contract Date.
Secretary President
For the Actuary
15 Day Free-Look
The Participant may return his/her Participant Certificate within 15 days of its
mailing and have all Contributions refunded to him/her if, after examination,
the Participant is not satisfied with it for any reason.
This Group Annuity Contract is the legal contract between the Group
Policyholder, for the benefit of the Participants, and the Great-West Life &
Annuity Insurance Company. PLEASE READ THIS CONTRACT CAREFULLY. IT IS A CONTRACT
WHICH MAY PROVIDE FOR PAYMENTS OR VALUES WHICH ARE NOT GUARANTEED TO
FIXED-DOLLAR AMOUNT BUT MAY VARY ACCORDING TO THE INVESTMENT EXPERIENCE OF A
VARIABLE ANNUITY ACCOUNT.
Group Deferred Tax-Sheltered Annuity
GTSMF184
<PAGE>
TABLE OF CONTENTS
<TABLE>
<S>
<C>
DEFINITIONS
........................................................................................Page
4
OWNERSHIP 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 Plan
.........................................................................................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
TRANSFERS
Transfer Terms
...................................................................................15
No Receipt of Transferred Amounts
................................................................15
RETIREMENT PROVISIONS
Adequate Proof
...................................................................................16
Payment On Retirement
............................................................................16
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
...................................................................21
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
<PAGE>
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.
DEFINITIONS (continued)
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.
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.
DEFINITIONS (continued)
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.
</TABLE>
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.
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.
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.
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
$1 on the date a Deposit was first made under a Variable Annuity Method of
Payment to the Variable Sub-Account(s).
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.
CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Net Investment Factor (continued)
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.
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.
CONTRACT 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.
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:
o 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.
o if a Transfer is made within 30 days of the Annuity Commencement Date,
the Company may delay the Annuity Commencement Date by 30 days.
o 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.
o with the exception of the first two Transfers in a calendar year, a
Transfer Charge of $10 will be deducted.
o 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.
o no Transfers are permitted after the Annuity Commencement Date.
o 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.
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:
o Elect or Change a Method of Payment Option.
o make a Partial Surrender or Surrender.
o 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.
o 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.
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.
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.
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.
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.
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.
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.
METHODS 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 $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 $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.
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.
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 (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.
<PAGE>
TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
------------------------------------------------------------------------------------------------------------------------
Age of Payee Without With Guaranteed
Period
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.
<PAGE>
TABLE B - Joint and One-Half Survivor Variable Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
---------------------
---------------------------------------------------------------------------------------------------
Age of Annuitant If Designated Payee Is Age
---------------------
---------------------------------------------------------------------------------------------------
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.
<PAGE>
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.
<PAGE>
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.
<PAGE>
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.
</TABLE>
<PAGE>
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 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 Guaranteed Fund Rider - 1
<PAGE>
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 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 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
o The following provisions will apply to the Transfer of amounts to or from
the Guaranteed Certificate Fund:
o 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.
o 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.
o 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.
o 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, and Premium Tax.
This Rider, unless and until Modified, forms part of the Group Annuity Contract.
Guaranteed Certificate Fund Rider - 3
<PAGE>
Conversion Deposit Rider
1-84
<PAGE>
CONVERSION DEPOSIT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
A Conversion Deposit Rider is defined as the amount Deposited into this Group
Annuity Contract from the Great-West Life Assurance Company contract # GP (the
"Previous Contract"), on the Participants' acceptance 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 Participant. 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 within 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 to 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. GCDRTSA 184
(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%
15-Day Free-Look
Notwithstanding any other provision in this Group Annuity Contract to the
contrary, the Conversion Deposit is not included in the 15-Day Free-Look
provision described in this Contract.
Contract Modification
The Contract Modification provisions of the Contract are applicable to the
Conversion Deposit, as appropriate.
Name of Group Policyholder
By:
Signature
Title
This Rider, unless and until Modified, forms part of the Group Annuity Contract
Conversion Deposit Rider -2
Form No. GCDRTSA 184
<PAGE>
Periodic Payment Option Rider
<PAGE>
PERIODIC PAYMENTS OPTION RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
WHEREAS, the Group Policyholder has previously entered into a Tax Deferred
Annuity Contract with GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (hereinafter
referred to as the Company),
AND WHEREAS, the Group Policyholder and the Company desire to make the Periodic
Payment Option available to Accountholders (a Participant or Payee under the
Contract) under the Contract,
NOW THEREFORE, the Group Policyholder and the Company agree that the following
provisions will be added to the Contract as of the date executed below.
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
Ability To Elect Frequency and Amount of Payments An Accountholder may elect the
Periodic Payment Option if the The Accountholder will elect by Request:
Accountholder is eligible to receive a distribution in accordance othe payment
frequency of either 12-, 6-, 3-, with the Distributions To An Accountholder or
Surrender sections or 1-month intervals; of the Contract. Notwithstanding the
above, the Periodic Payment oa payment amount; a minimum of $50 is required;
Option may not be used to effect transfers under Revenue Ruling othe month, day
and year on which payments will 90-24. be made; oone payment option; and The
Accountholder must Request that all or part of the Annuity othe allocation of
payments from the Variable Account be applied to a Periodic Payment Option. All
outstanding and/or Guaranteed Sub-Account(s) as follows: loan balances must be
paid in full or treated as a distribution 1)Prorate the amount to be paid across
all before an Accountholder may apply for a Periodic Payment Option. Variable
and Guaranteed Sub-Accounts in proportion to the
assets in each
sub-account; or
Operation of Participant Annuity Account 2)Select
the Investment Division(s) from which
While periodic payments are being received: payments will be
made. Once the Investment Division(s) have
o the Accountholder may continue to exercise all contractual been depleted, the
Company will automatically prorate the
rights that are available prior to electing a payment remaining payments
unless the Accountholder Requests the
option, except that no Contributions may be made by an selection of another
Investment Division(s).
Accountholder;
o Accountholders may continue to keep their current Guaranteed The
Accountholder may elect to change the payment option and Variable
Sub-Accounts; and/or frequency once each calendar year.
o charges and fees under the Contract, if applicable, continue
to apply, except as noted below; Payments will cease
on the earlier of:
o a Contingent Deferred Sales Charge does not apply
to o
periodic payments lasting a minimum of 36 months; and the date the
amount elected to be paid under the option o if a partial withdrawal is made, a
Contingent Deferred Sales selected has been reduced to zero;
Charge and/or Loss of Interest Charge, if
applicable, o
will be deducted. the Accountholder
Requests the payments to stop; or
o
If periodic payments cease, the Accountholder may resume making the Annuity Account
Value is zero.
Contributions or Deposits. Additionally, if periodic payments
cease, periodic payment options may not commence again for at Payments to a
Beneficiary
least a 36 month period. Upon the
Participant's death, the Beneficiary shall elect a
payment
option on
the death
claim
form
which
complies
with the
distribution
requirements
of
Section
401(a)(9)
of the
Internal
Revenue
Code.
PERIODIC PAYMENTS OPTION RIDER (continued)
Payment Options Available 3) Interest
Only. The payments will be based on the
The Accountholder must elect one of the following 4 payment amount of interest
credited to the Guaranteed Sub-Account(s)
options: between each
payment. Available only if 100% of the account
1)Income for a Specified Period for at least thirty-six (36) value is invested
in the Guaranteed Sub-Account and
months. The Accountholder elects the duration over which Accountholder is
younger than 70 1/2; or
payments will be made. This amount may vary based on the 4) Minimum
Distribution. The Accountholder may
duration; or Request minimum
distributions as specified under Internal
2)Income of a Specified Amount for at least thirty-six (36) Revenue Code Section
401(a)(9).
months. The Accountholder elects the dollar amount of the
payments. Based on the amount elected, the duration may vary; or
</TABLE>
Signed for Great-West Life & Annuity Insurance Company on the Issue Date.
W.T. McCallum,
President and Chief Executive Officer
Signed for the Group Policyholder on the day of ,
19 .
Group Policyholder Name
(Signature)
<PAGE>
SBPJA Rider
1-97
<PAGE>
SBJPA 1-97 (84)
IRC 403(b) RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Due to modifications under the Small Business Job Protection Act of 1996, all
elective deferrals under the Contract will be subject to the provisions noted in
Section 1 below.
1. Each Participant's elective deferrals under the Contract are limited to the
amount permitted under IRC Section 402(g). Should any Participant's
elective deferrals exceed the allowable amount, such Participant must
request that the excess deferrals be distributed from the Contract in
accordance with Internal Revenue Service requirements, as amended from time
to time. If such excess deferral is not timely distributed, the Participant
Annuity Account may lose its ss.403(b) status for tax purposes.
With respect to all monies transferred from a custodial account contract issued
in accordance with the provisions of IRC Section 403(b)(7), including interest
and investment earnings thereon, the following provisions in Sections 2 and 3
below will apply to such monies.
2. No such amounts may be paid or made available to any distributee before: A)
the Participant dies, or B) the Participant attains age 59 1/2, or C) the
Participant separates from service, or D) the Participant becomes disabled
[within the meaning of IRC Section 72(m)(7)], or E) in the case of
contributions made pursuant to a salary reduction
agreement, the Participant encounters financial hardship.
3. The distribution provisions in the "Surrender" and "Partial Surrender"
sub-sections of the "Provisions Relating to Amount Payable on Death,
Partial Surrender and Surrender" section of the contract shall not apply to
monies contributed under a custodial account contract issued under IRC
Section 403(b)(7). Distribution of such custodial account amounts shall be
restricted in accordance with the provisions noted in Section 2 above.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
W.T. McCallum,
President and Chief Executive Officer
<PAGE>
Group Deferred Tax Sheltered Annuity for Assn.
1-84
<PAGE>
HOME OFFICE - WICHITA, KANSAS
ADMINISTRATIVE OFFICES
DENVER, COLORADO
GROUP POLICYHOLDER John Doe University
GROUP POLICY NUMBER 12345GP
GROUP ANNUITY CONTRACT DATE December X, 19XX
Group Deferred Tax-Sheltered Annuity, Non-Participating, for Association
The provisions on the following pages, together with the Application for this
Group Annuity Contract and the Participation Agreement, are part of this Group
Annuity Contract.
Signed for the Great-West Life & Annuity Insurance Company on the issuance of
the Group Annuity Contract on the Annuity Contract Date.
Secretary President
For the Actuary
15 Day Free-Look
The Participant may return his/her Participant Certificate within 15 days of its
mailing and have all Contributions refunded to him/her if, after examination,
the Participant is not satisfied with it for any reason.
Group Deferred Tax-Sheltered Annuity for Association
GATSMF 184
<PAGE>
This Group Annuity Contract is a legal contract between the Group Policyholder,
for the benefit of the Participants, and the Great-West Life & Annuity Insurance
Company. PLEASE READ THIS CONTRACT CAREFULLY. IT IS A CONTRACT WHICH MAY PROVIDE
FOR PAYMENTS OR VALUES WHICH ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT BUT
MAY VARY ACCORDING TO THE INVESTMENT EXPERIENCE OF A VARIABLE ANNUITY ACCOUNT.
<PAGE>
TABLE OF CONTENTS
<TABLE>
<S> <C> <C> <C> <C> <C>
<C>
15 DAY FREE-LOOK
..............................................................................................Page
1
DEFINITIONS
......................................................................................................5
OWNERSHIP PROVISIONS
Ownership of Series Account
....................................................................................9
Ownership of Group Annuity Contract and Participant
Annuity Account Value
........................................................................................9
Transfer and Assignment
........................................................................................9
GENERAL PROVISIONS
The Group Annuity Contract
....................................................................................10
Participant Certificate
.......................................................................................10
Entire Contract
...............................................................................................10
Non-Participating
.............................................................................................10
Beneficiary
...................................................................................................10
Currency and Payment of Contributions
.........................................................................11
Age
...........................................................................................................11
Voting Rights and Reports
.....................................................................................11
Notice and Proof
..............................................................................................12
PURCHASE PROVISIONS
Commencement and Termination of Coverage
......................................................................13
Contributions
.................................................................................................13
Allocation of Contributions
...................................................................................13
CONTRACT VALUE PROVISIONS
Variable Contract Value
.......................................................................................14
Accumulation Unit
.............................................................................................14
Accumulation Unit Value
.......................................................................................14
Annuity Unit Value
............................................................................................14
Net Investment Factor
.........................................................................................15
Risk Charge
...................................................................................................16
Guaranteed Contract Value
.....................................................................................16
Guaranteed Sub-Account Riders
.................................................................................16
Asset Management Fee
..........................................................................................16
Variable and Guaranteed Contract Value Provisions
.............................................................16
Contract Maintenance Charge
...................................................................................16
Transfer Charge
...............................................................................................17
TRANSFERS
Transfer Provisions
...........................................................................................18
No Receipt of Transferred Amounts
.............................................................................18
RETIREMENT PROVISIONS
Payment on Retirement
.........................................................................................19
TABLE OF CONTENTS (continued)
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND SURRENDER
Amount Payable on Death of Participant
........................................................................20
Partial Surrender
.............................................................................................20
Amount Payable on Partial Surrender
...........................................................................20
Surrender
.....................................................................................................21
Contingent Deferred Sales Charge
..............................................................................21
Contingent Deferred Sales Charge Free Amount
..................................................................21
Payment on Death, Partial Surrender, and Surrender
............................................................22
METHODS OF PAYMENT PROVISIONS
Amount To Be Applied
..........................................................................................23
Variable Dollar Method of Payment
.............................................................................23
Amount of First Monthly Payment
...............................................................................23
Annuity Units
.................................................................................................24
Amount of Monthly Payments After the First
....................................................................24
Variable Dollar Method of Payment Options
.....................................................................24
Fixed Dollar Method of Payment
................................................................................25
Amount of Payment
.............................................................................................25
Fixed Dollar Method of Payment Options
........................................................................25
How to Elect Method of Payment Option
.........................................................................26
Availability of Options
.......................................................................................26
Settlement
....................................................................................................27
CONTRACT MODIFICATION
Modification of Tables
........................................................................................28
Modification of Guaranteed Sub-Account Riders, If Any
.........................................................28
Modification of Offering of Guaranteed Sub-Accounts
...........................................................28
Modification of Interest Guarantee Period
.....................................................................28
CESSATION OF DEPOSITS
...........................................................................................29
TABLE A
..........................................................................................................30
TABLE B
..........................................................................................................31
TABLE C
..........................................................................................................32
TABLE D
..........................................................................................................33
TABLE E 34
GUARANTEED SUB-ACCOUNT RIDERS, IF ANY
<PAGE>
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
later of the first of the month after the
month he/she attains age
75 or terminates service, unless earlier
Elected by him/her. The
Company may allow a later age which will
not be greater than age
85.
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.
Beneficiary - the person(s) entitled to
receive (a) the Amount Payable
On Death when the Participant
has died before the Annuity
Commencement Date, or (b) the
amount, if any, payable under
a method of Payment Option
when the Participant has died
after the Annuity Commencement
Date.
Company - the Great-West Life & Annuity Insurance
Company.
Deposit - includes Contributions,
Transfers and other amounts
Deposited into Guaranteed or
Variable Sub-Accounts.
Eligible Employer - includes an
organization which meets the
requirements of Section
170(b)(1)(A)(ii) or Section
501(c)(3) of the Internal
Revenue Code of 1954, as
amended.
Eligible Fund - a registered management
investment company in which
the assets of the Series
Account may be invested.
DEFINITIONS (continued)
Eligible Person - includes any person who may be a member
of the Group
Policyholder but who is in the employment
of a Participating
Employer on the date that the Application
for Coverage under this
Group Annuity Policy is made in respect of
him/her. An Eligible
Person does not include any person who by
law may not be Covered
under this Group Annuity Policy.
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 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
Participant under his/her
Participant Annuity Account.
Guaranteed Interest Rate - a minimum
interest rate applicable to
Guaranteed Sub-Accounts which
on an annual effective basis
is 4%.
Guaranteed Sub-Account - a sub-division
of the Guaranteed Contract
Value having a Guaranteed
Interest Rate and containing
fixed dollar amounts. This
sub-division 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 An Eligible Person who is Covered under
this Group Annuity
Contract.
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 Participant
under his/her Participant
Annuity Account.
Participant Certificate - an individual
certificate, containing a copy
of the Group Annuity Contract,
issued to each Participant to
evidence his/her Coverage
under this Group Annuity
Contract.
Participant Effective Date - the date on
which the first Deposit is
credited to a Participant
Annuity Account.
Participating Employer - includes any
Eligible Employer which has
executed a Participation
Agreement with respect to this
Group Annuity Contract with
the Group Policyholder and the
Company.
Payee - includes a Beneficiary, if
the Participant is not living,
the Participant, if living,
and the designated Payee of a
Joint and One-Half Survivor
Fixed Annuity.
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 a
Participant.
Valuation Date - the date on which the
net asset value of each
Eligible Fund is determined.
DEFINITIONS (continued)
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 a
Participant under his/her
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.
Written Request - the Request required in the Allocation
of Deposits,
Beneficiary, 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 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.
</TABLE>
OWNERSHIP PROVISIONS
Ownership of Series Account
The Company has absolute ownership of the assets of the Series Account.
Ownership of Group Annuity Contract and Participant Annuity Account Value
Upon the Group Policyholder's Application for this Group Annuity Contract, the
Group Policyholder becomes the owner of the Group Annuity Contract for the
benefit of the Eligible Persons.
Each Eligible Person for whom Contributions have been made participates in this
Group Annuity Contract and is a Participant for whom a Participant Annuity
Account is established. The Participant owns his/her Participant Annuity Account
Value.
Transfer and Assignment
The interest of any Participant, Participating Employer, or the Group
Policyholder in this Group Annuity Contract may not be transferred, sold,
assigned, pledged, charged, encumbered or in any way alienated by any of them.
To the extent-permitted by law, no proceeds or payments under the Group Annuity
Contract will be subject to the claims of creditors or legal process.
GENERAL PROVISIONS
The Group Annuity Contract
The Group Annuity Contract is issued by the Company to the Group Policyholder.
Participant Certificate
The Company will issue to each Participant an individual certificate, called the
Participant Certificate, as evidence of his/her Coverage under this Group
Annuity Contract.
Entire Contract
This Group Annuity Contract, its Application, Tables, and Guaranteed Sub-Account
Riders, if any, and the Participation Agreement form the entire contract among
the Group Policyholder, each Participating Employer, and the Company. A copy of
the Application and the Participation Agreement(s) are 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 and Participation Agreement(s), 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.
Non-Participating
This Group Annuity Contract is non-participating. It is not eligible to
share in the Company's divisible surplus.
Beneficiary
While the Participant is living, he/she may by written Request Designate or
Change a Beneficiary from time to time. When recorded, a Change of Beneficiary
will take effect as of the date the writing was signed. If the Participant dies
between the date the writing was signed and the date it was recorded, the Change
will take effect unless the Company has made a payment or has otherwise taken
action on a Designation before receipt or recording of the Change of
Beneficiary.
GENERAL PROVISIONS (continued)
Beneficiary (continued)
Unless otherwise provided in the Designation of Beneficiary, the following terms
will apply to the Designation:
o if a Beneficiary dies before the Participant, the Beneficiary's interest
will pass to any Designated surviving Beneficiary.
o if there is more than one Designated surviving Beneficiary, the Participant
Annuity Account will be shared equally among them.
o if there is no Designated surviving Beneficiary, the Participant Annuity
Account will pass to the Participant.
o if the Designation of Beneficiary is not adequately made, the Participant
Annuity Account will pass to the Participant.
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 Certificate 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.
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 each
Participant in proportion to his/her interest in the Variable Sub-Account. In
such event, the Company will send proxy materials and form(s) to the Participant
for his/her 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 Participant, and all other provisions concerning
Voting Rights will apply to the Payee of a Variable Dollar Method of Payment
Option.
GENERAL PROVISIONS (continued)
Voting Rights and Reports (continued)
The Company will furnish the Participant 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 each Participant or Payee of a Variable Dollar Method of Payment Option. The
Company will furnish the Participant not less frequently than annually a
statement of his/her Participant Annuity Account Value.
Notice and Proof
Any notice or demand by the Company to or upon the Group Policyholder, a
Participating Employer, the Participant, 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, a Participating Employer, the Participant, or any Payee must
be made in a form satisfactory to the Company. When the Company requires it, the
Participant or Payee will obtain the signature of his/her spouse on forms
provided by the Company.
Written materials developed by the Group Policyholder or Participating Employer
to describe this Group Annuity Contract must first be approved 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.
PURCHASE PROVISIONS
Commencement and Termination of Coverage
The Participating Employer may make Application for Coverage of any of its
Eligible Persons 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 Eligible Person 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 his/her Surrender or Partial Surrender which results
in a Participant Annuity Account Value of $0.
Contributions
Unless a Date of Cessation of Contributions has been declared, the Participating
Employer may from time to time pay Contributions in cash in respect of its
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 Participating Employer in respect
of its Participant will be determined by the Participating Employer.
The Participating Employer will report the amount paid as Contributions on forms
acceptable to the Company. The Participating Employer's report is conclusive and
binding on it and anyone claiming an interest under the Group Annuity Contract
or any Participant Certificate. When the Participating Employer's report does
not coincide with the Contributions received, the Company may return them.
Allocation of Contributions
After an adequate Application for 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 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 Participant.
A Change of Allocation will be effective for Contributions which are received
after the Company's receipt and recording of the Change.
CONTRACT VALUE PROVISIONS
Variable Contract Value
The Variable Contract Value for a 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 for the Participant.
The value of a Participant's interest in a Variable Sub-Account will be
determined by multiplying the number of Accumulation Units held for 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 for 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
$1 on the date a Deposit was first made under a Variable Annuity Method of
Payment to the Variable Sub-Account(s).
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 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.
CONTRACT VALUE PROVISIONS (continued)
Variable Contract Value (continued)
Net Investment Factor (continued)
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.
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 Participant.
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 for a Participant after that date,
the 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.
CONTRACT 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 Contract 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 Participant may by Written Request Transfer amounts within and between
currently offered Variable and Guaranteed Sub-Accounts.
Transfer Provisions
The following provisions will apply to any Transfer:
o a Transfer 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.
o if a Transfer is made within 30 days of the Annuity Commencement Date,
the Company may delay the Annuity Commencement Date by 30 days.
o if a Participant dies prior to the Annuity Commencement Date, one Transfer
may be made after the Death of the Participant by the Beneficiary to effect
the Election of the Method of Payment Option.
o with the exception of the first two Transfers in a calendar year, a
Transfer Charge of $10 will be deducted.
o when the Company requires it, the Participant or Payee and the
Participating Employer will execute forms provided by the Company as
necessary to the requested Transfer.
o no Transfers are permitted after the Annuity Commencement Date.
o 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 pursuant to the Participant Annuity Account.
RETIREMENT PROVISIONS
On the Company's receipt of the Participant's Written Request at least 30 days
before the Annuity Commencement Date, the Participant may in the Written
Request:
o Elect or Change a Method of Payment Option.
o make a Partial Surrender or Surrender.
o Elect or Change the Participant's Annuity Commencement Date to any future
date which is not later than the later of his/her 75th birthday or his/her
termination of service, unless a later date is permitted by the Company,
which date will not be later than the Participant's 85th birthday. 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.
o if the Participant has failed to elect a Method of Payment Option within 30
days of his/her Annuity Commencement Date, the Company will pay him/her a
Variable Life Annuity with 10 Year Guaranteed Period from his/her Variable
Contract Value and a Fixed Life Annuity with 10 Year Guaranteed Period from
his/her Guaranteed Contract Value.
Payment on Retirement
Payment under the Retirement Provisions will only be made to the order of the
Participant as directed in the Written Request.
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 Beneficiary 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
Beneficiary 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
Beneficiary 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 Beneficiary.
The Contingent Deferred Sales Charge will not apply to this single payment.
Partial Surrender
By Written Request 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 Payee 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 Payee, and his/her Partial Surrender 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.
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER (continued)
Surrender
By Written Request 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 Payee, and his/her 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 the 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 to 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 to 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.
PROVISIONS RELATING TO AMOUNT PAYABLE ON DEATH, PARTIAL SURRENDER, AND
SURRENDER (continued)
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 to the order of the Participant or
Beneficiary as directed in the Written Request.
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 Participant or Beneficiary 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 of the Option
Elected. 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 terms:
o if the Beneficiary is not the Participant's spouse, Election of an Option
by the Participant may not be made unless the present value of the payments
to be made to the Participant is at least 50% of the present value of the
total payments to be made to the Participant and Beneficiary. The present
values shall be determined by the Company.
o if the Beneficiary is the Participant's spouse, Election of an Option by
the Participant may not be made unless the amount of each payment does not
exceed the amount of any payment made to the Participant during his/her
lifetime.
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 to the Participant Annuity
Account on the 5th Valuation Date preceding the Annuity Commencement Date and
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.
METHODS OF PAYMENT PROVISIONS (continued)
Variable Dollar Method of Payment (continued)
Annuity Units
The number of Annuity Units for each Variable Sub-Account to be credited to 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.
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 continues to a designated Payee, if living, and terminates upon his/her
death. Table B is applicable this Option.
METHODS OF PAYMENT PROVISIONS (continued)
Variable Dollar Method of Payment Options: (continued)
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 terms:
o if the Beneficiary is not the Participant's spouse, Election of an Option
by the Participant may not be made unless the present value of the payments
to be made to the Participant is at least 50% of the present value of the
total payments to be made to the Participant and the Beneficiary. The
present values shall be determined by the Company.
o if the Beneficiary is the Participant's spouse, Election of an Option by
the Participant may not be made unless the amount of each payment does not
exceed the amount of any payment made to the Participant during his/her
lifetime.
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. 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 the
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.
METHODS OF PAYMENT PROVISIONS (continued)
Fixed Dollar method of Payment (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
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 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 $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 $1,000,000. For the
Application of any greater Amount, the Company's consent is required.
METHODS OF PAYMENT PROVISIONS (continued)
Settlement
If the Payee has received payments or was to receive payments which had not yet
commenced under Variable Dollar Method of Payment Option 1, or under Fix Dollar
Method of Payment Options 1, 2, or 3, any remaining amounts payable under the
Option Elected will be paid to the Beneficiary or designated Payee.
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 affected Participants, affect the terms,
provisions, or conditions of this Group Annuity Contract which are or may be
applicable to Contributions paid for 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 this Group
Annuity Contract which are or may be applicable to Contributions paid for
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 affected Participants, 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 Participants of the current offering of Variable
and 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.
CESSATION OF DEPOSITS
Upon 30 days' written notice to the others, the Group Policyholder for the Group
Annuity Policy, a Participating Employer for its Participants, 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. Notification will also be given
to Participants of the Cessation of Deposits.
If a Date of Cessation of Deposits has been declared for certain Sub-Accounts,
the Participant may by Written Request make a Change of Allocation of his/her
Contributions. When no Change of Allocation 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 has been declared by the Group
Policyholder or the Company in respect of this Group Annuity Contract or all
Sub-Accounts, no Participant Annuity Account will be established.
After the Date of Cessation of Deposits has been declared by a Participating
Employer for its Participants, no Participant Annuity Account will be
established for its Eligible Persons.
<PAGE>
TABLE A - Variable Life Annuity
Monthly Payment for Each $1,000
of Participant Annuity Account Value
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
----------------------------------------------------------------------------------------------------------------------
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.
<PAGE>
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 6.42
-------------------- ------------- ------------- --------------- ---------------------
----------------- --------------
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.
<PAGE>
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.
<PAGE>
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.
<PAGE>
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.
</TABLE>
<PAGE>
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 Daily Interest Guaranteed 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 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 - 1
<PAGE>
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 Participant who may by Written Request Allocate any Deposit
to any one Certificate. The Participant may Allocate his/her Deposits only to
those Certificates currently being offered by the Company.
If 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
Certificate - represents the amount Deposited
into the Guaranteed 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.
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.
Guaranteed Certificate Fund Rider - 1
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
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 Participant the Company may Modify the
Interest Guarantee Period of amounts previously Deposited into the Guaranteed
Certificate Fund.
If such Modification is made, 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:
o 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.
o 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.
o the Participant'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.
o the terms of the provisions on Transfers of this Group Annuity Contract
will apply to any Transfer to or from the Guaranteed Certificate Fund.
Application of Certificate on Partial Surrender, Surrender, or Retirement
If any amount Deposited into a Certificate of the Guaranteed Certificate Fund is
Applied under the Partial Surrender, Surrender, or Retirement Provisions prior
to the Maturity Date of the Certificate, the Credited Interest Rate applicable
to that amount from the date of Deposit to the date the Amount is Applied will
be reduced to not less than the Guaranteed Interest Rate. Certificates which are
closest to their Maturity Date will be Applied first under the respective
Partial Surrender, Surrender, or Retirement Provisions. This reduction of the
Credited Interest Rate will not apply to the Certificate Free Amount.
Guaranteed Certificate Fund Rider - 2
GUARANTEED CERTIFICATE FUND SUB-ACCOUNT RIDER (continued)
Application of Certificate on Partial Surrender, Surrender, or Retirement
(continued)
This reduction of the Credited Interest Rate will not apply if all of the
following provisions apply:
o the amount is Applied under the Retirement Provisions, and
o the Participant has on his/her Annuity Commencement Date attained the age
of 55, and
o the Participant has been covered as a Participant under this Group
Annuity Contract for at least 10 calendar years, and
o the Method of Payment Option Elected by the Participant or Beneficiary is
any Variable Dollar Method of Payment Option or is one of the Fixed Dollar
Method of Payment Options 3, 4, 5, or 6, if life contingent, or one of the
Fixed Dollar Method of Payment Options 1 or 2, if payable for a period of
not less than 120 months.
Application of Certificate Free Amount
The Amount of the Certificate Free Amount on any Partial Surrender, the
Surrender, or Retirement is equal to 10% of the sum of the Variable and
Guaranteed Contract Values at December 31 of the calendar year prior to the year
in which the amount is Applied. Only one Certificate Free Amount is available to
a Participant in each calendar year beginning after the second calendar year
he/she is Covered under this Group Annuity Contract.
That Certificate Free Amount will be Applied on the Surrender or the first
Partial Surrender or payment under the Retirement Provisions made under the
Participant Annuity Account in that year.
Application of Certificate on Death
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, 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 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
<PAGE>
Conversion Deposit Rider
1-84
<PAGE>
CONVERSION DEPOSIT RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
A Conversion Deposit Rider is defined as the amount Deposited into this Group
Annuity Contract from the Great-West Life Assurance Company contract # GP (the
"Previous Contract"), on the Participants' acceptance 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 Participant. 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 within 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 to 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. GCDRTSA 184
(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%
15-Day Free-Look
Notwithstanding any other provision in this Group Annuity Contract to the
contrary, the Conversion Deposit is not included in the 15-Day Free-Look
provision described in this Contract.
Contract Modification
The Contract Modification provisions of the Contract are applicable to the
Conversion Deposit, as appropriate.
Name of Group Policyholder
By:
Signature
Title
This Rider, unless and until Modified, forms part of the Group Annuity Contract
Conversion Deposit Rider -2
Form No. GCDRTSA 184
<PAGE>
Periodic Payment Option Rider
<PAGE>
PERIODIC PAYMENTS OPTION RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
WHEREAS, the Group Policyholder has previously entered into a Tax Deferred
Annuity Contract with GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (hereinafter
referred to as the Company),
AND WHEREAS, the Group Policyholder and the Company desire to make the Periodic
Payment Option available to Accountholders (a Participant or Payee under the
Contract) under the Contract,
NOW THEREFORE, the Group Policyholder and the Company agree that the following
provisions will be added to the Contract as of the date executed below.
<TABLE>
<S> <C> <C> <C> <C> <C> <C>
Ability To Elect Frequency and Amount of Payments An Accountholder may elect the
Periodic Payment Option if the The Accountholder will elect by Request:
Accountholder is eligible to receive a distribution in accordance othe payment
frequency of either 12-, 6-, 3-, with the Distributions To An Accountholder or
Surrender sections or 1-month intervals; of the Contract. Notwithstanding the
above, the Periodic Payment oa payment amount; a minimum of $50 is required;
Option may not be used to effect transfers under Revenue Ruling othe month, day
and year on which payments will 90-24. be made;
oone payment option; and
The Accountholder must Request that all or part of the Annuity othe allocation
of payments from the Variable Account be applied to a Periodic Payment Option.
All outstanding and/or Guaranteed Sub-Account(s) as follows: loan balances must
be paid in full or treated as a distribution 1)Prorate the amount to be paid
across all before an Accountholder may apply for a Periodic Payment Option.
Variable and Guaranteed Sub-Accounts in proportion to the
assets in each
sub-account; or
Operation of Participant Annuity Account 2)Select
the Investment Division(s) from which
While periodic payments are being received: payments will be
made. Once the Investment Division(s) have
o the Accountholder may continue to exercise all contractual been depleted, the
Company will automatically prorate the
rights that are available prior to electing a payment remaining payments
unless the Accountholder Requests the
option, except that no Contributions may be made by an selection of another
Investment Division(s).
Accountholder;
o Accountholders may continue to keep their current Guaranteed The
Accountholder may elect to change the payment option and Variable
Sub-Accounts; and/or frequency once each calendar year.
o charges and fees under the Contract, if applicable, continue
to apply, except as noted below; Payments will cease
on the earlier of:
o a Contingent Deferred Sales Charge does not apply
to o
periodic payments lasting a minimum of 36 months; and the date the
amount elected to be paid under the option o if a partial withdrawal is made, a
Contingent Deferred Sales selected has been reduced to zero;
Charge and/or Loss of Interest Charge, if
applicable, o
will be deducted. the Accountholder
Requests the payments to stop; or
o
If periodic payments cease, the Accountholder may resume making the Annuity Account
Value is zero.
Contributions or Deposits. Additionally, if periodic payments
cease, periodic payment options may not commence again for at Payments to a
Beneficiary
least a 36 month period. Upon the
Participant's death, the Beneficiary shall elect a
payment
option on
the death
claim
form
which
complies
with the
distribution
requirements
of
Section
401(a)(9)
of the
Internal
Revenue
Code.
PERIODIC PAYMENTS OPTION RIDER (continued)
Payment Options Available 3) Interest
Only. The payments will be based on the
The Accountholder must elect one of the following 4 payment amount of interest
credited to the Guaranteed Sub-Account(s)
options: between each
payment. Available only if 100% of the account
1)Income for a Specified Period for at least thirty-six (36) value is invested
in the Guaranteed Sub-Account and
months. The Accountholder elects the duration over which Accountholder is
younger than 70 1/2; or
payments will be made. This amount may vary based on the 4) Minimum
Distribution. The Accountholder may
duration; or Request minimum
distributions as specified under Internal
2)Income of a Specified Amount for at least thirty-six (36) Revenue Code Section
401(a)(9).
months. The Accountholder elects the dollar amount of the
payments. Based on the amount elected, the duration may vary; or
</TABLE>
Signed for Great-West Life & Annuity Insurance Company on the Issue Date.
W.T. McCallum,
President and Chief Executive Officer
Signed for the Group Policyholder on the day of ,
19 .
Group Policyholder Name
(Signature)
<PAGE>
SBPJA Rider
1-97
<PAGE>
SBJPA 1-97 (84)
IRC 403(b) RIDER
ATTACHED TO AND FORMING PART OF THE GROUP ANNUITY CONTRACT
Due to modifications under the Small Business Job Protection Act of 1996, all
elective deferrals under the Contract will be subject to the provisions noted in
Section 1 below.
1. Each Participant's elective deferrals under the Contract are limited to the
amount permitted under IRC Section 402(g). Should any Participant's
elective deferrals exceed the allowable amount, such Participant must
request that the excess deferrals be distributed from the Contract in
accordance with Internal Revenue Service requirements, as amended from time
to time. If such excess deferral is not timely distributed, the Participant
Annuity Account may lose its ss.403(b) status for tax purposes.
With respect to all monies transferred from a custodial account contract issued
in accordance with the provisions of IRC Section 403(b)(7), including interest
and investment earnings thereon, the following provisions in Sections 2 and 3
below will apply to such monies.
2. No such amounts may be paid or made available to any distributee before: A)
the Participant dies, or B) the Participant attains age 59 1/2, or C) the
Participant separates from service, or D) the Participant becomes disabled
[within the meaning of IRC Section 72(m)(7)], or E) in the case of
contributions made pursuant to a salary reduction
agreement, the Participant encounters financial hardship.
3. The distribution provisions in the "Surrender" and "Partial Surrender"
sub-sections of the "Provisions Relating to Amount Payable on Death,
Partial Surrender and Surrender" section of the contract shall not apply to
monies contributed under a custodial account contract issued under IRC
Section 403(b)(7). Distribution of such custodial account amounts shall be
restricted in accordance with the provisions noted in Section 2 above.
Signed for Great-West Life & Annuity Insurance Company on the Issue Date of this
Rider.
W.T. McCallum,
President and Chief Executive Officer
