Western-Southern life Assurance Company
Cincinnati, Ohio
Issued by a Stock Company
Home Office: 000 Xxxxxxxx, Xxxxxxxxxx, Xxxx 00000
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
Income Payable at Income Date
Death Benefit Prior to Income Date
Non-Participating
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
ENDORSEMENT FOR INDIVIDUAL RETIREMENT ANNUITY
This contract is issued as an Individual Retirement Annuity under Section 408(b)
of the Internal Revenue Code (Code). To qualify, your contract must meet the
following requirements:
1. You may not change ownership of this contract at any time.
2. Your entire interest in the contract is nonforfeitable. It is
established for the exclusive benefit of you or your beneficiaries.
3. Your contract is not transferable and may not be used as security for
a loan.
4. You must be the Annuitant and no joint owner or contingent owner is
permitted.
5. You must begin taking distributions no later than April 1 of the
calendar year following the calendar year in which you attain age
70 1/2 over (a) your life or the lives of you and your designated
beneficiary or (b) a period certain not extending beyond your life
expectancy, or the joint and last survivor expectancy of you and your
designated beneficiary. You must receive additional minimum
distributions by December 31 for each year after the calendar year you
attain age 70 1/2. Payments must be made in periodic payments at
intervals of no longer than one year. In addition, payments must be
either nonincreasing or they may increase only as provided in Q&A F-3
of Section 1.401(a)(9)-1 of the Proposed Income Tax Regulations.
All distributions made under the contract shall be in accordance with
the requirements of Section 401(a)(9) of the Code, including the
incidental death benefit requirements of Section 401(a)(9)(G) of the
Code, and the regulations thereunder, including the minimum
distribution incidental benefit requirement of Section 1.401(a)(9)-2
of the Proposed Income Tax Regulations.
In addition to meeting the distribution requirements referenced above,
payments under a partial withdrawal option or an annuity option must
also comply with the minimum distribution incidental benefit (MDIB)
requirements applicable to IRAs. The amount to be distributed each
year beginning with the first calendar year for which distributions
are required and then for each succeeding calendar year shall not be
less than the quotient obtained by dividing the owner's benefit by the
lesser of (1) the applicable life expectancy, or (2) if your spouse is
not the designated beneficiary, the applicable divisor determined from
the table set forth in Q&A-4 of Section 1.401(a)(9)-2 of the Proposed
Income Tax Regulations. Distributions after your death shall be
calculated using the applicable life expectancy as the relevant
divisor without regard to Section 1.401(a)(9)-2 of the Proposed Income
Tax Regulations. This MDIB rule may increase the amount of your
payments. If you are required to take a distribution at year end
because payments made to you during the calendar year are insufficient
to meet MDIB requirements for this contract, we will waive any
surrender charge that might otherwise be applicable.
You may satisfy the minimum distribution requirements applicable to
two or more IRAs by receiving a distribution from one IRA equal to the
amounts required to satisfy the minimum distribution requirement for
all your IRAs, as described in more detail in IRS Notice 88-38, 1988
1-C.B. 524.
Life expectancy is computed by use of the expected return multiples in Tables V
and VI of Section 1.72-9 of the Income Tax Regulations. Unless otherwise
elected by you by the time distributions are required to begin, life expectancy
shall be recalculated annually. Such election shall be irrevocable and shall
apply to all subsequent years. The life expectancy of a non-spouse beneficiary
may not be recalculated. Instead, life expectancy will be calculated using the
attained age of such beneficiary during the calendar year in which you attain
age 70 1/2 and payments for subsequent years shall be calculated on such life
expectancy reduced by one for each calendar year which has elapsed since the
calendar year life expectancy was first calculated.
6. In the event of your death, your entire interest in this contract must be
distributed in conformity with the regulations described below and the
contract's provisions relating to the death of the Annuitant/Owner are
changed to the extent necessary to conform with those regulations.
If you die before the entire interest is distributed, the following
distribution provision shall apply:
a. If you die after distribution of your interest has commenced, the
remaining portion of such interest must be distributed at least as
rapidly as under the method of distribution being used prior to your
death.
b. If you die before distribution of interest commences, your entire
interest must be distributed by December 31 of the calendar year
containing the fifth anniversary of your death, unless an election is
made to receive distribution in accordance with (1), (2) or (3) below.
(1) Your entire interest may be distributed over the life or over a
period certain not greater than the life expectancy of the
designated beneficiary commencing on or before December 31 of the
calendar year immediately following the calendar year of your
death. A designated beneficiary may elect at any time to receive
greater payments, or
(2) If your designated beneficiary is your surviving spouse, your
spouse may elect to receive equal or substantially equal payments
over the life or life expectancy of the surviving spouse
commencing at any date prior to the later of (i) December 31 of
the calendar year immediately following the calendar year of your
death, and (ii) December 31 of the calendar year in which you
would have attained age 70 1/2. Such election must be made no
later than the earlier of December 31 of the calendar year
containing the fifth anniversary of your death or the date
distributions are required to begin pursuant to the preceding
sentence. The surviving spouse may accelerate these payments at
any time, i.e.,increase the frequency or amount of such payments,
or
(3) If your designated beneficiary is your surviving spouse, your
spouse may treat the annuity as his or her own individual
retirement arrangement. This election will be deemed to have
been made if your surviving spouse makes a regular IRA
contribution to the annuity, makes a rollover to or from such
annuity, or fails to elect any of the above three provisions.
Life expectancy is computed by use of the expected return
multiples and Tables V and VI of Section 1.72-9 of the income tax
regulations. For purposes of distributions beginning after your
death unless otherwise elected by your surviving spouse by the
time distributions are required to begin, life expectancy shall
be recalculated annually. Such election shall be irrevocable by
the surviving spouse and shall apply to all subsequent years. In
the case of any other beneficiary, life expectancy shall be
calculated using the attained age of such beneficiary during the
calendar year in which distributions are required to begin
pursuant to this section, and payments for any subsequent
calendar year shall be calculated based on such life expectancy
reduced by one for each calendar year which has elapsed since the
calendar year life expectancy was first calculated.
Distributions under paragraph 6 are considered to have begun if distributions
are made on account of your attaining your required beginning date or, if prior
to the required beginning date, distributions irrevocably commence over a period
permitted and in an annuity form acceptable under Section 1.401(a)(9) of the
Regulations.
2
7. Except in the case of a rollover contribution (as permitted by Sections
402(c), 403(a)(4), 403(b)(8) OR 408(d)(3), or a contribution made in
accordance with either the terms of a Simplified Employee Pension (SEP) as
described in Section 408(k) or the terms of a Savings Incentive Match Plan
for Employees (SIMPLE) as described in Section 408(p) no contributions will
be accepted unless they are in cash and the total contributions under
Sections 219(b) and 408(o) shall not exceed $2,000 for any taxable year.
The $2,000 annual contribution limit does not apply to the following:
(1) funds you receive as a result of the payment to you from a qualified
pension or profit sharing plan (corporate or Xxxxx) which has
terminated, excluding any funds you receive that represent a return of
your contributions to the plan;
(2) funds you receive as a lump sum distribution from a qualified
corporate or Xxxxx plan, excluding any funds you receive that
represent a return of your contributions to the plan. A lump sum
distribution is a distribution that occurs on account of your
attainment of age 59 1/2, your separation from service (if you are a
common law employee), your becoming disabled (if you are
self-employed) or your death;
(3) funds (other than the plan termination and lump sum distributions
described above) that qualify as eligible rollover distributions under
Section 402(c);
(4) funds you receive from another individual retirement annuity or
account, however, rollover contributions from one individual
retirement annuity or account to another may occur only once per year;
(5) contributions to a SEP permitted under Section 408(k);
(6) contributions to a SIMPLE permitted under Section 408(p).
Funds you receive in one of the ways described above, except for
contribution type 5 or type 6, must be contributed toward your contract
within 60 days of the date they are received by you, unless you elected to
make a direct rollover of such funds before distribution. For direct
rollovers, a reasonable period of time is allowed.
8. If your premium payments are being made pursuant to a program of automatic
withdrawals, your contract may be terminated due to an interruption in
premium payments if no premiums have been received for two full consecutive
contract years and your annuity benefit at maturity would be less than $20
per month by paying you the Surrender Value computed as provided in your
contract.
3
9. If this contract is issued in accordance with the terms of a SEP, the
One Life Minimum Income Table in the contract is deleted and the following
Table is substituted in lieu thereof:
ONE LIFE MINIMUM INCOME TABLE*
MONTHLY PAYMENTS FOR EACH $1,000 APPLIED
-------------------------------------------------------------------------------
Age of Age of
Payee Life Life Payee Life Life
Last 10 Years 20 Years Last 10 Years 20 Years
Birth- Certain Certain Birth- Certain Certain
day day
-------------------------------------------------------------------------------
15 and
under $2.80 $2.80 50 $3.87 $3.79
16 2.82 2.81 51 3.94 3.85
17 2.83 2.83 52 4.00 3.90
18 2.84 2.84 53 4.08 3.96
19 2.86 2.85 54 4.15 4.02
20 2.87 2.87 55 4.23 4.08
21 2.89 2.88 56 4.31 4.15
22 2.90 2.90 57 4.40 4.21
23 2.92 2.92 58 4.50 4.28
24 2.94 2.93 59 4.59 4.35
25 2.96 2.95 60 4.70 4.42
26 2.98 2.97 61 4.81 4.50
27 3.00 2.99 62 4.93 4.57
28 3.02 3.01 63 5.05 4.64
29 3.04 3.03 64 5.18 4.71
30 3.07 3.06 65 5.32 4.79
31 3.09 3.08 66 5.46 4.86
32 3.12 3.11 67 5.81 4.92
33 3.14 3.13 68 5.77 4.99
34 3.17 3.16 69 5.93 5.05
35 3.20 3.19 70 6.10 5.11
36 3.23 3.22 71 6.28 5.17
37 3.27 3.25 72 6.46 5.22
38 3.30 3.28 73 6.65 5.27
39 3.34 3.31 74 6.84 5.31
40 3.38 3.35 75 7.03 5.35
41 3.42 3.39 76 7.23 5.38
42 3.46 3.42 77 7.43 5.41
43 3.50 3.46 78 7.62 5.43
44 3.55 3.50 79 7.81 5.45
45 3.59 3.55 80 8.00 5.47
46 3.64 3.59 81 8.18 5.48
47 3.70 3.64 82 8.35 5.49
48 3.75 3.69 83 8.51 5.50
49 3.81 3.74 84 8.66 5.50
85 and
over 8.80 5.51
-------------------------------------------------------------------------------
*Values are based on the "1983 Table a" adjusted for age last birthday, with
compound interest at 3% a year.
In the event of any conflict between the terms of this contract and any
sections of the Internal Revenue Code applicable to contracts described in
Section 408(b) of the Internal Revenue Code, those sections will govern.
/s/ Xxxxxxxx X. Xxxxx /s/ Xxxx X. Xxxxxxx
Secretary President and
Chief Executive Officer
4
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
TAX SHELTERED ANNUITY ENDORSEMENT TO INDIVIDUAL
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
THIS ENDORSEMENT APPLIES ONLY IF THE APPLICATION STATES THAT THIS CONTRACT IS
A 403(b) TAX SHELTERED ANNUITY.
1. This Contract is not transferable and may not be sold, assigned,
discounted, or pledged as collateral for a loan (except for loans as
hereunder) or as security for the performance of any obligation to any
person other than to the Company.
2. You must be the Contract Owner and the Annuitant. You must be an employee
("Employee") of an employer described in Internal Revenue Code ("Code")
Section 403(b)(1)(A) ("Employer"). If your employment with the Employer is
terminated, you may continue to participate hereunder to the extent of the
Contract Value. No further purchase payments (other than rollover
contributions) will be accepted by us under the Contract on your behalf
when you are no longer employed by the Employer. However, if you are
employed by another Employer described in Code Section 403(b)(1)(A)
("Successor Employer"), you may continue to participate hereunder and
future purchase payments may continue to be made. Any reference to
Employer in this Endorsement shall include a Successor Employer. Any
election or change must be made by written notice satisfactory to the
Company and consistent with applicable state and federal law.
3. Except as otherwise provided in the Code, purchase payments must be made
by the Employer. Purchase payments made for your taxable year, other than
rollover contributions, as provided in Code Section 403(b)(8) and
regulations thereunder may not exceed the least of:
A. the exclusion allowance for a taxable year determined pursuant to Code
Section 403(b)(2);
B. the maximum amount permitted to be contributed for a taxable year
under Code Section 415; and
C. the annual limit on elective deferrals specified in Code Section
402(g) for salary reduction contributions made under a Code approved
salary reduction agreement. Unless otherwise permitted in the Code,
the limitation specified in Code Section 403(b)(1)(E) shall not be
exceeded.
4. Prior to the Income Date, you may receive a loan from the Contract Value
subject to the terms of the Contract and the Code which impose restrictions
on loans.
Loans are available beginning 30 days from the date of issue. You will be
required to complete a Company Loan Agreement and will be subject to the
terms of this Endorsement and such Loan Agreement. If your contract is
subject to the Employee Retirement Income Security Act of 1974 ("ERISA"),
you must also provide your spouse's written consent to the loan, or
verification that you are not married or your spouse cannot be located.
Loans hereunder shall be administered in a manner which satisfies the
conditions of this Section 4 and Code Section 72(p). You may borrow a
minimum of $1,000. The maximum balance of loans from the Contract Value
and from all other qualified employer plans which may be outstanding at
any time is 50% of the Contract Value of all such plans, but not more than
$50,000 in the aggregate. The $50,000 limit will be reduced by the highest
balance of loans from the Contract Value and from all other qualified
employer plans during the prior one-year period. Additional loans are
subject to the $1,000 minimum amount. Upon ninety (90) days prior written
notice, the Company may limit the number of outstanding loans or eliminate
loans as an option under this Endorsement.
Loans must be adequately secured. Loans may be secured by the Contract
Value, but not in excess of 50% of the Contract Value. You may be required
to provide a security interest in such other property as would be
appropriate in a normal commercial setting between unrelated parties on
arm's length terms.
All loans are made from the Fixed Account. No loans may be made of amounts
that are not 100% vested. A loan account will be established in the Fixed
Account equal to the loan balance. Unless you instruct otherwise, the
Company will first transfer to the Fixed Account from the Variable Account
on a prorata basis Contract Value from all sub-accounts where Contract
Value is allocated until the required balance is reached or all such
Variable Account Contract Value is exhausted. The remaining required
amounts, if any, will be allocated from the Fixed Account. No surrender
charges will be deducted on the transfer of amounts from the Variable
Account to the Fixed Account at the time of the loan.
The current interest rate to be paid by the borrower for loans from
Contract Value will be determined by the Company substantially in
accordance with prevailing commercial rates, and may vary in accordance with
such rates. Until a loan from Contract Value has been repaid in full, the
portion of the loan account equal to the outstanding loan balance shall be
credited with interest at an effective annual rate of 2.25% less than the
current effective annual interest rate credited to the Fixed Account for
the term of the loan. However, the effective annual interest rate credited
to your loan account balance will never be greater than the current
interest rate being paid by the borrower less 2.25%, or less than the Fixed
Account guaranteed rate (3%). The Company reserves the right to change the
interest rate to be credited to the loaned portion of Contract Value at the
Company's sole discretion. In no event, however, will such interest be less
than the contract guaranteed rate.
Loans must be repaid in substantially level payments, not less frequently
than quarterly, within five years. Loans used to purchase the principal
residence of the borrower must be repaid under the same conditions, but
within 15 years. However, in no event may a loan term extend beyond your
required beginning date described in paragraph 5. During the loan term, the
loan will continue to earn interest at the annual rate specified in the
Loan Agreement. Loan repayments will consist of principal and interest in
amounts which satisfy the terms set forth herein. Loan repayments will be
allocated to the Fixed and Variable Accounts in the same proportion as
current allocations, unless you specify otherwise. If a loan payment is
not made when due, interest will continue to accrue on the late payment.
A loan payment not made when due, plus interest, may be treated as a
taxable distribution to the borrower, and may be subject to a penalty tax.
The Company may use commercially reasonable procedures to ensure loan
repayment in the event of loan defaults, including acceleration of the
entire loan balance plus accrued interest and applicable surrender
charges. The loan will be considered to be in default if a loan payment
is not received within ninety (90) days after the due date.
If Contract Value is reduced by the amount of the loan outstanding plus
accrued interest and such reduction does not satisfy the distribution
limitations of Section 403(b)(11) with respect to loan amounts attributable
to salary reduction contributions, this contract may lose its tax qualified
status. If you die while a loan is outstanding, your death benefit will be
reduced by the amount of the loan outstanding plus accrued interest.
5. Your entire interest under the Contract accruing after December 31, 1986,
will, notwithstanding anything else contained herein, be distributed as
follows:
In general, you must begin taking distributions no later than April 1 of
the calendar year following the calendar year in which you attain age
70 1/2, or April 1 of the calendar year following the calendar year in
which you retire. Your entire interest will be distributed over (a) your
life or the lives of you and your designated beneficiary or (b) a period
certain not extending beyond your life expectancy, or the joint and last
survivor expectancy of you and your designated beneficiary.
2
Payments must be made in periodic payments at intervals of no longer
than one year. In addition, payments must be either nonincreasing or
they may increase only as provided in Q & A F-3 of Section 1.401(a)(9)-1
of the Proposed Income Tax Regulations.
All distributions made hereunder shall be in accordance with the
requirements of Section 401(a)(9) of the Code, including the incidental
death benefit requirements of Code Section 401(a)(9)(G) of the Code, and
the regulations thereunder, including the minimum distribution
incidental benefit requirement of Section 1.401(a)(9)-2 of the Proposed
Income Tax Regulations.
In addition to meeting the distribution requirements of the regulations
mentioned in the prior paragraph, payments under a partial withdrawal
option or an annuity option must also comply with the minimum
distribution incidental benefit (MDIB) requirements under Code Section
401(a)(9) of the Internal Revenue Code. The amount to be distributed
each year beginning with the first calendar year for which distributions
are required and then for each succeeding calendar year shall not be
less than the quotient obtained by dividing your benefit by the lesser
of (1) the applicable life expectancy, or (2) if your spouse is not the
designated beneficiary, the applicable divisor determined from the table
set forth in Q & A-4 of Section 1.401(a)(9)-2 of the Proposed Income Tax
Regulations. Distributions after your death shall be calculated using
the applicable life expectancy as the relevant divisor without regard to
Section 1.401(a)(9)-2 of the Proposed Income Tax Regulations. This MDIB
rule may increase the amount of your payments. If we are required to
make a distribution to you at year end because payments made to you
during the calendar year are insufficient to meet MDIB requirements for
this Contract, we will waive any surrender charge that might otherwise
be applicable.
You may satisfy the minimum distribution requirements applicable to two
or more 403(b) Tax Sheltered Annuities by receiving a distribution from
one such annuity equal to the amount required to satisfy the minimum
distribution requirement for all such 403(b) Tax Sheltered Annuities, as
described in more detail in IRS Notice 88-38, 1988 1 C.B. 524.
Life expectancy is computed by use of the expected return multiples in
Tables V and VI of Section 1.72-9 of the Income Tax Regulations. Unless
otherwise elected by you by the time distributions are required to
begin, life expectancy shall be recalculated annually. Such election
shall be irrevocable and shall apply to all subsequent years. The life
expectancy of a non-spouse beneficiary may not be recalculated. Instead,
life expectancy will be calculated using the attained age of such
beneficiary during the calendar year in which the individual attains age
70 1/2 and payments for subsequent years shall be calculated on such
life expectancy reduced by one for each calendar year which has elapsed
since the calendar year life expectancy was first calculated.
6. If you die before your entire interest which accrued after December
31, 1986, has been distributed, the following distribution rules shall
apply:
A. If you die after the distribution of your interest has commenced,
the remaining portion of your interest will continue to be
distributed at least as rapidly as under the methods of distribution
being used prior to your death.
B. If you die before distribution of your interest commences, your
entire post-1986 interest will be distributed in accordance with
one of the following three provisions:
(1) Your entire interest will be paid by December 31 of the
calendar year containing the fifth anniversary of your death, or
(2) If your interest is payable to a designated beneficiary and you
have not elected (1) above, then the entire interest will be
distributed over the life or over a period certain not greater
than the life expectancy of your designated beneficiary
commencing on or before December 31 of the calendar year
immediately following the calendar year of your death. Your
designated beneficiary may elect at any time to receive greater
payments.
3
(3) If your designated beneficiary is your surviving spouse, your
spouse may elect to receive equal or substantially equal
payments over the life or life expectancy of the surviving
spouse commencing at any date prior to the later of (i)
December 31 of the calendar year immediately following the
calendar year of your death; and (ii) December 31 of the
calendar year in which you would have attained age 70 1/2.
Such election must be made no later than the earlier of
December 31 of the calendar year containing the fifth
anniversary of your death or the date distributions are
required to begin pursuant to the preceding sentence. Your
surviving spouse may accelerate these payments at any time,
I.E., INCREASE the frequency or amount of such payments.
Life expectancy is computed by use of the expected return
multiples and Tables V and VI of Section 1.72-9 of the Income
Tax Regulations. For purposes of distributions beginning after
your death, unless otherwise elected by your surviving spouse
by the time distributions are required to begin, life
expectancy shall be recalculated annually. Such election shall
be irrevocable by the surviving spouse and shall apply to all
subsequent years. In the case of any other beneficiary, life
expectancy shall be recalculated using the attained age of
such beneficiary during the calendar year in which
distributions are required to begin pursuant to this section,
and payments for any subsequent calendar year shall be
calculated based on such life expectancy reduced by one for
each calendar year which has elapsed since the calendar year
life expectancy was first calculated.
Distributions under this Section are considered to have begun
if distributions are made on account of your attaining your
required beginning date or, if prior to the required beginning
date, distributions irrevocably commence over a period permitted
and in an annuity form acceptable under Section 1.401(a)(9) of
the Regulations.
7. You may withdraw part or all of the Contract Value at any time this
Contract is in force prior to the earlier of the Income Date or your
death
A. The withdrawal of Contract Value attributable to contributions made
pursuant to a salary reduction agreement (within the meaning of Code
Section 402(g)(3)(C)) may be executed only
(1) when you attain age 59 1/2, separate from service, die, or become
disabled (within the meaning of Code Section 72(m)(7));or
(2) in the case of hardship (as defined for purposes of Code Section
401(k)), provided that any withdrawal of Contract Value in the
case of hardship may not include any income attributable to
salary reduction contributions.
B. The withdrawal limitations described in A. above apply to
(1) salary reduction contributions to Code Section 403(b) contracts
made for plan years beginning after December 31, 1988, and
(2) earnings credited to such contracts after the last plan year
beginning before January 1, 1989, on amounts attributable to
salary reduction contributions.
C. Any request for a withdrawal due to hardship must be submitted with
evidence acceptable to the Company on forms provided by the Company
and consistent with applicable law.
8. A. Notwithstanding any provision of a plan to the contrary that would
otherwise limit a distributee's election under this Section, a
distributee may elect in writing and not less than 30 or more than
90 days prior to distribution, to have any portion of an eligible
rollover distribution hereunder paid directly to an eligible
retirement plan specified by the distributee in a direct rollover.
4
B. Definitions:
(1) Eligible rollover distributions: An eligible rollover
distribution is any distribution of all or any portion of the
balance to the credit of the distributee, except that an
eligible rollover distribution does not include: any distribution
that is one of a series of substantially equal periodic payments
(not less frequently than annually) made for the life (or life
expectancy) of the distributee or the joint lives (or joint life
expectancy) of the distributee and the distributee's designated
beneficiary, or for a specified period of ten years or more; any
distribution to the extent such distribution is required under
Code Section 401(a)(9) of the Code; and the portion of any
distribution that is not includible in gross income (determined
without regard to the exclusion for net unrealized appreciation
with respect to employer securities).
(2) Eligible retirement plan: An eligible retirement plan is an
individual retirement account described in Code Section 408(a),
an individual retirement annuity described in Code Section 408(b),
or an annuity plan described in Code Section 403(b), that accepts
the distributee's eligible rollover distribution.
(3) Distributee: a distributee includes an Employee or former Employee.
In addition, the Employee's or former Employee's surviving spouse
and the Employee's or former Employee's spouse or former spouse
who is the alternate payee under a qualified domestic relations
order, as defined in Code Section 414(p), are distributees with
regard to the interest of the spouse or former spouse.
(4) Direct rollover: A direct rollover is a direct payment hereunder
to the eligible retirement plan specified by the distributee.
9. If your Contract is subject to the Employee Retirement Income
Security Act of 1974 ("ERISA"), your spouse will have certain rights,
such as the right to a Qualified Joint and Survivor Annuity Benefit
("QJSA") or a Qualified Preretirement Survivor Annuity Benefit ("QPSA").
Your spouse's rights under ERISA may limit your choice of payment plan,
beneficiary, cash surrenders and loans, as follows:
If you are married on the Income Date, your payment plan must be an
immediate annuity for your life with a survivor annuity for the life of
your spouse which is not less than 50 percent and not more than 100
percent of the amount of the annuity which is payable during the joint
lives of you and your spouse, and which is the amount of benefit which
can be purchased with Contract Value in excess of the outstanding loan
balance, if any.
If you die before your Income Date and your spouse survives you, the
payment of the Death Benefit to your named Beneficiary is subject to your
spouse's right to receive an immediate annuity which is the actuarial
equivalent of one-half the portion of your Contract Value in excess of
the outstanding loan balance, if any.
Your spouse must consent to your choice of a form of benefit other than
the QJSA/QPSA, beneficiaries who are not your spouse, cash surrenders
and loans.
In order for your spouse to properly waive his or her QJSA/QPSA rights,
the Company must receive, in form satisfactory to the Company, your
spouse's written consent, or verification that you do not have a spouse,
or verification that your spouse cannot be located. Waiver of a spouse's
rights to QJSA/QPSA benefits and elections of an alternative form of
benefit cannot be made more than 90 days before your Income Date. A
waiver of a spouse's rights to QJSA/QPSA benefits may become ineffective
if made before you attain age 35, or if earlier, the date you terminate
your employment with your Employer. Waivers of a spouse's rights
hereunder with respect to a cash surrender or loan must be made not more
than 90 days before the date of distribution.
You may revoke an election requiring a waiver of your spouse's QJSA/QPSA
rights at any time during your lifetime and before the Income Date. Your
spouse, however, may not revoke his or her consent once give.
5
10. The following table is substituted for the One Life Minimum Table in the
Nonqualified Contract.
ONE LIFE MINIMUM INCOME TABLE*
MONTHLY PAYMENTS FOR EACH $1,000 APPLIED
--------------------------------------------------------------------------
Age Of Age Of
Payee Payee
Last Life Life Last Life Life
Birth- 10 Years 20 Years Birth- 10 Years 20 Years
day Certain Certain day Certain Certain
--------------------------------------------------------------------------
15 and
under $2.80 $2.80 50 $3.87 $3.79
16 2.82 2.81 51 3.94 3.85
17 2.83 2.83 52 4.00 3.90
18 2.84 2.84 53 4.08 3.96
19 2.86 2.85 54 4.15 4.02
20 2.87 2.87 55 4.23 4.08
21 2.89 2.88 56 4.31 4.15
22 2.90 2.90 57 4.40 4.21
23 2.92 2.92 58 4.50 4.28
24 2.94 2.93 59 4.59 4.35
25 2.96 2.95 60 4.70 4.42
26 2.98 2.97 61 4.81 4.50
27 3.00 2.99 62 4.93 4.57
28 3.02 3.01 63 5.05 4.64
29 3.04 3.03 64 5.18 4.71
30 3.07 3.06 65 5.32 4.79
31 3.09 3.08 66 5.46 4.86
32 3.12 3.11 67 5.61 4.92
33 3.14 3.13 68 5.77 4.99
34 3.17 3.16 69 5.93 5.05
35 3.20 3.19 70 6.10 5.11
36 3.23 3.22 71 6.28 5.17
37 3.27 3.25 72 6.45 5.22
38 3.30 3.28 73 6.65 5.27
39 3.34 3.31 74 6.84 5.31
40 3.38 3.35 75 7.03 5.35
41 3.42 3.39 76 7.23 5.38
42 3.46 3.42 77 7.43 5.41
43 3.50 3.46 78 7.62 5.43
44 3.55 3.50 79 7.81 5.45
45 3.59 3.55 80 8.00 5.47
46 3.64 3.59 81 8.18 5.48
47 3.70 3.64 82 8.35 5.49
48 3.75 3.69 83 8.51 5.50
49 3.81 3.74 84 8.66 5.50
85 and
over 8.80 5.51
--------------------------------------------------------------------------
*Values are based on the "1983 Table a" adjusted for age last birthday,
with compound interest at 3% a year.
In the event of any conflict between the terms of this Contract and any
sections of the Code or ERISA applicable to Section 403(b) tax sheltered
annuities, those sections will govern. The Company is not liable for any tax
or tax penalties paid by any party resulting from failure to comply with the
Code, ERISA and any rulings, regulations, and requirements thereunder
relating to the administration of this Contract.
/s/ Xxxxxxxx X. Xxxxx /s/ Xxxx X. Xxxxxxx
Secretary President and
Chief Executive Officer
6
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
ADDITIONAL WAIVER OF
SURRENDER CHARGES RIDER
ADDITIONAL TIMES In addition to those situations set forth in the
WHEN SURRENDER Contract, the surrender charge will not apply if the
CHARGES WILL BE Owner or the Annuitant is confined to a Long Term Care
WAIVED Facility or Hospital and has been so confined for at
least 30 days.
DEFINITIONS "Confined" means necessarily confined as an
inpatient. To be covered, confinement must commence
while this Contract is in force and be required by
sickness or injury. Such confinement must have been
upon the recommendation of a physician.
"Injury" means accidental bodily injury which is
sustained while this Contract is in force.
"Sickness" means sickness or disease which first
manifests itself while this Contract is in force.
"Immediate Family" means an individual's spouse,
child, parent, brother or sister.
"Inpatient" means a person who is confined in a
Hospital or Long Term Care Facility as a resident
patient and for whom a charge of at least one day's
room and board is made by the Hospital or Long Term
Care Facility.
"Physician" means a duly licensed physician. It
does not include the owner or the annuitant or the
Owner's or the Annuitant's Immediate Family.
"Long Term Care Facility" means a state licensed
Skilled Nursing Facility or Intermediate Care
Facility. Long Term Care Facility DOES NOT MEAN:
A Hospital; a place that primarily treats drug addicts
or alcoholics; a home for the aged or mentally ill, a
community living center, or a place that primarily
provides domiciliary, residency or retirement care; or
a place owned or operated by the Owner or the
Annuitant or a member of the Owner's or the
Annuitant's Immediate Family.
"Skilled Nursing Facility" means a facility which:
is operated as a Skilled Nursing Facility according to
the law of the jurisdiction in which it is located;
provides skilled nursing care under the supervision of
a physician; provides continuous 24 hours a day
nursing service by or under the supervision of a
registered graduate professional nurse (R.N.); and
maintains a daily medical record of each patient.
"Intermediate Care Facility" means a facility which:
is operated as an Intermediate Care Facility according
to the law of the jurisdiction in which it is located;
provides continuous 24 hours a day nursing service by
or under the supervision of a registered graduate
professional nurse (R.N.) or a licensed practical
nurse (L.P.N.); and maintains a daily medical record
of each patient.
"Hospital" means a facility which: is state licensed
and operated as a hospital according to the law of the
jurisdiction in which it is located; operates
primarily for the care and treatment of sick or
injured persons as inpatients: provides continuous 24
hours a day nursing service by or under the
supervision of a registered graduate professional
nurse (R.N.); is supervised by a staff of physicians;
and has medical, diagnostic and major surgical
facilities or has access to such facilities on a
pre-arranged basis.
Neither "registered graduate professional nurse" nor
"licensed practical nurse" includes the Owner or the
Annuitant or the Owner's or the Annuitant's Immediate
Family.
NOTICE AND PROOF Written notice and proof of confinement for 30 days
OF CLAIM in a Hospital or Long Term Care Facility must be
received at our Home Office prior to our waiver of
surrender charges because of confinement.
CONTRACT TERMS This rider is attached to and made a part of the
APPLY Contract. The terms of the Contract apply to the
rider except to the extent they are in conflict with
its terms.
WHEN RIDER ENDS This rider will end if the Contract terminates or is
surrendered for cash.
/s/ Xxxxx X. Xxxxx /s/ Xxxx X. Xxxxxxx
Secretary President and
Chief Executive Officer
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
SECTION 401 PLAN ENDORSEMENT
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
THIS ENDORSEMENT APPLIES ONLY IF THE APPLICATION STATES THAT THIS CONTRACT IS
ISSUED AS AN INVESTMENT OF A PLAN DESCRIBED IN SECTION 401 OF THE INTERNAL
REVENUE CODE.
1. The following table is substituted for the One Life Minimum Table in the
Nonqualified Contract.
ONE LIFE MINIMUM INCOME TABLE*
MONTHLY PAYMENTS FOR EACH $1,000 APPLIED
-------------------------------------------------------------------------------------
AGE OF AGE OF
PAYEE LIFE LIFE PAYEE LIFE LIFE
LAST 10 YEARS 20 YEARS LAST 10 YEARS 20 YEARS
BIRTHDAY CERTAIN CERTAIN BIRTHDAY CERTAIN CERTAIN
-------------------------------------------------------------------------------------
15 and
under $2.80 $2.80 50 $3.87 $3.79
16 2.82 2.81 51 3.94 3.85
17 2.83 2.83 52 4.00 3.90
18 2.84 2.84 53 4.08 3.96
19 2.86 2.85 54 4.15 4.02
20 2.87 2.87 55 4.23 4.08
21 2.89 2.88 56 4.31 4.15
22 2.90 2.90 57 4.40 4.21
23 2.92 2.92 58 4.50 4.28
24 2.94 2.93 59 4.59 4.35
25 2.96 2.95 60 4.70 4.42
26 2.98 2.97 61 4.81 4.50
27 3.00 2.99 62 4.93 4.57
28 3.02 3.01 63 5.05 4.64
29 3.04 3.03 64 5.18 4.71
30 3.07 3.06 65 5.32 4.79
31 3.09 3.08 66 5.46 4.86
32 3.12 3.11 67 5.61 4.92
33 3.14 3.13 68 5.77 4.99
34 3.17 3.16 69 5.93 5.05
35 3.20 3.19 70 6.10 5.11
36 3.23 3.22 71 6.28 5.17
37 3.27 3.25 72 6.46 5.22
38 3.30 3.28 73 6.65 5.27
39 3.34 3.31 74 6.84 5.31
40 3.38 3.35 75 7.03 5.35
41 3.42 3.39 76 7.23 5.38
42 3.46 3.42 77 7.43 5.41
43 3.50 3.46 78 7.62 5.43
44 3.55 3.50 79 7.81 5.45
45 3.59 3.55 80 8.00 5.47
46 3.64 3.59 81 8.18 5.48
47 3.70 3.64 82 8.35 5.49
48 3.75 3.69 83 8.51 5.50
49 3.81 3.74 84 8.66 5.50
85 and
over 8.80 5.51
-------------------------------------------------------------------------------------
"Values are based on the "1983 Table a" adjusted for
age last birthday, with compound interest at 3% a year.
2. In the event of any conflict between the terms of this Contract and any
sections of the Internal Revenue Code applicable to Section 401 plans,
those sections will govern. The Company is not liable for any tax or tax
penalties paid by any party resulting from failure to comply with the Code
and Internal Revenue Service rulings, regulations, and requirements
relating to the administration of this Contract.
/s/ Xxxxxxxx X. Xxxxx /s/ Xxxx X. Xxxxxxx
Secretary President and
Chief Executive Officer
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
CHARITABLE REMAINDER UNITRUST
WAIVER OF SURRENDER CHARGES
ENDORSEMENT
ADDITIONAL TIMES In addition to those situations set forth in the
WHEN SURRENDER contract, the surrender charge will not apply to
CHARGES WILL BE withdrawals of any amounts in excess of the total net
WAIVED purchase payment(s) made to that time when the contract
is owned by a trustee of a Charitable Remainder
Unitrust. Withdrawals from such a contract are deemed
to be taken first from any such excess amounts. Only
after such excess has been exhausted are withdrawals
deemed to be taken from net purchase payments.
DEFINITIONS "Charitable Remainder Unitrust" means a trust as
defined in Section 664(d)(2) of the Internal Revenue
Code of 1986, as amended.
/s/Xxxxxxxx X. Xxxxx /s/Xxxx X Xxxxxxx
Secretary President and
Chief Executive Officer
