NY3342G99
[GRAPHIC OMITTED]
A Stock Insurance Company
P.O. Box 21029, New York, New York 10129-1029
Administrative Office:
[P.O. Box 5423 Cincinnati, Ohio 45201-5423]
Group Flexible Premium Deferred Variable Annuity Contract
In consideration of the application, if any, the enrollment forms, if any, of
participants hereunder ("Participants"), and the payment of Purchase Payments
for the benefit of Participants, we have issued this Group Flexible Premium
Deferred Variable Annuity Contract ("Contract") to the Contract Owner identified
on the Contract Specifications page, effective as of the Contract Effective Date
and subject to all of the terms and conditions set out on the following pages.
As you read through this Contract, please note that the words "we", "us", "our",
and "Company" refer to Great American Life Insurance Company of New York. The
words "you" and "your" refer to the Contract Owner.
[GRAPHIC OMITTED][GRAPHIC OMITTED] [GRAPHIC OMITTED][GRAPHIC OMITTED]
Senior Vice President & Assistant Treasurer Executive Vice President
Nonparticipating - No Dividends
BENEFIT PAYMENTS AND OTHER VALUES DESCRIBED IN THIS CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE AND ARE
NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS. NO MINIMUM CONTRACT VALUE IS
GUARANTEED, EXCEPT FOR AMOUNTS IN THE FIXED ACCOUNT.
After a Variable Dollar Benefit is elected under a Certificate, the annual rate
of return earned on the assets of the Sub-Accounts must be equal to or exceed 3%
for the Variable Dollar Benefit payments not to decrease.
NY3342G99
CONTRACT SPECIFICATIONS
CONTRACT OWNER: XXXX XXX
CONTRACT NUMBER: 000000
CONTRACT EFFECTIVE DATE: JUNE 1, 1999
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SEPARATE ACCOUNT: GALIC of New York Separate Account I
Following is a list of the currently available Funds in which the Separate
Account invests:
[Xxxxx Xxxxx Series Aggressive Growth Portfolio]
[Janus Aspen Series Worldwide Growth Portfolio]
[Janus Aspen Series Balanced Portfolio]
[Janus Aspen Series Growth Portfolio]
[Janus Aspen Series International Growth Portfolio]
[Janus Aspen Series Capital Appreciation Portfolio]
[Dreyfus Variable Investment Fund-Capital Appreciation Portfolio]
[Dreyfus Variable Investment Fund-Money Market Portfolio]
[Dreyfus Variable Investment Fund-Growth and Income Portfolio]
[Dreyfus Variable Investment Fund-Small Cap Portfolio]
[The Dreyfus Socially Responsible Growth Fund, Inc.]
[Dreyfus Stock Index Fund]
[Strong Opportunity Fund II, Inc.]
[Strong Variable Insurance Funds, Inc.-Strong Mid Cap Growth Fund II]
[The Xxxxxxx Plan Small-Cap Variable Series]
[INVESCO VIF-Equity Income Fund]
INVESCO VIF-Total Return Fund]
[INVESCO VIF-High Yield Fund]
[Xxxxxx Xxxxxxx Xxxx Xxxxxx Universal Funds Inc. U.S. Real Estate Portfolio]
[Xxxxxx Xxxxxxx Xxxx Xxxxxx Universal Funds Inc. Value Portfolio]
[Xxxxxx Xxxxxxx Xxxx Xxxxxx Universal Funds Inc. Emerging Markets Equity
Portfolio]
[Xxxxxx Xxxxxxx Xxxx Xxxxxx Universal Funds Inc. Fixed Income Portfolio]
[Xxxxxx Xxxxxxx Xxxx Xxxxxx Universal Funds Inc. Mid Cap Value Portfolio]
[Pilgrim Xxxxxx PBHG Insurance Series Fund, Inc.-Growth II Portfolio]
[Pilgrim Xxxxxx PBHG Insurance Series Fund, Inc.-Large Cap Growth Portfolio]
[Pilgrim Xxxxxx PBHG Insurance Series Fund, Inc.-Technology & Communications
Portfolio]
[BT Insurance Funds Trust-EAFE(R) Equity Index Fund]
[BT Insurance Funds Trust-Equity 500 Index Fund]
[BT Insurance Funds Trust-Small Cap Index Fund]
TRANSFER FEE: [$25] per transfer in excess of twelve (12) in any Certificate
Year. -------------
CERTIFICATE MAINTENANCE FEE: [$40] Annually
MORTALITY AND EXPENSE RISK CHARGE: A charge equal to an effective annual rate of
[1.25%] of the daily Net Asset Value of the Sub-Accounts.
ADMINISTRATION CHARGE: A charge equal to an effective annual rate of [0.15%] of
the daily Net Asset Value of the Sub-Accounts.
TERMINATION: We reserve the right to terminate any Participant's participation
interest at any time prior to his or her Annuity Commencement Date if 1) no
Purchase Payments have been paid for the Participant for three (3) consecutive
years and 2) the Account Value of the Participant's participation interest is
less than $2,000. We will then pay the Participant the Account Value of his or
her participation interest as of the end of the Valuation Period in which the
Contract is terminated.
[The following terms and conditions apply to termination of this Contract:
_____________________]
INQUIRIES: For information, or to make a complaint, call or write:
Variable Annuity Service Center
Great American Life Insurance Company of New York
Post Office Box 21029
New York, New York 10129-1029
[0-000-000-0000]
TABLE OF CONTENTS PAGE
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DEFINITIONS.................................................................6
GENERAL PROVISIONS..........................................................9
Entire Contract..........................................................9
Participant Certificate..................................................9
Changes -- Waivers.......................................................9
Nonparticipating.........................................................9
Misstatement.............................................................9
Required Reports.........................................................9
Exclusive Benefit.......................................................10
State Law...............................................................10
Claims of Creditors.....................................................10
Company Liability.......................................................10
Voting Rights...........................................................10
Incontestability........................................................10
Discharge of Liability..................................................10
Transfer By the Company.................................................10
Termination.............................................................10
PURCHASE PAYMENTS..........................................................11
Purchase Payments.......................................................11
Allocation of Purchase Payments.........................................11
No Termination..........................................................11
FIXED ACCOUNT..............................................................11
Fixed Accumulation Account..............................................11
SEPARATE ACCOUNT...........................................................12
General Description.....................................................12
Sub-Accounts of the Separate Account....................................12
Valuation of Assets.....................................................12
Variable Account Value..................................................12
Accumulation Unit Value.................................................13
TRANSFERS..................................................................13
FEES AND CHARGES...........................................................14
Mortality and Expense Risk Charge.......................................14
Administration Charge...................................................14
Certificate Maintenance Fee.............................................14
SURRENDERS.................................................................14
Surrenders..............................................................14
Deferral of Payment.....................................................15
OWNERSHIP PROVISIONS.......................................................15
Ownership of Separate Account...........................................15
Ownership of Contract and Participant Account...........................15
Transfer and Assignment.................................................15
Successor Owner.........................................................15
Community Property......................................................16
BENEFICIARY PROVISIONS.....................................................16
Beneficiary.............................................................16
Change of Beneficiary...................................................16
BENEFIT ON ANNUITY COMMENCEMENT DATE.......................................16
Annuity Commencement Date...............................................16
Annuity Benefit Payments................................................16
Form of Annuity Benefit.................................................17
BENEFIT ON DEATH OF PARTICIPANT............................................17
Death Benefit...........................................................17
Death Benefit Amount....................................................17
Transfers After Death...................................................18
Form of Death Benefit...................................................18
SETTLEMENT OPTIONS.........................................................18
Conditions..............................................................18
Benefit Payments........................................................19
Fixed Dollar Benefit....................................................19
Variable Dollar Benefit.................................................19
Limitation on Election of Settlement Option.............................20
Settlement Option Computations..........................................20
Available Settlement Options............................................20
Settlement Option Tables................................................21
Group Flexible Premium Deferred Variable Annuity Contract...............24
.........
DEFINITIONS
Account(s): The Sub-Account(s) and/or the Fixed Accumulation Account.
Account Value: The aggregate value of a Participant's interest in the
Sub-Account(s) and the Fixed Accumulation Account as of the end of any Valuation
Period. The value of a Participant's interest in all Sub-Accounts is his or her
"Variable Account Value," and the value of a Participant's interest in the Fixed
Accumulation Account is his or her "Fixed Account Value."
Accumulated Earnings: A Participant's Account Value in excess of Purchase
Payments received by us and which have not been returned to the Participant.
Accumulation Period: The period prior to the applicable Commencement Date under
a Certificate.
Accumulation Unit: A unit of measurement used to calculate the value(s) of the
Sub-Account(s) prior to the applicable Commencement Date. The value of an
Accumulation Unit is referred to as an "Accumulation Unit Value."
Administrative Office: The home office of the Company or any other place of
business which we may designate for administration.
Age: Age as of most recent birthday.
Annuitant: For each participation interest under this Contract, the Annuitant is
the Participant, and is the person on whose life Annuity Benefit payments are
based.
Annuity Benefit: Periodic payments made under a settlement option, which
commence on or after the Annuity Commencement Date.
Annuity Commencement Date: For each Participant, the first day of the first
Payment Interval for which an Annuity Benefit payment is to be made under a
settlement option.
Beneficiary: A person entitled to the Death Benefit under a Certificate.
Benefit Payment: The Annuity Benefit or Death Benefit payable under a settlement
option. Variable Dollar Benefit payments may vary in amount. Fixed Dollar
Benefit payments remain constant except under certain joint and survivor
settlement options.
Benefit Payment Period: The period starting on the Commencement Date during
which Benefit Payments are to be made under a Certificate.
Benefit Unit: A unit of measure used to determine the dollar value of any
Variable Dollar Benefit payments after the first Benefit Payment is made by us.
The value of a Benefit Unit is referred to as a "Benefit Unit Value."
Certificate Anniversary: An annual anniversary of a Participant's Certificate
Effective Date.
Certificate Effective Date: The date shown on a Participant's Certificate
Specifications page.
Certificate Year: For a Participant's Certificate, any period of twelve (12)
consecutive months commencing on the Certificate Effective Date and on each
Certificate Anniversary thereafter.
Code: The Internal Revenue Code of 1986, as amended, and the rules and
regulations thereunder.
Commencement Date: The Annuity Commencement Date if an Annuity Benefit is
payable under a Certificate, or the Death Benefit Commencement Date if a Death
Benefit is payable under a Certificate.
Death Benefit: The benefit described in the Benefit on Death of Participant
section of this Contract.
Death Benefit Commencement Date: For each Participant, the first day of the
first Payment Interval for which a Death Benefit payment is to be made under a
settlement option, or the date a Death Benefit is to be paid in a lump sum.
Death Benefit Valuation Date: The date that Due Proof of Death has been received
by us and the earlier to occur of:
1) our receipt of a Written Request with instructions as to the form of
Death Benefit; or
2) the Death Benefit Commencement Date.
Due Proof of Death: Any of the following:
1) a certified copy of a death certificate;
2) a certified copy of a decree of a court of competent jurisdiction as to
the finding of death; or
3) any other proof satisfactory to us.
Fund: A management investment company or portfolio thereof, registered under the
Investment Company Act of 1940, in which the Separate Account invests.
Net Asset Value: The amount computed by an investment company, no less
frequently than each Valuation Period, as the price at which its shares or
units, as the case may be, are redeemed in accordance with the rules of the
Securities and Exchange Commission.
Owner: The person identified as such on the Contract Specifications page.
Participant: A person who participates in the benefits of this Contract pursuant
to the enrollment form for such person, if any, as evidenced by a Certificate.
Payment Interval: A monthly, quarterly, annual or other regular interval during
a Benefit Payment Period.
Person Controlling Payments: The "Person Controlling Payments" means the
following, as the case may be:
1) with respect to Annuity Benefit payments, the Participant; and
2) with respect to Death Benefit payments,
a) the Beneficiary; or
b) if the Beneficiary is deceased, the payee.
Purchase Payment: A contribution amount paid to us in consideration for a
Participant's participation interest under this Contract, after the deduction of
any and all of the following which may apply:
1) any fee charged by the person remitting payments for you;
2) premium taxes; and/or
3) other taxes.
Separate Account: An account, which may be an investment company, which is
established and maintained by the Company pursuant to the laws of the State of
New York.
Sub-Account: The Separate Account is divided into Sub-Accounts, each of which is
invested in the shares of a designated Fund.
Valuation Period: The period commencing at the close of regular trading on the
New York Stock Exchange on any Valuation Date, and ending at the close of
trading on the next succeeding Valuation Date. "Valuation Date" means each day
on which the New York Stock Exchange is open for business.
Written Request: Information provided, or a request made, that is complete and
satisfactory to us, that is sent to us on our form or in a manner satisfactory
to us, which may, at our discretion, be telephonic, and that is received by us
at our Administrative Office. A Written Request is subject to any payment made
or any action we take before we acknowledge it. A Written Request may be
modified or revoked only by a subsequent Written Request, when permitted by the
terms of this Contract. A Participant may be required to return his or her
Certificate to us in connection with a Written Request.
GENERAL PROVISIONS
Entire Contract
We have issued this Contract to the Contract Owner identified on the Contract
Specifications page. This Contract is a group flexible premium deferred variable
annuity contract. This Contract is restricted by endorsement as required to
obtain favorable tax treatment under the Code, and is not valid without the
requisite endorsement(s) being attached. This Contract, its endorsements, the
application, if any, and the enrollment forms, if any, of all Participants under
it, form the entire Contract between you and us. Certificates are not contracts
and are not a part of this Contract.
Only statements in the application, if any, or in a Participant's enrollment
form, if any, will be used to void a Participant's participation interest
hereunder, or to defend a claim based on it. Such statements are representations
and not warranties.
Participant Certificate
A Certificate of Participation ("Certificate") is evidence of a Participant's
participation interest under this Contract.
Changes -- Waivers
No changes or waivers of the terms of this Contract are valid unless made in
writing by our President, Vice President, or Secretary. No agent or other person
not named above has authority to change or waive any provision of this Contract.
We reserve the right both to administer and to change the provisions of this
Contract to conform to any applicable laws, regulations or rulings issued by a
governmental agency.
In any event, the Company reserves the right to add or delete Sub-Accounts, to
substitute shares of a different Fund or different class or series of a Fund for
shares held in a Sub-Account, to merge or combine Sub-Accounts, to merge or
combine the Separate Account with any other separate account of the Company, to
transfer the assets of the Separate Account to another life insurance company by
means of a merger or reinsurance, to convert the Separate Account into a managed
separate account, and to de-register the Separate Account under the Investment
Company Act of 1940. Any such change will be made in accordance with applicable
insurance and securities laws and after obtaining any necessary federal and/or
state regulatory approvals.
Nonparticipating
This Contract does not pay dividends or share in the Company's divisible
surplus.
Misstatement
If the age of a person on whose life Benefit Payments are based is misstated,
the payments or other benefits under this Contract shall be adjusted to the
amount which would have been payable based on the correct age. If we made any
underpayments based on any misstatement, the amount of any underpayment with
interest, at the rate of six percent (6%) per year, shall be immediately paid in
one sum. In addition to any other remedies that may be available at law or at
equity, we may deduct any overpayments made, with interest, at the rate of six
percent (6%) per year, from any succeeding payments due.
Required Reports
At least once each Certificate Year, we will send a report of a Participant's
current values and any other information required by law, until the first to
occur of the following:
1) the date the Participant's participation interest under this Contract
is fully surrendered;
2) the Participant's Annuity Commencement Date; or
3) the Participant's Death Benefit Commencement Date.
The report will be mailed to the last known address of the Participant. The
reported values will be based on the information in our possession at the time
the report is prepared by us. We may adjust the reported values at a later date
if that information proves to be incorrect or has changed.
Exclusive Benefit
This Contract is for the exclusive benefit of Participants and their
Beneficiaries. Their interests under this Contract are nonforfeitable by us.
State Law
All factors, values, benefits and reserves under this Contract will not be less
than those required by the law of the state in which this Contract is delivered.
Claims of Creditors
To the extent allowed by law, this Contract and all values and benefits under it
are not subject to the claims of creditors or to legal process.
Company Liability
We will not incur any liability or be responsible for any failure, in whole or
in part, by you or by any person having rights or benefits arising out of or
related to this Contract, to comply with any applicable laws, regulations or
rulings issued by a governmental agency.
Voting Rights
To the extent required by law, we will vote all shares of the Funds held in the
Separate Account, at regular and special shareholder meetings of the Funds, in
accordance with instructions received from the Participant, or, if applicable,
from the Person Controlling Payments. If there is a change in the law which
permits us to vote the shares of the Funds without such instructions, then we
reserve the right to do so.
Incontestability
This Contract, and the participation interests of Participants under it, shall
not be contestable by us.
Discharge of Liability
Upon payment of any partial or full surrender, or any Benefit Payment, we shall
be discharged from all liability to the extent of each such payment.
Transfer By the Company
We reserve the right to transfer our obligations under this Contract to another
qualified life insurance company under an assumption reinsurance arrangement
without your prior consent.
Termination
Either we or you may terminate this Contract by giving sixty (60) days advance
notice in writing. Refer to the Contract Specifications page for information
regarding the benefits and charges, if any, in the event of termination of this
Contract. If this Contract is terminated, a Participant may continue his or her
participation interest under it on a deferred paid-up basis, subject to all of
the terms and conditions of this Contract, unless he or she surrenders his or
her participation as a whole. Termination of this Contract will not affect
Benefit Payments being made by us.
PURCHASE PAYMENTS
Purchase Payments
One or more Purchase Payments may be paid to us for a Participant at any time
before the Participant's Annuity Commencement Date, so long as:
1) the Participant is still living; and
2) the Participant's participation interest has not been fully
surrendered.
The initial Purchase Payment for a Participant must be paid to us on or before
the Participant's Certificate Effective Date. Each Purchase Payment must be paid
to us at our Administrative Office, and is subject to any minimums or maximums
that we set for such from time to time. Upon request, we will provide you with a
receipt as proof of payment.
Allocation of Purchase Payments
We will allocate Purchase Payments to the Sub-Accounts according to the
instructions we receive in the Participant's enrollment form, if any, or
subsequent Written Request. Allocations must be made in whole percentages. The
minimum amount that can be allocated to a Sub-Account is $10. The minimum amount
that can be allocated to a Fixed Account option other than the Fixed
Accumulation Account Option is $2,000.
You shall be responsible to collect Purchase Payment(s) by payroll deduction or
otherwise and to remit Purchase Payment(s) to us in the proper amount, together
with all information necessary to apply such amounts properly under the terms of
this Contract and with respect to the participation interests of Participants
hereunder.
No Termination
Except as stated elsewhere in this Contract, neither this Contract nor the
participation interest of a Participant under it will be terminated by us due to
failure to make additional Purchase Payments.
FIXED ACCOUNT
Fixed Accumulation Account
The Fixed Accumulation Account is part of the Company's general account. The
values of the Fixed Accumulation Account are not dependent upon the investment
performance of the Sub-Accounts. The Fixed Accumulation Account is not available
as an investment option, but any loan collateral will be allocated to the Fixed
Accumulation Account and will earn a fixed rate of interest no less than three
percent (3%) per year, compounded annually.
SEPARATE ACCOUNT
General Description
The variable benefits under this Contract are provided through the Separate
Account. The Separate Account is registered with the Securities and Exchange
Commission as a unit investment trust under the Investment Company Act of 1940.
The income, if any, and any gains or losses, realized or unrealized, on the
Separate Account will be credited to or charged against the amounts allocated to
such account without regard to other income, gains, or losses of the Company.
The amounts allocated to the Separate Account and the accumulations thereon
remain the property of the Company, but that portion of the assets of the
Separate Account that is equal to the reserves and other contractual liabilities
under all policies, annuities, and other contracts identified with the Separate
Account, is not chargeable with liabilities arising out of any other business of
the Company. The Company is not, and does not hold itself out to be, a trustee
in respect of such amounts.
We have the right to transfer to our general account, in our sole discretion and
at any time without prior written notice, any assets of the Separate Account
which are in excess of the required reserves and other contractual liabilities
under all policies, annuities, and other contracts identified with the Separate
Account.
Sub-Accounts of the Separate Account
The assets of the Separate Account are divided into Sub-Accounts. The
Sub-Accounts available as of the Contract Effective Date are listed on the
Contract Specifications page. Each Sub-Account invests exclusively in shares of
an underlying Fund as shown on the Contract Specifications page. Any amounts of
income and any gains on the shares of a Fund will be reinvested in additional
shares of that Fund at its Net Asset Value.
Valuation of Assets
Shares of Funds held for each Sub-Account will be valued at their Net Asset
Value at the end of each Valuation Period, as reported by each such Fund.
Variable Account Value
Purchase Payment(s) may be allocated among and, as described elsewhere in this
Contract, Account values may be transferred to the various Sub-Accounts within
the Separate Account. For each Sub-Account, the Purchase Payment(s) or amounts
transferred are converted into Accumulation Units. The number of Accumulation
Units credited is determined by dividing the dollar amount directed to each
Sub-Account by the value of the Accumulation Unit for that Sub-Account at the
end of the Valuation Period on which the Purchase Payment(s) or transferred
amount is received.
The following events will result in the cancellation of an appropriate number of
Accumulation Units of a Sub-Account:
1) transfer from a Sub-Account;
2) full or partial surrender of a Participant's Variable Account Value;
3) payment of a Death Benefit;
4) application of a Participant's Variable Account Value to a settlement
option;
5) deduction of a Certificate Maintenance Fee; or
6) deduction of any Transfer Fee.
Accumulation Units will be canceled as of the end of the Valuation Period during
which the Company receives a Written Request regarding the event giving rise to
such cancellation, or an applicable Commencement Date, or the end of the
Valuation Period on which a Certificate Maintenance Fee or Transfer Fee is due,
as the case may be.
A Participant's Variable Account Value at any time is equal to the sum of the
number of Accumulation Units for each Sub-Account attributable to his or her
participation multiplied by the Accumulation Unit Value for each Sub-Account at
the end of the preceding Valuation Period.
Accumulation Unit Value
The initial Accumulation Unit Value for each Sub-Account, with the exception of
the Money Market Sub-Account, was set at $10.00. The initial Accumulation Unit
Value for the Money Market Sub-Account was set at $1.00. Thereafter, the
Accumulation Unit Value at the end of each Valuation Period is the Accumulation
Unit Value at the end of the previous Valuation Period multiplied by the Net
Investment Factor, as described below.
The Net Investment Factor is a factor applied to measure the investment
performance of a Sub-Account from one Valuation Period to the next. Each
Sub-Account has a Net Investment Factor for each Valuation Period which may be
greater or less than one. Therefore, the Accumulation Unit Value for each
Sub-Account may increase or decrease. The Net Investment Factor for any
Sub-Account for any Valuation Period is determined by dividing (1) by (2) and
subtracting (3) from the result, where:
1) is equal to:
a) the Net Asset Value per share of the Fund held in that
Sub-Account, determined at the end of the applicable Valuation
Period; plus
b) the per share amount of any dividend or net capital gain
distributions made by the Fund held in that Sub-Account, if
the "ex-dividend" date occurs during the applicable Valuation
Period; plus or minus
c) a per share charge or credit for any taxes reserved for, which
is determined by the Company to have resulted from the
investment operations of the Sub-Account;
2) is the Net Asset Value per share of the Fund held in that Sub-Account,
determined at the end of the immediately preceding Valuation Period;
and
3) is the factor representing the Mortality and Expense Risk Charge and
the Administration Charge deducted from the Sub-Account for the number
of days in the applicable Valuation Period.
TRANSFERS
Prior to his or her applicable Commencement Date, a Participant may transfer
amounts in a Sub-Account to a different Sub-Account.
The minimum transfer amount for any transfer is $500. The number of transfers
per year for each Participant, over which we will charge a Transfer Fee on each
additional transfer, and the amount of the Transfer Fee, are shown on the
Contract Specifications page.
We reserve the right, in our sole discretion and at any time without prior
notice, to terminate, suspend or modify the transfer privileges described above.
FEES AND CHARGES
Mortality and Expense Risk Charge
The Mortality and Expense Risk Charge is shown on the Contract Specifications
page and is deducted daily from each Sub-Account. This deduction is made to
compensate the Company for assuming the mortality and expense risks under this
Contract.
Administration Charge
The Administration Charge is shown on the Contract Specifications page and is
deducted daily from each Sub-Account. This deduction is made to reimburse the
Company for expenses incurred in the administration of this Contract, the
Certificates thereunder, and the Separate Account.
Certificate Maintenance Fee
The Certificate Maintenance Fee ("Fee") is shown on the Contract Specifications
page and is deducted for each Participant as of the Valuation Period next
following each Certificate Anniversary prior to the applicable Commencement
Date. In addition, the full annual Fee will be charged at the time of a full
surrender of a Participant's participation interest. The Fee will be allocated
to each Sub-Account in the same proportion as each Sub-Account's value is to the
Participant's total Variable Account Value as of the end of such Valuation
Period. The Fee does not apply to the Fixed Account.
After his or her applicable Commencement Date, if a Variable Dollar Benefit is
elected by a Participant, the Fee will be deducted pro-rata from each Benefit
Payment and will result in a reduction in the amount of such payment.
The Fee may be waived in whole or in part in our sole discretion.
SURRENDERS
Surrenders
A surrender in full may be made for a Participant's Account Value, or partial
surrenders may be made for a lesser amount, by Written Request at any time prior
to the Participant's Annuity Commencement Date. The amount of any partial
surrender must be at least $500. If a partial surrender would reduce a
Participant's Account Value to less than $500, we will treat the surrender
request as a request for full surrender. Surrenders will be deemed to be
withdrawn first from the portion of the Account Value that represents a
Participant's Accumulated Earnings and then from Purchase Payments. For purposes
of this Contract, Purchase Payments are deemed to be withdrawn on a "first-in,
first-out" (FIFO) basis.
The amount available for surrender will be the Account Value at the end of the
Valuation Period in which the Written Request is received by us.
Deferral of Payment
The Company has the right to suspend or delay the date of payment of a partial
or full surrender of the Variable Account Value for any period:
1) when the New York Stock Exchange is closed, or when trading on the New
York Stock Exchange is restricted; or
2) when an emergency exists (as determined by the Securities and Exchange
Commission) as a result of which:
a) the disposal of securities in the Separate Account is not
reasonably practicable; or
b) it is not reasonably practicable to determine fairly the value
of the net assets in the Separate Account; or
3) when the Securities and Exchange Commission so permits for the
protection of security holders.
The Company further reserves the right to delay payment of a partial or full
surrender of the Fixed Account Value for up to six (6) months after we receive a
Written Request.
OWNERSHIP PROVISIONS
Ownership of Separate Account
The Company has absolute ownership of the assets in the Separate Account.
However, the Company is not, and does not hold itself out to be, a trustee in
respect of any amounts under the Separate Account.
Ownership of Contract and Participant Account
The Contract Owner must be an employer or the trustee for an employer's
retirement plan. The Contract Owner is shown on the Contract Specifications
page. This Contract is held by the Contract Owner for the benefit of the
Participants and Beneficiaries.
Each participant for whom Purchase Payment(s) are made will participate in this
Contract as a Participant. A participant account will be established for each
Participant.
Transfer and Assignment
Neither you nor a Participant may transfer, sell, assign, pledge, charge,
encumber or in any way alienate an interest under this Contract.
Successor Owner
By Written Request, a Participant's spouse may, in some cases, succeed to the
ownership of a Participant's participation interest under this Contract after
the Participant's death. Specifically, if a Participant dies and his or her
spouse is the sole surviving Beneficiary of the Participant's participation
interest, he or she will become the Successor Owner of the Participant's
participation interest if: 1) the Participant makes that Written Request before
his or her death; or 2) after the Participant's death, his or her spouse makes
that Written Request within one (1) year of the Participant's death and before
the Death Benefit Commencement Date.
As Successor Owner, the Participant's spouse will then succeed to all the
Participant's rights of ownership under this Contract except the right to name
another Successor Owner.
Community Property
If a Participant lives in a community property state and has a spouse at any
time while he or she participates under this Contract, the laws of that state
may vary his or her ownership rights.
BENEFICIARY PROVISIONS
Beneficiary
A Participant's Beneficiary is the person or persons so designated on his or her
enrollment form, if any, or under the Change of Beneficiary provision of this
Contract. If a Participant has not designated a Beneficiary, or if no
Beneficiary designated survives the Participant, then the Beneficiary will be
the Participant's estate.
A Beneficiary will be deemed not to have survived a Participant if he or she
dies within thirty (30) days after the Participant's death.
A Beneficiary designation may be joint or contingent or both. Unless otherwise
stated, joint Beneficiaries will be entitled to equal shares. A contingent
Beneficiary will be entitled to a benefit only if there is no surviving primary
Beneficiary.
Change of Beneficiary
Unless a Participant has designated an irrevocable Beneficiary, he or she may
change his or her designation of a Beneficiary at any time before the Annuity
Commencement Date.
Any such change is subject to the following:
1) it must be made by Written Request; and
2) unless otherwise elected or required by law, it will not cancel any
settlement option election previously made.
BENEFIT ON ANNUITY COMMENCEMENT DATE
Annuity Commencement Date
The Annuity Commencement Date for a Participant is shown on the Participant's
Certificate Specifications page. A Participant may change his or her Annuity
Commencement Date by Written Request made at least thirty (30) days prior to the
date that Annuity Benefit payments are scheduled to begin. Unless the Company
agrees otherwise, a Participant's Annuity Commencement Date cannot be later than
the Certificate Anniversary following his or her 85th birthday, or five (5)
years after his or her Certificate Effective Date, whichever is later.
Annuity Benefit Payments
An amount equal to the Participant's Account Value (after deduction of any fees
and charges, loans, or applicable premium tax or other taxes not previously
deducted) will be used to provide Annuity Benefit payments to Participants under
this Contract commencing on or after a Participant's Annuity Commencement Date.
Annuity Benefit payments will be made to the Participant as payee. Any Annuity
Benefit amounts remaining payable on his or her death will be paid to the
contingent payee designated by the Participant by Written Request. We may reject
the naming of a non-natural payee. The Participant will be the person on whose
life any Annuity Benefit payments are based.
If no contingent payee designated by the Participant is surviving at the time
payment is to be made, then after the Participant's death any Annuity Benefit
amounts remaining payable will be paid to the person or persons designated as
contingent payee by Written Request by the last payee who received payments.
Failing that, any such amounts will be paid to the estate of the last payee who
received payments.
Form of Annuity Benefit
Annuity Benefit payments will be Fixed Dollar Benefit payments, made monthly in
accordance with the terms of Option B with a fixed period of one hundred twenty
(120) months under the SETTLEMENT OPTIONS section of this Contract.
In lieu of that, a Participant may elect to have Annuity Benefit payments made
pursuant to any other available settlement option under the SETTLEMENT OPTIONS
section of this Contract. Any such election must be made by Written Request
before the Annuity Commencement Date. A Participant may change his or her
election of a settlement option by Written Request made at least thirty (30)
days prior to the date that Annuity Benefit payments are scheduled to begin.
BENEFIT ON DEATH OF PARTICIPANT
Death Benefit
A Death Benefit will be paid under this Contract if:
1) a Participant dies before his or her Annuity Commencement Date and
before his or her participation
interest is fully surrendered;
2) the Participant's Death Benefit Valuation Date has occurred; and
3) the Participant's spouse does not become the Successor Owner of the
Participant's participation interest.
If a Death Benefit becomes payable with respect to a Participant:
1) it will be in lieu of all other benefits with respect to that
Participant under this Contract; and
2) all other rights with respect to that Participant under this Contract
will be terminated except for rights related to the Death Benefit.
Death Benefit payments shall be made to the Participant's Beneficiary as payee.
The Participant's Beneficiary will be the person on whose life any Death Benefit
payments under a settlement option are based.
Any Death Benefit amounts remaining payable on the death of a Beneficiary will
be paid:
1) to any contingent payee designated by the Participant as part of any
Death Benefit settlement option election made by the Participant, or if
none is surviving at the time payment is to be made; then
2) to any contingent payee designated by the Beneficiary by Written
Request, or if none is surviving at the time payment is to be made;
then
3) to the estate of the last payee who received payments.
Only one Death Benefit will be paid with respect to a Participant's
participation interest under this Contract.
Death Benefit Amount
The Death Benefit will be an amount equal to the greater of:
1) the Participant's Account Value as of the Death Benefit Valuation Date;
or
2) one hundred percent (100%) of the Purchase Payment(s) received by us
for him or her, less any amounts returned.
As of the Death Benefit Valuation Date for a Participant, the amount of the
Death Benefit will be allocated among the Sub-Accounts in the same proportion as
each Account's value is to the total Account Value for that Participant as of
the end of the Valuation Period immediately preceding the Death Benefit
Valuation Date.
Any applicable premium tax or other taxes not previously deducted, and any
outstanding loans, will be deducted from the Death Benefit amount described
above.
Transfers After Death
Between the Death Benefit Valuation Date and the Death Benefit Commencement
Date, a Beneficiary may transfer funds among Sub-Accounts as described under the
TRANSFERS section of this Contract.
Form of Death Benefit
Payments under the Death Benefit provision of this Contract will be Fixed Dollar
Benefit payments made monthly in accordance with the terms of Option A with a
period certain of forty-eight (48) months under the SETTLEMENT OPTIONS section
of this Contract.
In lieu of that, a Participant may elect at any time before his or her death to
have payments under the Death Benefit provision of this Contract made in one
lump sum or pursuant to any available settlement option under the SETTLEMENT
OPTIONS section of this Contract. If a Participant does not make any such
election, the Beneficiary may make that election at any time after the
Participant's death and before the Death Benefit Commencement Date.
A Participant may change his or her election of a settlement option at any time
before his or her death.
If a Beneficiary elects a settlement option as noted above, he or she may change
his or her own election of a settlement option by Written Request made at least
thirty (30) days prior to the date that Death Benefit payments are scheduled to
begin.
Any election or change of election must be made by Written Request.
SETTLEMENT OPTIONS
Conditions
The amount applied to a settlement option must be at least $2,000. We will pay
the Participant the Account Value in one lump sum on the Annuity Commencement
Date if it is less than $2,000. The amount of any Fixed Dollar Benefit payment,
or the amount of the first Variable Dollar Benefit payment, under a settlement
option must be at least $20. More than one settlement option may be elected if
the requirements for each settlement option elected are satisfied. Once payment
begins under a settlement option, the settlement option may not be changed.
All elected settlement options must comply with current applicable laws,
regulations and rulings issued by any governmental agency.
If more than one person is the payee under a settlement option, payments will be
made to the payees jointly. No more than two persons may be initial payees under
any joint and survivor settlement options.
If payment under a settlement option depends on whether a specified person is
still alive, we may at any time require proof that such person is still living.
We will require proof of the age of any person on whose life Benefit Payments
are based.
Benefit Payments
Benefit Payments may be calculated and paid:
1) as a Fixed Dollar Benefit;
2) as a Variable Dollar Benefit; or
3) as a combination of both.
If only a Fixed Dollar Benefit is to be paid, we will transfer all of the
Participant's Account Value to the Company's general account on the applicable
Commencement Date, or on the Death Benefit Valuation Date (if applicable).
Similarly, if only a Variable Dollar Benefit is elected, we will transfer all of
the Participant's Account Value to the Sub-Accounts as of the end of the
Valuation Period immediately prior to the applicable Commencement Date; we will
allocate the amount applied to a Variable Dollar Benefit among the Sub-Accounts
in accordance with a Written Request. No transfers between the Fixed Dollar
Benefit and the Variable Dollar Benefit will be allowed after the Commencement
Date. However, after the Variable Dollar Benefit has been paid for at least
twelve (12) months, the Person Controlling Payments may, no more than once each
twelve (12) months thereafter, transfer all or part of the Benefit Units upon
which the Variable Dollar Benefit is based from the Sub-Account(s) then held, to
the Benefit Units in different Sub-Account(s).
If a Variable Dollar Benefit is elected, the amount to be applied under that
benefit is the Variable Account Value as of the end of the Valuation Period
immediately preceding the applicable Commencement Date. If a Fixed Dollar
Benefit is to be paid, the amount to be applied under that benefit is the Fixed
Account Value as of the applicable Commencement Date, or as of the Death Benefit
Valuation Date (if applicable).
Fixed Dollar Benefit
Fixed Dollar Benefit payments are determined by multiplying the Participant's
Fixed Account Value (expressed in thousands of dollars and after deduction of
any fees and charges, loans, or applicable premium tax or other taxes not
previously deducted) by the amount of the monthly payment per $1,000 of value
obtained from the Settlement Option Table for the settlement option elected.
Fixed Dollar Benefit payments will remain level for the duration of the Benefit
Payment Period.
If at the time a Fixed Dollar Benefit is elected, we have available options or
rates on a more favorable basis than those guaranteed, the higher benefits shall
be applied and shall not change for as long as that election remains in force.
Variable Dollar Benefit
The first monthly Variable Dollar Benefit payment is equal to the Participant's
Variable Account Value (expressed in thousands of dollars and after deduction of
any fees and charges, loans, or applicable premium tax or other taxes not
previously deducted) as of the end of the Valuation Period immediately preceding
the applicable Commencement Date multiplied by the amount of the monthly payment
per $1,000 of value obtained from the Settlement Option Table for the Benefit
Payment elected less the pro-rata portion of the Certificate Maintenance Fee.
The number of Benefit Units in each Sub-Account held by a Participant is
determined by dividing the dollar amount of the first monthly Variable Dollar
Benefit payment from each Sub-Account by the Benefit Unit Value for that
Sub-Account as of the applicable Commencement Date. The number of Benefit Units
remains fixed during the Benefit Payment Period, except as a result of any
transfers among Sub-Accounts after the applicable Commencement Date.
The dollar amount of the second and subsequent Variable Dollar Benefit payment
will reflect the investment performance of the Sub-Account(s) selected and may
vary from month to month. The total amount of the second and any subsequent
Variable Dollar Benefit payment will be equal to the sum of the payments from
each Sub-Account less a pro-rata portion of the Certificate Maintenance Fee.
The payment from each Sub-Account is found by multiplying the number of Benefit
Units held in each Sub-Account by a Participant by the Benefit Unit Value for
that Sub-Account as of the end of the fifth Valuation Period preceding the due
date of the payment.
The Benefit Unit Value for each Sub-Account is originally established in the
same manner as Accumulation Unit Values. Thereafter, the value of a Benefit Unit
for a Sub-Account is determined by multiplying the Benefit Unit Value as of the
end of the preceding Valuation Period by the Net Investment Factor, determined
as set forth under the Accumulation Unit Value provision of this Contract, for
the Valuation Period just ended. The product is then multiplied by the assumed
daily investment factor (0.99991781), for the number of days in the Valuation
Period. The factor is based on the assumed net investment rate of three percent
(3%) per year, compounded annually, that is reflected in the Settlement Option
Tables.
Variable Dollar Benefit payments will not be adversely affected by actual
mortality and expense experience of the Sub-Accounts.
Limitation on Election of Settlement Option
Fixed periods shorter than five (5) years are not available, except as a Death
Benefit settlement option.
Settlement Option Computations
The 1983 Group Annuity Mortality Table with interest at three percent (3%) per
year, compounded annually, is used to compute all guaranteed settlement option
factors, values, and benefits under this Contract.
Available Settlement Options
The available settlement options are set out below.
Option A Income for a Fixed Period
We will make periodic payments for a fixed period. The first payment
will be paid as of the last day of the initial Payment Interval. The
maximum time over which payments will be made by us or money will be
held by us is thirty (30) years. The Option A Table applies to this
Option.
Option B Life Annuity with Payments for at Least a Fixed Period
We will make monthly payments for at least a fixed period. If the
person on whose life Benefit Payments are based lives longer than the
fixed period, then we will make payments until his or her death. The
first payment will be paid as of the first day of the initial Payment
Interval. The Option B Table applies to this Option.
Option C Joint and One-half Survivor Annuity
We will make periodic payments until the death of the primary person on
whose life Benefit Payments are based; thereafter, we will make
one-half (1/2) of the periodic payment until the death of the secondary
person on whose life Benefit Payments are based. The first payment will
be paid as of the first day of the initial Payment Interval. The Option
C Table applies to this Option.
Option D Life Annuity
We will make periodic payments until the death of the person on whose
life Benefit Payments are based. The first payment will be paid as of
the first day of the initial Payment Interval. The Option D Table
applies to this Option.
Option E Any Other Form
We will make periodic payments in any other form of settlement option
which is acceptable to us at the time of election.
Settlement Option Tables
The Option Tables show the payments we will make at sample Payment Intervals for
each $1,000 applied at the guaranteed interest rate. Amounts may vary with the
Payment Interval and the age of the person on whose life Benefit Payments are
based.
OPTION A TABLE - INCOME FOR A FIXED PERIOD
Payments for fixed number of years for each $1,000
applied.
---------------------------------------------------------------------------------------------------------------------------
Terms of Semi-Annual Terms Semi-Annual Terms of Semi-Annual
Payments Annual Quarterly Monthly of Annual Quarterly MonthlyPayments Annual Quarterly Monthly
Payments
---------------------------------------------------------------------------------------------------------------------------
Years Years Years
6 184.60 91.62 45.64 15.18 11 108.08 53.64 26.72 8.88 16 79.61 39.51 19.68 6.54
7 160.51 79.66 39.68 13.20 12 100.46 49.86 24.84 8.26 17 75.95 37.70 18.78 6.24
8 142.46 70.70 35.22 11.71 13 94.03 46.67 23.25 7.73 18 72.71 36.09 17.98 5.98
9 128.43 63.74 31.75 10.56 14 88.53 43.94 21.89 7.28 19 69.81 34.65 17.26 5.74
10 117.23 58.18 28.98 9.64 15 83.77 41.57 20.71 6.89 20 67.22 33.36 16.62 5.53
---------------------------------------------------------------------------------------------------------------------------
OPTION B TABLE - LIFE ANNUITY
With Payments For At Least A Fixed Period
---------- ---------------- --------------- ---------------- ----------------
60 Months 120 Months 180 Months 240 Months
---------- ---------------- --------------- ---------------- ----------------
Age
---------- ---------------- --------------- ---------------- ----------------
55 $4.55 $4.51 $4.44 $4.33
56 4.65 4.61 4.52 4.39
57 4.76 4.71 4.61 4.46
58 4.87 4.81 4.70 4.53
59 4.99 4.92 4.79 4.60
60 5.12 5.04 4.89 4.67
61 5.25 5.16 4.99 4.74
62 5.40 5.29 5.09 4.81
63 5.55 5.42 5.19 4.87
64 5.72 5.56 5.30 4.94
65 5.89 5.71 5.40 5.00
66 6.08 5.86 5.51 5.06
67 6.27 6.02 5.62 5.11
68 6.48 6.19 5.72 5.17
69 6.71 6.36 5.83 5.22
70 6.95 6.54 5.93 5.26
71 7.20 6.72 6.03 5.30
72 7.46 6.90 6.12 5.34
73 7.75 7.08 6.21 5.37
74 8.04 7.27 6.30 5.40
---------- ---------------- --------------- ---------------- ----------------
OPTION C TABLE - JOINT AND ONE-HALF SURVIVOR
ANNUITY Monthly payments for each $1,000 of proceeds by
ages of persons named.*
-------------- -------------------------------------------------------------------------------------------------------
Secondary Age
Primary Age
60 61 62 63 64 65 66 67 68 69 70
60 4.73 $4.75 $4.78 $4.80 $4.83 $4.85 $4.87 $4.89 $4.92 $4.93 $4.95
61 4.81 4.84 4.87 4.90 4.92 4.95 4.97 5.00 5.02 5.04 5.06
62 4.90 4.93 4.96 4.99 5.02 5.05 5.08 5.11 5.13 5.16 5.18
63 4.99 5.03 5.06 5.09 5.13 5.16 5.19 5.22 5.25 5.28 5.30
64 5.09 5.12 5.16 5.20 5.23 5.27 5.30 5.34 5.37 5.40 5.43
65 5.18 5.22 5.26 5.31 5.35 5.38 5.42 5.46 5.49 5.53 5.56
66 5.28 5.33 5.37 5.42 5.46 5.50 5.54 5.58 5.62 5.66 5.70
67 5.38 5.43 5.48 5.53 5.58 5.62 5.67 5.72 5.76 5.80 5.84
68 5.49 5.54 5.59 5.65 5.70 5.75 5.80 5.85 5.90 5.95 5.99
69 5.60 5.65 5.71 5.77 5.82 5.88 5.93 5.99 6.04 6.10 6.15
70 5.71 5.77 5.83 5.89 5.95 6.01 6.07 6.13 6.19 6.25 6.31
-------------- -------- -------- --------- --------- -------- --------- -------- --------- -------- --------- --------
*Payments after the death of the Primary Payee will be one-half (1/2) of the
amount shown.
OPTION D TABLE - LIFE ANNUITY Monthly
payments for each $1,000 applied.
------------------------------ -------------------------
Age
------------------------------ -------------------------
55 $4.65
56 4.67
57 4.77
58 4.89
59 5.01
60 5.14
61 5.28
62 5.43
63 5.59
64 5.76
65 5.95
66 6.14
67 6.35
68 6.58
69 6.82
70 7.08
71 7.36
72 7.66
73 7.98
74 8.33
------------------------------ -------------------------
[GRAPHIC OMITTED]
Group Flexible Premium Deferred Variable Annuity Contract
Nonparticipating - No Dividends
