EXHIBIT 10.2
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(Aetna Logo Goes Here) AETNA LIFE INSURANCE AND ANNUITY COMPANY
HOME OFFICE: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000
Aetna Life Insurance and Annuity
Company, herein called Aetna, agrees to pay
the benefits stated in this Contract.
SPECIFICATIONS
Plan
INFORMATION ANALYSIS INC. 401(K) PROFIT SHARING PLAN
Type of Plan
ALLOCATED PENSION OR PROFIT SHARING PLAN
Contract Holder
TRUSTEES OF INFORMATION ANALYSIS INC. 401(K) PROFIT SHARING PLAN
Group Contract No.
PH0052
.-
Effective Date
NOVEMBER 10, 1993
This Contract is Delivered in VIRGINIA and is Subject to the Laws of that
Jurisdiction
THE VARIABLE FEATURES OF THE GROUP CONTRACT ARE DESCRIBED IN PART IV.
RIGHT TO CANCEL
The Contract Holder may cancel this Contract within 10 days of receiving it by
returning this Contract along with a written notice to Aetna at the above
address or to the agent from whom it was purchased. Within 7 days after it
receives the notice of cancellation and this Contract at its Home Office, Aetna
will return the entire consideration paid plus any increase or minus any
decrease in the current value of any funds allocated to the Separate Account.
This page, the following pages, and the application make up the entire Contract.
Signed at the Home Office on the Effective Date.
/s/ Xxxx X. Xxxxxxx /s/ Xxxxxx X. Xxxxxxx
Xxxx X. Xxxxxxx Xxxxxx X. Xxxxxxx
President Secretary
Multiple Asset Portfolio (MAP) V-Allocated
Group Annuity Contract
Nonparticipating
ALL PAYMENTS AND VALUES PROVIDED BY THE GROUP CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THIS CONTRACT CONTAINS MARKET VALUE ADJUSTMENT FORMULAS.
APPLICATION OF A MARKET VALUE ADJUSTMENT TO THE GAA MAY RESULT IN EITHER AN
INCREASE OR DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA
DOES NOT APPLY TO A GUARANTEED TERM AT THE TIME OF ITS MATURITY. APPLICATION OF
A MARKET VALUE ADJUSTMENT TO THE FIXED ACCOUNT MAY RESULT IN A DECREASE IN THE
CURRENT VALUE.
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SPECIFICATIONS (continued)
GUARANTEED There are guaranteed interest rates for amounts held
INTEREST RATE in the Fixed Account and the Guaranteed Accumulation
Account. (See 4.02 and 4.03(d).)
INSTALLATION This Contract may be subject to an Installation
CHARGE Charge. (See Contract Specifications and 4.08.)
DEDUCTION FROM Purchase Payment(s) are subject to deductions for
PURCHASE premium taxes and conversion charges, if any.
PAYMENT(S) (See 3.01.)
DEDUCTIONS A Daily Asset Charge expressed as an annual rate
FROM of Current Value will be deducted for Aetna's expense
THE SEPARATE risks, which may include profit. (See 4.05.) The
ACCOUNT Daily Asset Charge varies by the total value of
assets held under this Contract and certain other
related contracts. (See Contract Specifications).
SURRENDER Certain withdrawals from this Contract may be subject
CHARGE to a Surrender Charge. (See Contract Specifications
and 7.04.)
This Contract is a legal contract and constitutes the entire legal relationship
between Aetna and the Contract Holder.
READ THIS CONTRACT CAREFULLY. This Contract sets forth, in detail, all of the
rights and obligations of both you and Aetna. IT IS, THEREFORE, IMPORTANT THAT
YOU READ THIS CONTRACT CAREFULLY.
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SPECIFICATIONS
(continued)
Contract Holder TRUSTEES OF INFORMATION ANALYSIS INC. 401(K) PROFIT
SHARING PLAN
Group Contract No. PH0052
I. Installation $ 0
Charge
(See 4.08)
II. Amount of Daily CURRENT VALUE OF ALL PLAN ACCOUNTS ASSET CHARGE
Asset Charge
Expressed as an Less than $400,000 1.25%
annual percentage $400,000 but less than $1 million 1.05%
$1 million but less than $5 million .95%
$5 million but less than $10 million .85%
More than $10 million .85%
This Asset Charge does not reflect the charge to a Split-Funded Plan (see 2.03).
The Daily Asset Charge will be adjusted (up or down) no less often than annually
in accordance with Aetna's existing administrative practice to reflect
changes in the Current Value of all Plan Accounts. See 8.12 for rules
permitting the aggregation of Plan Accounts with certain other contracts issued
by Aetna for purposes of satisfying the Current Value breakpoints shown above.
The Daily Asset Charge does not include investment advisory fees charged by a
Fund investment manager. The investment advisory fee is disclosed in the
applicable Fund prospect.
.
III. Maintenance Fee The Participant Accounts maintained under this
Deduction Contract may have multiple asset accounts (see
3.02). The Participant Account Maintenance Fee
. will be deducted from the employer profit
sharing (unless paid directly by the contract
holder) asset account. (See 4.09)
-
IV. Surrender Charge Contract Years Completed Surrender Charge
(See 7.04)
Less than 1 5%
1 but less than 2 4%
2 but less than 3 3%
3 but less than 4 2%
4 but less than 5 1%
more than 5 0%
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(Intentionally Left Blank)
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TABLE OF CONTENTS
I. GENERAL DEFINITIONS
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Page
1.01 Annuitant 5
1.02 Annuity 5
1.03 Code 5
1.04 Contract Holder 5
1.05 Contract Year 5
1.06 Current Value 5
1.07 Deposit Period 5
1.08 General Account 5
1.09 Good Order 5
1.10 Group Trust Contract Holder 5
1.11 Guaranteed Accumulation Account (GAA) 5
1.12 Fixed Account 5
1.13 Fixed Annuity 5
1.14 Fund(s) 5
1.15 Market Value Adjustment (MVA) 5
1.16 Matured Term Value 6
1.17 Maturity Date 6
1.18 Nonunitized Separate Account 6
1.19 Participant 6
1.20 Participant Account 6
1.21 Plan 6
1.22 Plan Account 6
1.23 Purchase Payments 6
1.24 Separate Account 6
1.25 Separated Employee Account 6
1.26 Single Plan Contract Holder 6
1.27 Split-Funded Plan 6
1.28 Sub-Contract Holder 6
1.29 Surrender 7
1.30 Term 7
1.31 Trustee Account 7
1.32 Valuation Period (Period) 7
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II. PLAN ADMINISTRATIVE SERVICES
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Page
2.01 General 7
2.02 Additional Services 7
2.03 Split-Funded Plans 7
III. PURCHASE PAYMENT AND PLAN ACCOUNTS
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3.01 Net Purchase Payment(s) 8
3.02 Participant Accounts 8
3.03 Investment Allocation 8
3.04 Individual Certificates 9
3.05 Trustee Accounts 9
3.06 Separated Employee Accounts 9
3.07 Notice to the Contract Holder 9
IV. ACCOUNT VALUES
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4.01 Current Value 10
4.02 Guaranteed Interest Rate--Fixed Account 10
4.03 Guaranteed Accumulation Account (GAA) 10
4.04 Fund(s) Record Units--Separate Account 13
4.05 Net Return Factor(s)--Separate Account 13
4.06 Fund(s) Record Unit Value--Separate Account 13
4.07 Experience Credits 13
4.08 Installation Charge 13
4.09 Maintenance Fee 14
4.10 Automation Discount 15
V. TRANSFERS AND DISTRIBUTIONS
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5.01 Transfer of Current Value from the Funds or GAA 15
5.02 Transfer of Current Value from the Fixed Account 16
5.03 Systematic Allocation 16
5.04 Required Distribution to Participant 17
5.05 Sum Payable at Death (Before Annuity Payments Start) 17
5.06 Distribution Options 17
3
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VI. ANNUITY PROVISIONS
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PAGE
6.01 Choices to be Made 21
6.02 Annuity Payments to Annuitant 21
6.03 Annuity Payments to Participant's Beneficiary
Under the Plan 22
6.04 Terms of Annuity Options 22
6.05 Death of Annuitant 23
6.06 Annuity Options 23
6.07 Annuity Tables 23
VII. WITHDRAWALS AND TERMINATION OF CONTRACT
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7.01 Payment of Surrender Value 27
7.02 Payment of Fixed Account Surrender Value 28
7.03 Payment of GAA Surrender Value 28
7.04 Surrender Charge 29
7.05 Reinstatement 30
7.06 Termination or Transfer to Another Contract 30
VIII. GENERAL PROVISIONS
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8.01 Change of Contract 30
8.02 Substitution, Elimination, and Addition of Fund(s) 32
8.03 Nonparticipating Contract 32
8.04 Payments 32
8.05 State Laws 32
8.06 Control of Contract 32
8.07 Designation of Beneficiary 33
8.08 Misstatements and Adjustments 33
8.09 Incontestability 33
8.10 Grace Period 33
8.11 Nonwaiver 33
8.12 Aggregation of Contracts 33
8.13 Conversion of Xxxxxxxxx 00
0
00
X. GENERAL DEFINITIONS
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1.01 ANNUITANT: A person on whose life an Annuity has been effected under this Contract.
1.02 ANNUITY: Payment of an income:
(a) For the life of one or two persons;
(b) For a stated period; or
(c) For some combination of (a) and (b).
1.03 CODE: The Internal Revenue Code of 1986, as it may be
amended from time to time
1.04 CONTRACT HOLDER: The Contract Holder will be either a Single Plan
Contract Holder (see 1.26) or a Sub-Contract Holder (see 1.28).
1.05 CONTRACT YEAR: The period of 12 months measured from the date the
first Net Purchase Payment is applied to the Contract or from
any anniversary of such date.
1.06 CURRENT VALUE: See 4.01.
1.07 DEPOSIT PERIOD: See 4.03(a).
1.08 GENERAL ACCOUNT: The account holding the assets of Aetna, other than those
assets held in a Separate Account or a Nonunitized Separate
Account.
1.09 GOOD ORDER: An authorized Participant or Contract Holder
instruction to Aetna is in Good Order when given with such clarity and
completeness that Aetna is not required to exercise any discretion,
utilizing such forms as Aetna may require.
1.10 GROUP TRUST The trustees of a group trust which (a) acquires this Contract,
CONTRACT HOLDER: (b) limits participation to Pension and Profit Sharing
Plans and Trusts qualified under Section 401 (a) of the Code and exempt
from tax under Section 501 (a) of the Code, and (c) which is
intended to meet the requirements of Internal Revenue
Service Revenue Ruling 81-100, as modified
or superseded.
1.11 GUARANTEED ACCUMULATION An accumulation option which guarantees a stipulated rate of
ACCOUNT (GAA): interest for a specified period of time.
1.12 FIXED ACCOUNT: An accumulation option with a guaranteed minimum interest
rate. Aetna may credit a higher rate which is not guaranteed.
1.13 FIXED ANNUITY: An Annuity with payments which do not vary in amount.
1.14 Fund(s): The open-end, registered, management investment companies
(mutual funds) made available by Aetna under this Contract.
1.15 MARKET VALUE See 7.02(b) for the Fixed Account Market Value Adjustment; see
ADJUSTMENT (MVA): 7.03(b) for the GM Market Value Adjustment.
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1.16 MATURED TERM VALUE: The amount payable on a GM Term's Maturity Date.
1.17 MATURITY DATE: The last day of a GM Term.
1.18 NONUNITIZED SEPARATE A separate account set up by Aetna under Title 38a, Section
ACCOUNT: 38a-433, of the Connecticut General Statutes to hold assets for
GM Terms. See 4.03(c) and (9). Aetna owns the assets held in
such an account and is not a trustee as to the amounts held.
The assets in such account may be charged with other Aetna
liabilities.
1.19 PARTICIPANT: A person who participates in the Plan named on the cover page
of this Contract or in the Plan named on the cover page of the
Sub-Contract Holder Certificate.
1.20 PARTICIPANT ACCOUNT: See 3.02.
1.21 PLAN: The Plan named on the Contract or Certificate cover page. The
Plan is not a part of the Contract. Aetna is not bound by the
terms of the Plan.
1.22 PLAN ACCOUNT: Participant Accounts, Separated Employee Accounts, and
Trustee Accounts.
1.23 PURCHASE PAYMENTS: Payments made to Aetna for allocation to Plan Accounts under
this Contract.
1.24 SEPARATE ACCOUNT: An account set up by Aetna under Title 38a, Section 38a-433, of
the Connecticut General Statutes which buys and holds shares
of the Fund(s). Income, gains or losses, realized or unrealized
are credited or charged to this account without regard to other
income, gains or losses of Aetna. Aetna owns the assets held in
such an account and is not a trustee as to the amounts held.
These accounts generally are not guaranteed and assets therein are held at
market value. The assets of such accounts to the
extent of reserves and other contract liabilities of the account,
shall not be charged with other Aetna liabiiities.
1.25 SEPARATED EMPLOYEE See 3.06.
ACCOUNT:
1.26 SINGLE PLAN CONTRACT The trustees of a Pension or Profit Sharing Plan and Trust
HOLDER: which (a) acquires this Contract, (b) is adopted by an employer
or by a controlled group or affiiiated service group of employers,
and (c) which is qualified under Section 401 (a) of the Code and
exempt from tax under Section 501 (a) of the Code.
1.27 SPLIT-FUNDED PLAN: A Plan which offers Participants investment options not provided
under this Contract, excluding investment options no longer
accepting payments and scheduled to convert to this Contract.
1.28 SUB-CONTRACT HOLDER: The trustees of a Pension or Profit Sharing Plan and Trust
which (a) is quaiified under Section 401(a) of the Code and exempt from tax under
Section 501 (a) of the Code, (b) has
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1.28 SUB-CONTRACT HOLDER adopted the group trust of the Group Trust Contract Holder as
(Cont'd): part of such plan and trust, and (c) has agreed in
writing to be bound by the provisions of the
group trust and this Contract.
1.29 SURRENDER: See 7.01.
1.30 Term: See 4.03(b) and 4.03(c).
1.31 TRUSTEE ACCOUNT: See 3.05.
1.32 VALUATION PERIOD The period of time for which a Fund determines its net asset
(Period): value, usually from 4:15 p.m. Eastern Time each day the New
York Stock Exchange is open until 4:15 p.m. the next such day,
or such other day that one or more of the Funds determines its
net asset value.
II. PLAN ADMINISTRATIVE SERVICES
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2.01 GENERAL: The person or entity designated as administrator in the Plan
document is primarily responsible for Plan administration. Aetna
is not the Plan Administrator. Aetna will provide certain services
to the Plan as set forth herein and as selected by the Contract
Holder. The amount of the Daily Asset Charge wiil be affected
by the level of service provided by Aetna and/or its licensed
representatives under this Contract.
2.02 ADDITLONAL SERVICES: Aetna or its licensed representatives wiil provide certain basic
enrollment and administrative services to the Plan, under this
Contract. The full range of such services to be provided to the
Plan by Aetna will be disclosed to the Contract Holder on or
before the Effective Date. Aetna and the Group Trust Contract
Holder or the Single Plan Contract Holder, as appropriate, may
agree in writing to have additional services provided to the Plan
by Aetna or its licensed representatives. At the option of the
Contract Holder, the cost of such additional services may be
billed directly or assessed in conjunction with the Maintenance
Fee. With Aetna's consent, the cost of such additional service
may be included as an adjustment to the Daily Asset Charge
deducted from a Separate Account or as an adjustment to the
interest credited to the Fixed Account and GAA.
2.03 SPILT-FUNDED PLANS: For Split-Funded Plans the Daily Asset Charge, when expressed
as an annual percentage rate, shall be .10 percentage points
higher than that of Plans which offer Participants only the
investment options provided under this Contract. Aetna credits a
lower Fixed Account rate of interest for such Plans. If a Plan
becomes a Split-Funded Plan after the Effective Date, the higher
Daily Asset Charge and the new Fixed Account credited rate will
become effective in accordance with Aetna's existing
administrative practice, but in no event later than the first day of
the next succeeding Contract Year. If a Plan ceases being
Split-Funded, the lower Daily Asset Charge and the new Fixed
Account credited rate will become effective in
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2.03 SPLIT-FUNDED PLANS Aetna's existing administrative practice, but in no event later
(Cont'd): than the first day of the next succeeding Contract Year. The
Group Trust Contract Holder or the Single Plan Contract Holder,
as appropriate, must inform Aetna whether its Plan offers
Participants investment options not provided under this Contract.
III. PURCHASE PAYMENT AND PLAN ACCOUNTS
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3.01 NET PURCHASE The actual Purchase Payment(s) less premium tax and charges
PAYMENT(S): due at conversion, if any. As a rule, Aetna will deduct the
premium tax when Annuity benefits are purchased (see Part VI).
If Aetna determines that a premium tax is due when Purchase
Payments are received or at any other time, it will deduct the tax
at that time. Conversion charges may arise when any Purchase
Payment is derived from the cancellation of any contract or
policy issued by Aetna or any of its affiiiates (see 8.13). Such
Purchase Payment may be subject to deductions in accordance
with Aetna's administrative practice.
3.02 PARTICIPANT ACCOUNTS: Aetna will maintain an individual account for each Participant. If
instructed by the Contract Holder, Aetna will maintain up to 5
asset accounts for each such Participant Account. These will
be:
(a) Up to 4 asset accounts for crediting employer or employee Net
Purchase Payment(s); and
(b) One asset account for crediting employee rollovers from other
pension plans or individual retirement accounts.
More than 5 asset accounts, if permitted by Aetna, may be
subject to an additional fee in accordance with Aetna's
administrative practice.
Net Purchase Payments will be allocated to Participant Accounts
and their asset accounts as directed by the Contract Holder or
the Participant, as appropriate.
3.03 INVESTMENT ALLOCATION: For each Plan Account the Contract Holder will direct that the
Net Purchase Payment(s) allocated to that Account be credited
among no more than 10 of the following:
(a) The Fixed Account;
(b) The GAA; and
(c) The Fund(s) in which the Separate Account invests.
Allocations to more than 10 such investment options, if
permitted by Aetna, may be subject to an
additional fee in accordance with Aetna's administrative practice.
Aetna must be told the percentage of the Net Purchase
Payment(s) to be applied to each investment above.
With the consent of the Contract Holder, the Participant
may direct the
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3.03 INVESTMENT ALLOCATION investment allocation of his or her
(CONT'D): Participant Account or any asset account
thereof. If Aetna does not receive
allocation instructions, unless otherwise
agreed with the Contract Holder, it will
return the Purchase Payment.
The investment allocation for Plan Accounts
may be changed up to 12 times during any
calendar year. More than 12 such changes
in any calendar year, if permitted by
Aetna, may be subject to an additional
fee in accordance with Aetna's
administrative practice.
3.04 INDIVIDUAL CERTIFICATES: Aetna shall issue certificates to the Sub-
Contract Holder and/or Participants as
required by the state in which this
Contract is delivered. The certificate will
summarize certain provisions of the
Contract. Certificates are for information
only and are not a part of the Contract.
3.05 TRUSTEE ACCOUNTS: Aetna will maintain one or more Trustee
Accounts as if each were a Participant
Account for the temporary holding of
amounts not allocated to other Plan
Accounts by the Contract Holder. When Aetna
receives Net Purchase Payments or Plan
forfeitures, but has not been told to
which Plan Accounts such amounts are to
be allocated, at the direction of the
Contract Holder such amounts will be
placed in a Trustee Account. Amounts
held in a Trustee Account will be invested
in a Fund or the Fixed Account selected by
the Contract Holder and will be
allocated to Participant Accounts when
Aetna receives allocation instructions.
Amounts in the Fixed Account will be
subject to the provisions of Sections 5.02
and (except when transferred to
Participant Accounts or Separated
Employee Accounts) 7.02. If Aetna does
not receive allocation instructions,
amounts held in a Trustee Account will be
allocated to the money market mutual fund
managed by Aetna and made available as a
Fund under this Contract.
3.06 SEPARATED EMPLOYEE At termination of employment, if the
ACCOUNTS: vested value of the terminating
Participant's Participant Account exceeds
$3,500.00, the Contract Holder may direct
that such vested value be transferred to a
Separated Employee Account. Aetna will
maintain the Separated Employee Account as
an individual account for such former
Participant. Investment allocations and
distributions will be as directed by the
Contract Holder.
3.07 NOTICE TO THE With respect to the Current Value of Plan
CONTRACT HOLDER: Accounts, Aetna will notify the Contract
Holder each year of:
(a) The value of any amounts held in:
(1) The Fixed Account;
(2) The GAA; and
(3) The Fund(s) for the Separate
Account.
(b) The number of any Fund(s) Record Units;
and
(c) The Fund(s) Record Unit Value.
Such number or values will be as of a date
no more than 60 calendar days before the
date of the notice.
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IV. ACCOUNT VALUES
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4.01 CURRENT VALUE: The Current Value of any Plan Account is
equal to:
(a) Any amounts in the Fixed Account,
including Fixed Account interest added
by Aetna; plus
(b) Any amounts in the GAA, including GAA
interest added by Aetna; plus
(c) The value of all Separate Account
Record Units.
Current Value does not include amounts used
to purchase an Annuity.
4.02 GUARANTEED INTEREST On any Net Purchase Payment(s) maintained
RATE -- FIXED ACCOUNT: in the Fixed Account, Aetna will add
interest daily at an annual rate no less
than 3%. Aetna may add interest daily at
any higher rate. Aetna will periodically
advise the Contract Holder of the rate
being currently credited to the Fixed
Account.
4.03 GUARANTEED The GAA guarantees stipulated rates of
ACCUMULATION interest for stated periods of time (see
ACCOUNT (GAA): (a) and (c) below). Amounts withdrawn
before the end of a Guaranteed Term may be
subject to a Market Value Adjustment (MVA)
(see 7.03(b)).
(a) Deposit Period--A calendar month, a
calendar quarter, or any other period
of time specified by Aetna during
which Net Purchase Payment(s) and
transfers are accepted into the GAA for
one or more Guaranteed Terms.
(b) Guaranteed Term (Term)--The period of
time for which interest rates are
guaranteed on Net Purchase Payment(s)
and on transfers allocated into a
Deposit Period of the GAA. Terms are
offered at Aetna's discretion for
various lengths of time ranging up to
and including ten years.
(c) Guaranteed Term Classifications--The
grouping of Terms according to
their time to maturity. The
following are the Classifications:
(1) Short Term: Terms of at least one
month up to and including 3 years;
or
(2) Long Term: Terms of greater than 3
years and up to and including 10
years.
During a Deposit Period, Aetna may make
available one or more Terms within a
Classification. At least one Term in the
Short Term Classification will be
available each Deposit Period. The
Contract Holder or Participant, as
appropriate, has the option to allocate
Net Purchase Payment(s) and transfers into
any or all of the available Deposit Period
Terms. If no specific direction is given,
Net Purchase Payment(s) and transfers will
go into available Terms on a pro rata basis
within the Classification(s)
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4.03 GUARANTEED previously chosen by the Contract Holder.
ACCUMULATION If there are no Terms available in the
ACCOUNT (GAA) Long Term Classification previously
(CONT'D): chosen, such amounts will be allocated to
the Term within the Short Term
Classification with the longest period.
(d) Guaranteed GAA Interest Rates
(Guaranteed Rates)--Aetna will
declare all interest rate(s)
applicable to a specific Term prior
to the start of the Deposit Period
for that Term. These rate(s) are
guaranteed by Aetna for that Deposit
Period and the ensuing Term and are not
based on the actual investment
experience of the underlying assets in
the GAA. The Guaranteed Rates are
annual effective yields. The interest
is credited daily at a rate that will
produce the guaranteed annual effective
yield over the period of a year. No
annual rate will be less than 3%.
(e) Withdrawals--Amounts in the GAA may be
transferred to other investment
options at any time subject to certain
limits (see 5.01). Amounts transferred
prior to the Maturity Date of a Term
are subject to an MVA (see
7.03(b)). Amounts will be removed from
the elected Classification starting
with the Term still in effect with the
oldest Deposit Period.
During the Deposit Period and the 90
days following the close of the
Deposit Period, any amounts applied
to the GAA during that Deposit Period
may not be withdrawn unless due to:
(1) A full or partial surrender;
(2) A payment of a premium for an
Annuity Option; or
(3) The Sum Payable at Death provision
(see 5.05).
(f) Maturity Date/Reinvestment--At least
18 calendar days before a Term's
Maturity Date, the Contract Holder or
Participant, as applicable, will be
mailed a notice. This notice will
contain the current Deposit Period's
Guaranteed Rate(s), Term(s) and a
projected Matured Term Value.
The Matured Term Value may be
surrendered or transferred on the
Term's Maturity Date without an MVA.
If no specific direction is given by
the Contract Holder or Participant, as
applicable, prior to the Maturity
Date, each Matured Term Value will be
reinvested in a Term of the same
duration. In the event that a Term of
the same duration is unavailable, each
Matured Term Value will automatically
be reinvested in the next shortest Term
available in the same Classification
during the then current Deposit Period.
If, however, only one Term is
available within the Classification,
then the Matured Term Value will
automatically be reinvested in that
Term. If there are no Terms available
in the Long Term Classification
previously chosen, the Matured Term
Value will be allocated to the Term
within the Short Term Classification
with the longest period. Within two
business days after the Maturity Date,
the Contract Holder or Participant, as
applicable, will be mailed a
confirmation statement. This
statement will state the Terms and
Guaranteed Rates which will apply to
the reinvested Matured Term Value.
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4.03 GUARANTEED During the calendar month following the
ACCUMULATION Term's Maturity Date, one exception is
ACCOUNT (GAA) allowed to the 90 day transfer
(CONT'D): restriction and MVA under sub-paragraph
(e) and Section 7.03 (b). This
exception is applicable to each Matured
Term Value plus any interest accrued
thereon, provided no part of the
Matured Term Value was transferred on
the Maturity Date.
During this calendar month period, the
Contract Holder or Participant, as
applicable, may request that Aetna
transfer or surrender all or part of
the Matured Term Value plus any
interest accrued thereon from the GAA
without an MVA. This provision only
applies to the first such request
received during this period for any
Matured Term Value. The Matured Term
Value plus any interest accrued thereon
may be transferred upon such request
without an MVA:
(1) To any other Terms of the GAA
available in the current Deposit
Period;
(2) To the Fixed Account; or
(3) To any other allowable Fund(s).
If no such notification is given, the
Matured Term Value will remain
subject to the terms and conditions
of the new Term. All Surrender and
transfer requests will be processed
as of the date they are received in
Good Order at Aetna's Home Office.
(g) Net Purchase Payments to the GAA --
All amounts in the GAA under the Short
Term Classification are normally
maintained in the General Account. At
its option, Aetna may hold Short
Term Classifications of a given
class in a Nonunitized Separate
Account.
Amounts in the GAA under the Long
Term Classifications are normally
maintained in a Nonunitized Separate
Account. There are no discrete units
for this Nonunitized Separate
Account. The Group Trust Contract
Holder, Contract Holder, or
Participant, as applicable, does not
participate in the gain or loss
from the assets held in the
Nonunitized Separate Account. Such
gain or loss is borne entirely by
Aetna. These assets may be chargeable
with liabilities arising out of any
other business of Aetna. At its option,
Aetna may hold Long Term
Classifications of a given class in its
General Account.
For Terms under both the Short Term and
Long Term Classifications, Aetna
guarantees stipulated interest rates to
be credited to the GAA. All assets of
Aetna including amounts maintained in
the GAA are available to meet the
guarantees under the GAA.
(h) Changes--Aetna may change this
Section 4.03, including eliminating
the GAA entirely, with 30 days
advance written notice to the Contract
Holder. Any such change shall become
effective for Purchase Payments,
transfers or reinvestments applied to
any new Term by any present or future
Participant.
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4.04 FUND(S) RECORD UNITS - The portion of the Net Purchase Payment(s)
SEPARATE ACCOUNT: applied to a Separate Account will
determine the number of Fund(s) Record
Units. This number is equal to the Net
Purchase Payment(s) applied to the Fund
divided by the Fund(s) Record Unit Value
(see 4.06) for the Valuation Period in
which the Purchase Payment is received in
Good Order.
4.05 NET RETURN FACTOR(S)- The Net Return Factor(s) are used to
SEPARATE ACCOUNT: compute all Separate Account Record Units
for any Fund(s).
The Net Return Factor for each Fund is
equal to 1.0000000 plus the Net Return
Rate.
The Net Return Rate is equal to:
(a) The value of the shares of the Fund
held by a Separate Account at the end
of a Valuation Period; minus
(b) The value of the shares of such Fund
held by the Separate Account at the
start of the Valuation Period; plus or
minus
(c) Taxes (or reserves for taxes) on the
Separate Account (if any); divided by
(d) The total value of such Fund's Record
Units (see 4.04) in the Separate
Account at the start of the Valuation
Period; minus
(e) The Daily Asset Charge (see
Specifications).
A Net Return Rate may be more or less
than 0. The value of a share of any Fund is
equal to the net assets of the Fund
divided by the number of shares
outstanding.
4.06 FUND(S) RECORD UNIT A Fund(s) Record Unit Value is computed by
VALUE--SEPARATE multiplying the Net Return Factors for the
ACCOUNT: current Valuation Period by the Fund(s)
Record Unit Value for the previous Period.
The dollar value of a Fund(s) Record Unit
and Separate Account assets may go up or
down due to investment gain or loss.
4.07 EXPERIENCE CREDITS: Aetna may apply Experience Credits
(investment, administrative, mortality or
otherwise) under this Contract. Such
credits may be applied as a reduction in
Maintenance Fees or Daily Asset Charge, or
an increase in the Fixed Account interest
rate. Experience Credits may be applied
in such other manner as Aetna deems
appropriate for the class of contracts to
which this Contract belongs within the
state of issue. Any such credit will be
computed for contracts of the same class in
accordance with Aetna's administrative
practice consistently applied.
4.08 INSTALLATION CHARGE: The Installation Charge, if any, is payable
at the Effective Date. If an Installation
Charge is applicable to this Contract it
will be disclosed in the Specifications.
The amount of the Installation Charge is
determined by the number of employees
eligible to participate in the Plan(s) and
the existence and duration of any
applicable Surrender Charge (see 7.04).
This charge is to be
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4.08 INSTALLATION CHARGE paid separately by the Contract Holder to
(CONT'D): Aetna with the application. Aetna will
refund any Purchase Payment received from
the Contract Holder prior to the payment of
the Installation Charge to Aetna.
4.09 MAINTENANCE FEE: There is an annual Maintenance Fee of
$25 per Plan Account. The "due date" for
such Fee is the last day of each Contract
Year. The Fee will be deducted from each
Plan Account on the due date. If Aetna
maintains asset accounts within a
Participant Account (see 3.02), only
one annual Maintenance Fee will be
deducted for such Participant Account.
With respect to such Participant
Accounts, the Fee will be deducted from
the Current Value of the asset account(s)
identified in the Specifications. Aetna, in
its discretion, may change such asset
account designation by notifying the
Contract Holder of such change.
Aetna will not apply the Maintenance Fee
to the Trustee Account or a Separated
Employee Account on any due date that the
Current Value of such Account is less than
$100. Aetna will not apply the
Maintenance Fee to a Participant's
Participant Account on any due date that:
(a) The Current Value of the asset
account(s) designated in the
Specifications, or as subsequently
changed by Aetna, is less than
$100; or
(b) Is within 120 calendar days of
the Participant's signed election
for enrollment under this
Contract.
The Maintenance Fee for all of the
Participant Accounts, the Trustee
Accounts, and/or all of the Separated
Employee Accounts may be paid to Aetna
separately by the Contract Holder. If this
option is requested, a notice will be
mailed to the Contract Holder on or before
the due date. If the Fee is not received
by Aetna by the 30th calendar day
following the due date, it will be
deducted from the Plan Accounts. Unless the
Contract Holder requests a reinstatement of
the annual notice, Maintenance Fees will
continue to be deducted for all
subsequent Contract Years.
Upon full Surrender (see 7.01 ) of this
Contract the annual Maintenance Fee will be
deducted. If, however, such a Surrender
occurs less than 90 calendar days after
the previous due date, Aetna will not
apply the Maintenance Fee.
After 5 completed Contract Years Aetna
may change the Maintenance Fee with 30
days advance written notice to the Contract
Holder. Any such change shall apply from
its Effective Date to all amounts held
in Plan Accounts. In no event, however,
will any such change result in a
Maintenance Fee higher than the then
current Maintenance Fee being charged to
purchasers of contracts of the same class
as this Contract.
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4.10 AUTOMATION DISCOUNT: Aetna may reduce the Maintenance Fee
applied to Participant Accounts if the
Contract Holder remits electronic data, in
Good Order and in a format acceptable to
Aetna, for crediting Net Purchase Payments
to Participant Accounts, in accordance with
Aetna's existing administrative practices.
At installation, this includes data Aetna
needs to establish Participant Accounts for
enrolling Participants.
Aetna reserves the right to revoke this
Maintenance Fee reduction if, in Aetna's
opinion, Good Order requirements are not
met.
V. TRANSFERS AND DISTRIBUTIONS
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5.01 TRANSFER OF CURRENT Before an Annuity Option is elected, all or
VALUE FROM THE FUNDS any portion of the Current Value of any
OR GAA: Plan Account held in a Fund or the GAA may
be transferred:
(a) To any other allowable Fund;
(b) To the Fixed Account; or
(c) To Terms of the GAA available in the
current Deposit Period.
With respect to any Plan Account, the
aggregate transfers to the Fixed Account
from the Fund(s) and/or the GAA and/or
Purchase Payments from investment options
not provided under this Contract may not,
in any calendar year, exceed 20% of the
value of the Fund(s) and the GAA in such
Plan Account as of January 1 of that
calendar year. Aetna may, on a temporary
basis allow any larger percent to be
transferred to the Fixed Account.
Amounts in a specific GAA Term cannot be
transferred to the Deposit Period of
another Term within the same
Classification except at the Term's
maturity (see 4.03(f)).
Amounts applied to Classifications of the
GAA may not be transferred to the Funds
during the Deposit Period or for 90 days
after the close of the Deposit Period.
Transfers from Terms of the GAA are
subject to the Withdrawal and MVA
provisions (see 7.03).
Twelve transfers (excluding transfers
from the GAA at the end of a Guaranteed
Term) can be made during a calendar year
period. However, only the Contract
Holder or the Participant (with the
consent of the Contract Holder) may tell
Aetna to make such transfers. Aetna, in
its sole discretion, may refuse to make
such transfers at the direction of any
other person, even if such other person
has been authorized by the Contract
Holder or Participant to make such
transfers. More than 12 such transfers in
any calendar year, if permitted by Aetna,
may be subject to an additional fee in
accordance with Aetna's existing
administrative practice.
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5.02 TRANSFER OF CURRENT 10% of that portion of the Current Value of
VALUE FROM THE FIXED each Plan Account held in the Fixed Account
ACCOUNT: as of January 1 of a calendar year may be
transferred to any of the other Fund(s), or
to the GAA Term(s) available during the
current Deposit Period. Such transfer will
be:
(a) Without charge;
(b) Allowed once per calendar year; and
(c) Not allowed under an Annuity Option.
Aetna may, on a temporary basis allow
any larger percent to be transferred.
Any remaining balance in the Fixed Account
under a Plan Account may be transferred
by the Contract Holder or the Participant
(with the consent of the Contract
Holder) in its entirety to any of the
other Fund(s), or to the GAA Term(s)
available during the current Deposit
Period if:
(a) The Plan Account Current Value in the
Fixed Account is less than $2000; or
(b) The maximum percentage of the Plan
Account Current Value in the Fixed
Account was transferred in each of the
four consecutive prior calendar
years and no additional Net Purchase
Payment(s) have been allocated to the
Fixed Account during the same four
consecutive prior calendar year
periods.
5.03 SYSTEMATIC ALLOCATION: A Systematic Allocation involves placing
a lump sum in one Fund (mutual fund)
and having it reallocated to another
Fund in substantially equal monthly
installments. The purpose of a Systematic
Allocation is to permit shares of the
second Fund to be purchased using the
"dollar-cost-averaging" method. The amount
applied to a Systematic Allocation must be
no less than $100 per month over a
period of at least 12 months. Systematic
Allocations for a period longer than 24
months must be consented to by Aetna.
Systematic Allocations may not be made
from, or to, the Fixed Account or the GAA.
Aetna reserves the right to limit the
Funds that can be used to pay out or
receive Systematic Allocations.
With respect to a Participant Account,
the Participant (with the consent of the
Contract Holder), may initiate a Systematic
Allocation. Unless otherwise consented to
by Aetna, no Participant may have more than
one Systematic Allocation in effect. A
Participant may revoke a Systematic
Allocation at any time.
Transfers made by reason of a Systematic
Allocation will not reduce the number of
investment transfers that can be made
pursuant to Section 5.01.
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5.04 REQUIRED DISTRIBUTION Distribution from a Participant Account or
TO PARTICIPANT: a Separated Employee Account to the
Participant must begin in the form of
periodic payments no later than the April 1
following the calendar year in which the
Participant attains age 70 1/2, or such
other age as may be provided by law, or be
made in a lump sum by the same date. The
Contract Holder must direct Aetna to
commence such Annuity or make such payment.
5.05 SUM PAYABLE AT DEATH Aetna will pay the Current Value to the
(BEFORE ANNUITY beneficiary (see 8.07) if:
PAYMENTS START):
(a) The Participant dies before Annuity
payments start; and
(b) The notice of death is received by
Aetna.
The sum paid will be the Current Value for
the Valuation Period in which the notice
is received in Good Order at Aetna's Home
Office.
5.06 DISTRIBUTION OPTIONS: The following distribution options may be
elected from the Participant Accounts and
Separated Employee Accounts.
(a) Estate Conservation Option (ECO): A
distribution option under which a
portion of the Participant
Account Current Value will
automatically be surrendered and
distributed each year. An ECO payment
will be calculated on the Participant
Account Current Value and will be
withdrawn pro rata from each investment
option and asset account used for
distribution. Except as stated in
sub-paragraph (5) below, all
rights, provisions and charges
described in the Contract continue to
apply to the remaining Current Value
in the Participant Account.
(1) Amount of Distribution: Each year
that ECO is in effect, Aetna will
calculate and distribute an
amount equal to the minimum
distribution required under the
Code. The annual distribution will
be determined by dividing the
Participant Account Current Value
as of December 31 of the year prior
to the payment year, by a life
expectancy factor.
As elected by the Contract Holder
on behalf of the Participant, the
factor is either the single life or
joint life expectancy based on
tables in Code Section 401 (a)(9)
or related regulations. Life
expectancy factors will be
recalculated each year. If the
joint life expectancy is elected
and the spouse is not the
beneficiary under the Plan, the
beneficiary's life expectancy
will not be recalculated.
These calculations may be changed
as necessary to comply with the
Code minimum distribution rules.
The joint life expectancy will be
based on the joint life of the
Participant and his or her
beneficiary under the Plan. If
joint life expectancy is elected
and the Participant or
beneficiary under the Plan dies,
payments will be based on the
survivor's life expectancy. If
the beneficiary under the Plan is
not the Participant's spouse and
the non-spousal beneficiary dies
first, the joint life
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5.06 DISTRIBUTION OPTIONS expectancy continues. If a single
(CONT'D): life expectancy is elected and
the Participant dies, or if a
joint life expectancy is elected
and the survivor dies, the sum
payable at death (see 5.05) will be
paid in a lump sum.
Aetna assumes no responsibility for
tax consequences resulting from
failure to receive required minimum
distributions on additional
Purchase Payments made after each
year's annual distribution.
(2) Minimum Current Value: At its
discretion, Aetna may require a
minimum initial Current Value for
election of this option. If after
election of this option, the
Current Value is insufficient to
make a scheduled ECO payment,
Aetna will distribute the entire
balance of the Participant Account.
(3) Date of Distribution: The Contract
Holder shall specify an annual
distribution date on behalf of the
Participant. The distribution
date may be the 15th of any month,
or such other date Aetna may
designate or allow. Distributions
may not start earlier than the year
the Participant attains age 70 1/2,
or such later time when
distributions must commence as
specified under the Code, whichever
is appropriate. Subsequent
distributions will be made on the
anniversary of that date.
Aetna will allow a later annual
distribution date to be
designated; however, Aetna will
not be responsible for compliance
with the Code minimum distribution
requirements for any prior time
periods. In addition, Aetna will
not be responsible for compliance
with the Code requirements for
any Participant Accounts and/or
Contracts for which this election
is not made.
(4) Election and Revocation: ECO may
be elected by the Contract Holder
on behalf of the Participant by
submitting a completed and signed
election form to Aetna's Home
Office. For a Participant subject
to the Retirement Equity Act
(REA), the Participant's spouse
must consent to the election of
this option in writing in a form
acceptable to Aetna.
Once elected, this option may be
revoked by the Contract Holder by
submitting a written request to
Aetna at its Home Office. Any
revocation will apply only to
amounts not yet paid. ECO may be
elected only once.
(5) Reservation of Rights: Aetna
reserves the right to change the
terms of ECO for future elections
and discontinue the availability
of this option after proper
notification. Aetna also reserves
the right to allow payments to
be made more frequently than
annually.
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5.06 DISTRIBUTION OPTIONS (b) Systematic Withdrawal Option (SWO):
(CONT'D): A distribution option under which a
portion of the Participant Account
Current Value will automatically be
surrendered and distributed each year.
A SWO payment will be calculated on the
Participant Account Current Value
and will be withdrawn pro rata from
each investment option and asset
account used for distribution. Except
as stated in sub-paragraph (5) below,
all rights, provisions and charges
described in the Contract continue to
apply to the remaining Current Value
in the Participant Account.
(1) Amount of Distribution: The
Contract Holder may elect one of
the three payment methods described
below on behalf of a Participant.
These calculations may be changed
as necessary to comply with the
Code minimum distribution rules.
o Specified Payment: Payments of a
designated dollar amount which
must be no greater than 10% of
the initial Current Value and
shall remain constant.
Beginning with the year the
Participant attains age 70 1/2
or such time distributions must
commence under the Code, Aetna
will calculate the minimum
required distribution by
dividing the Participant Account
Current Value as of December 31
of the year prior to the payment
year by a life expectancy
factor, and distribute this
amount if it is greater than the
elected Specified Payment; or
o Specified Period: Payments which
are made over a period of time
which must be at least 10 years.
The maximum specified period
will be limited by the life
expectancy factor. The amount
paid each year is calculated by
dividing the Participant
Account Current Value as of
December 31 of the year prior to
the payment year by the number of
payment years remaining; or
o Specified Percentage: Payments
of a designated percentage of
the Current Value. The
percentage specified cannot be
greater than 10% of the initial
Current Value. By written request
this percentage may be changed,
however Aetna reserves the right
to limit the number of changes.
The amount paid each year is
calculated by multiplying the
Participant Account Current
Value as of December 31 of the
year prior to the payment year by
the chosen percentage. Payments
will be made until the year the
Participant attains age 70 1/2,
or such later time when
distributions must commence as
specified under the Code.
As elected by the Contract Holder
on behalf of the Participant if
Specified Payment or Specified
Period is elected, the factor is
either the single life or joint
life expectancy based on tables in
Code Section 401(a)(9) or related
regulations. With each subsequent
year, the life expectancy will be
the life expectancy factor for the
initial distribution year, reduced
by one.
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5.06 DISTRIBUTION OPTIONS The joint life expectancy will be
(CONT'D): based on the joint life of the
Participant and his or her
beneficiary under the Plan. If
joint life expectancy is elected
and the Participant or beneficiary
under the Plan dies on or after the
required beginning date for minimum
distributions to the Participant,
the joint life expectancy factor
will continue to be reduced by
one for each distribution year.
Payments will continue, unless the
survivor elects an alternate
payment method. Any method elected
must provide payments to be made at
least as rapidly as those made
prior to the Participant's death.
If the Participant dies before
the required beginning date for
minimum distributions, SWO payments
will cease and the Participant
Account Current Value will be paid
(see 5.05). If joint life
expectancy is elected and the
beneficiary under the Plan dies
before the required beginning date
for minimum distributions to the
Participant, payments to the
Participant, will continue under
the elected payment method.
Aetna assumes no responsibility
for tax consequences resulting
from failure to receive required
minimum distributions on
additional deposits made after
December 31 of the prior year.
(2) Minimum Current Value: At its
discretion, Aetna may require a
minimum initial Current Value for
election of this option. If after
election of this option the Current
Value is insufficient to make a
scheduled SWO payment, Aetna will
distribute the entire balance of
the Participant Account.
(3) Date of Distribution: The
Contract Holder shall specify
the initial distribution date on
behalf of the Participant, but not
before the Participant attains the
age of 59 1/2 and not later than
the required beginning date for
distributions under the Code.
SWO payments will be made monthly,
quarterly, semi-annually, or
annually on the 15th of any month,
or such other date Aetna my
designate or allow. If payments
are made more frequently than
annually, the annual amount
payable each year is divided by the
number of payments due per year.
At its discretion, Aetna may
require a minimum initial payment
amount.
Aetna will not be responsible for
compliance with the Code minimum
distribution requirements for any
prior time periods or for any
Participant Accounts and/or
Contracts for which election is not
made.
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5.06 DISTRIBUTION OPTIONS (4) Election and Revocation: SWO may
(CONT'D): be elected by the Contract Holder
on behalf of the Participant by
submitting a completed and signed
election form to Aetna's Home
Office. For a Participant subject
to the Retirement Equity Act
(REA), the Participant's spouse
must consent to the election of
this option in writing in a form
acceptable to Aetna.
Once elected, this option may be
revoked by the Contract Holder by
submitting a written request to
Aetna at its Home Office. Any
revocation will apply only to
amounts not yet paid. SWO may be
elected only once.
(5) Reservation of Rights: Aetna
reserves the right to change the
terms of SWO for future elections
and discontinue the availability
of this option after proper
notification.
(c) Other Distribution Options: Other
distribution options may be made
available by Aetna to the class of
business to which this Contract belongs
in accordance with Aetna's
administrative practice.
VI. ANNUITY PROVISIONS
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6.01 CHOICES TO BE MADE: The Contract Holder may tell Aetna, on
behalf of a retired Participant, to pay
any portion of a Participant's Participant
Account (minus any premium tax) as a
premium for an Annuity under Option 1, 2,
3, or 4 (see 6.06). The first Annuity
payment must generally be made no later
than the April 1 of the calendar year
following the year in which the retired
Participant turns age 70 1/2 or such later
date as may be allowed under federal law
or regulations. In lieu of the election
of an annuity or a distribution option
under 5.06, the Contract Holder may tell
Aetna to make a lump sum payment (see
7.01).
When an Annuity Option is chosen, Aetna
must also be told if payments are to be
made other than monthly.
Only a Fixed Annuity using the General
Account is available under this Contract.
Aetna will add interest daily at an annual
rate no less than 3.0%. Aetna may add
interest daily at any higher rate.
6.02 ANNUITY PAYMENTS In no event may any payments to the
TO ANNUITANT: Annuitant under any Annuity Option extend
beyond.
(a) The life of the Annuitant;
(b) The lives of the Annuitant and the
Annuitant's beneficiary under the
Plan;
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6.02 ANNUITY PAYMENTS (c) Any certain period greater than
TO ANNUITANT (CONT'D): the Annuitant's life expectancy as
determined according to regulations
under Code Section 401 (a)(9); or
(d) Any certain period greater than the
life expectancy of the Annuitant and
the Annuitant's beneficiary under the
Plan, as determined according to
regulations under Code Section 401
(a)(9).
6.03 ANNUITY PAYMENTS TO If the beneficiary (see 8.07) elects an
PARTICIPANT'S BENEFICIARY Annuity Option on behalf of the
UNDER THE PLAN: Participant's beneficiary under the Plan,
in no event may payments to the
Participant's beneficiary under an
Annuity Option extend beyond:
(a) The life of the Participant's
beneficiary determined as of the date
payments are to commence; or
(b) Any certain period greater than the
Participant's beneficiary's life
expectancy as determined by
regulations under Code Section 401
(a)(9).
However, if a Participant's
beneficiary dies while under Option 1
or while receiving Annuity
payments, the present value of any
remaining payments will be paid in
one lump sum to the estate of the
Participant's beneficiary. The
interest rate used to determine the
first payment will be used to
calculate the present value.
6.04 TERMS OF ANNUITY (a) When payments start, the age of the
OPTIONS: Annuitant plus the number of years, if
any, for which payments are guaranteed
must not exceed 95.
(b) The present value of the expected
payments to the Annuitant when
payments start shall be more than 50%
of the present value of the total
expected payments to be made. This
restriction does not apply if Option 4
is chosen and the second Annuitant is
the spouse of the Annuitant.
(c) No choice of any Annuity Option may be
made if the first payment would be
less than $50 or if the total payments
in a year would be less than $250
(unless otherwise required by state
law).
(d) If an Annuity under Option 2, 3, or 4
is chosen and a larger payment would
result from applying the Surrender
Value to a current Aetna single premium
immediate Annuity, Aetna will make the
larger payment.
(e) For purposes of calculating the
payments for an Annuity, the
Annuitant's and Second Annuitant's
adjusted age will be used. The
Annuitant's and Second Annuitant's
adjusted age is his or her age as
of the birthday closest to the Annuity
commencement date reduced by one year
for Annuity commencement date
occurring during the period of time
from July 1, 1992 through December 31,
1999. The Annuitant's age will be
reduced by two years for Annuity
commencement dates occurring during
the period of time from January 1, 2000
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6.04 TERMS OF ANNUITY through December 31, 2009. The
OPTIONS (CONT'D): Annuitant's and Second Annuitant's
age will be reduced by one additional
year for Annuity commencement dates
occurring in each succeeding decade.
6.05 DEATH OF ANNUITANT: When an Annuitant dies under Option 2 or
3, the present value of any remaining
guaranteed payments will be paid in one
sum to the beneficiary, or upon election
by the beneficiary, any remaining
payments will continue to the beneficiary.
6.06 ANNUITY OPTIONS: Option 1--Payment of Interest on Sum Left
with Aetna--This Option may be used only by
the beneficiary when the Participant
dies before Aetna has started paying an
Annuity. A portion or all of the sum paid
upon death may be held under this Option
and will be held in the General Account of
Aetna at interest (see 6.01). The
beneficiary may later tell Aetna to:
(a) Pay a portion or all of the sum held by
Aetna; or
(b) Apply a portion or all of the sum held
by Aetna to any Annuity Option below.
Option 2--Payments for a Stated Period of
Time--An Annuity will be paid for the
number of years chosen. The number of years
must be at least 5 and not more than 30.
Option 3--Life Income--An Annuity will be
paid for the life of the Annuitant. If also
chosen, Aetna will guarantee payments for
60, 120, 180, or 240 months.
Option 4--Life Income for Two Payees--An
Annuity will be paid during the lives of
the Annuitant and a second Annuitant. At
the death of either, payments will
continue to the survivor. When this Option
is chosen, a choice must be made of:
(a) 100% of the payment to continue to the
survivor;
(b) 66 2/3% of the payment to continue to
the survivor;
(c) 50% of the payment to continue to the
survivor;
(d) Payments for a minimum of 120 months
with 100% of the payment to continue to
the survivor; or
(e) 100% of the payment to continue to
the survivor if the survivor is the
Annuitant and 50% of the payment to
continue to the survivor if the
survivor is the second Annuitant.
Other Options -- Aetna may make other
options available as allowed by the laws
of the state in which this Contract is
delivered.
6.07 ANNUITY TABLES: In the following Annuity tables, the
rates shown for Options 3 and 4 are based
on mortality from the 1983 GAM, Table a.
The rates do not differ by sex. Rates for
ages not shown will be provided on
request and will be computed on a basis
consistent with the rates shown in the
following tables.
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OPTION 2
Payments for a Stated Period of Time
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Guaranteed Monthly Quarterly Semi-Annual Annual
Years Rate Payment Payment Payment Payment
5 3.00% 17.91 53.59 106.78 211.99
6 3 00% 15.14 45.30 90.27 179.22
7 3.00% 13.16 39.39 78.49 155.83
8 3.00% 11.68 34.96 69.66 138.31
9 3.00% 10.53 31.52 62.81 124.69
10 3.00% 9.61 28.77 57.33 113.82
11 3.00% 8.86 26.52 52.85 104.93
12 3.00% 8.24 24.65 49.13 97.54
13 3.00% 7.71 23.08 45.98 91.29
14 3.00% 7.26 21.73 43.29 85.95
15 3.00% 6.87 20.56 40.96 81.33
16 3.00% 6.53 19.54 38.93 77.29
17 3.00% 6.23 18.64 37.14 73.74
18 3.00% 5.96 17.84 35.56 70.59
19 3.00% 5.73 17.13 34.14 67.78
20 3.00% 5.51 16.50 32.87 65.26
21 3.00% 5.32 15.92 31.72 62.98
22 3.00% 5.15 15.40 30.68 60.92
23 3.00% 4.99 14.92 29.74 59.04
24 3.00% 4.84 14.49 28.88 57.33
25 3.00% 4.71 14.09 28.08 55.76
26 3.00% 4.59 13.73 27.36 54.31
27 3.00% 4.47 13.39 26.68 52.97
28 3.00% 4.37 13.08 26.06 51.74
29 3.00% 4.27 12.79 25.49 50.60
30 3.00% 4.18 12.52 24.95 49.53
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OPTION 3
Life Income
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Payments Guaranteed for a Stated Period of Months
Adjusted
Age of
Annuitant None 60 120 180 240
50 $ 4.05 $4.05 $ 4.03 $ 3.99 $ 3.93
51 4.12 4.11 4.09 4.05 3.99
52 4.19 4.19 4.16 4.11 4.04
53 4.27 4.26 4.23 4.18 4.10
54 4.35 4.34 4.31 4.25 4.16
55 4.44 4.42 4.39 4.32 4.22
56 4.53 4.51 4.47 4.40 4.29
57 4.62 4.61 4.56 4.48 4.35
58 4.72 4.71 4.65 4.56 4.42
59 4.83 4.81 4.75 4.64 4.49
60 4.95 4.93 4.86 4.73 4.55
61 5.07 5.05 4.97 4.83 4.62
62 5.20 5.17 5.08 4.92 4.69
63 5.34 5.31 5.20 5.02 4.76
64 5.49 5.45 5.33 5.12 4.83
65 5.65 5.61 5.47 5.22 4.89
66 5.82 5.77 5.61 5.33 4.96
67 6.01 5.94 5.75 5.44 5.02
68 6.20 6.13 5.91 5.54 5.08
69 6.41 6.33 6.07 5.65 5.14
70 6.64 6.54 6.23 5.76 5.19
71 6.88 6.76 6.41 5.86 5.24
72 7.14 7.00 6.59 5.97 5.28
73 7.43 7.26 6.77 6.06 5.32
74 7.73 7.53 6.96 6.16 5.35
75 8.06 7.82 7.14 6.25 5.38
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OPTION 4
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Adjusted Ages
Second
Annuitant Annuitant Option 4a Option 4b Option 4c Option 4d Option 4e
55 50 $3.69 $4.05 $4.27 $3.69 $4.03
55 55 3.88 4.25 4.47 3.87 4.14
55 60 3.99 4.44 4.71 3.98 4.42
60 55 3.99 4.44 4.71 3.98 4.42
60 60 4.24 4.71 4.99 4.23 4.57
60 65 4.38 4.97 5.32 4.38 4.93
65 60 4.38 4.97 5.32 4.38 4.93
65 65 4.72 5.33 5.70 4.71 5.14
65 70 4.93 5.68 6.15 4.91 5.66
70 65 4.93 5.68 6.15 4.91 5.66
70 70 5.40 6.21 6.70 5.36 5.96
70 75 5.69 6.68 7.32 5.62 6.67
75 70 5.69 6.68 7.32 5.62 6.67
75 75 6.37 7.45 8.15 6.23 7.12
75 80 6.78 8.11 8.99 6.54 8.13
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VII. WITHDRAWALS AND TERMINATION OF CONTRACT
7.01 PAYMENT OF
SURRENDER VALUE:
The charges on, and adjustments to, withdrawals from this Contract depend upon
whether the withdrawal constitutes a Surrender or a Benefit. A "Surrender" is
any withdrawal from this Contract for any purpose other than to pay a Benefit.
"Benefits" are payments under this Contract made pursuant to Plan provisions for
reasons of Participant retirement, termination of employment, death, disability,
hardship, loan, or in-service withdrawals after age 59 1/2. Benefits are not
subject to a Surrender Charge or Maintenance Fee deduction. Benefits may also
include such other payments made pursuant to Plan provisions as may be agreed to
by Aetna in accordance with its existing administrative practice. The Contract
Holder must supply documentation acceptable to Aetna to support requests for
Benefit payments.
Participant Surrenders are not permitted under this Contract, except for
Split-Funded Plans paying the higher Daily Asset Charge (see 2.03). A Plan that
permits in-service withdrawals prior to age 59 1/2, may do so by electing to pay
the Daily Asset Charge for a Split-Funded Plan, in which event such a withdrawal
can be effected as a Participant Surrender.
The Contract Holder may surrender this Contract for its Current Value. At the
time of a Participant or Contract Holder full or partial Surrender request, the
Current Value will be adjusted by the following items in the order presented:
(a) the Fixed Account MVA, as applicable (see 7.02(b));
(b) the GAA MVA, as applicable (see 7.03(b));
(c) the Maintenance Fee, as applicable (see 4.09); and
(d) the Surrender Charge, as applicable (see 7.04).
Certain withdrawals to pay Benefits will also be subject to MVAs (see 7.02(b)
and 7.03(b)).
Full and partial Surrenders are satisfied by withdrawing amounts from each of
the Fund(s), the Fixed Account, the GAA Short Term Classification and the GAA
Long Term Classification on a pro rata basis. However, the Contract Holder may
specify a particular order in which investment options will be liquidated in
order to satisfy a partial Surrender request.
Under certain emergency conditions, Aetna may defer payment from the General
Account or GAA:
(a) For a period of up to 6 months (unless not allowed by state law);
or
(b) As provided by federal law.
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7.02 PAYMENT OF FIXED ACCOUNT SURRENDER VALUE:
Aetna will pay an unadjusted lump sum from the Fixed Account for the purpose of
paying a Benefit, where the withdrawal is made proportionately from the Fixed
Account, GAA, and the Funds from all applicable asset accounts. On all Benefits
payable from the Fixed Account that are not so withdrawn proportionately, and on
all Surrenders from the Fixed Account, Aetna reserves the right to pay the Fixed
Account Surrender Value in one of the following two ways, as elected by the
Contract Holder:
(a) In equal principal payments, with interest, over a period not to exceed 60
months.
Interest, as used above will not be more than two percentage points below
any rate determined prospectively by Aetna for this class of Contract. In
no event, will the interest rate be less than 3%.
(b) As a single payment, which has been subjected to a Market Value Adjustment
(MVA). The amount of the withdrawal will be adjusted to a market value
amount equal to the lesser of (1) or (2):
(1) The value of the following factor multiplied by the amount being withdrawn
on the date of the surrender:
Factor = (1 + a) 5.25
------------
(1 + b) 5.25
Where: a is the Fixed Account credited rate as of
the date of surrender; and
b is the rate for a 7-year Treasury Bond
as published in the Salomon Brothers
Bond Market Roundup for the week
prior to the surrender plus 0.25%
(2) The value of the amount being withdrawn.
7.03. PAYMENT OF GAA
SURRENDER VALUE:
Full or partial Surrenders may be requested at any time from the GAA. However,
amounts withdrawn prior to the Maturity Date of a Term to satisfy a Surrender or
Benefit request may be subject to an MVA (see (b) below).
(a) For purposes of withdrawals, Terms within the GAA Short Term and Long Term
Classifications are considered as two separate investment options. Also,
amounts will be removed within a GAA Classification starting with the Term
still in effect with the oldest Deposit Period.
(b) Market Value Adjustment (MVA)--There will be an MVA for a withdrawal from
the GAA before the end of a Term except for withdrawals made under the ECO
Distribution Option (see 5.06 (a)). The amount of the withdrawal will be
adjusted to a market value amount as described below.
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7.03. PAYMENT OF GAA SURRENDER VALUE (CONT'D):
The market value adjusted amount will be equal to the amount withdrawn
multiplied by the following ratio:
x
---
(1 + i) 365
------------
x
---
( 1 + j) 365
Where: i is the Deposit Yield
j is the Current Yield
x is the number of days remaining, (computed from
Wednesday of the week of withdrawal) in the
Guaranteed Term.
The Deposit Period Yield will be determined as follows:
o At the close of the last business day of each week of the Deposit Period, a
yield will be computed as the average of the yields on that day of U.S. Treasury
Notes which mature in the last three months of the Guaranteed Term.
o The Deposit Period Yield is the average of those yields for the Deposit
Period. If withdrawal is made prior to the close of the Deposit Period, it
is the average of those yields on each week preceding withdrawal.
The Current Yield is the average of the yields on the last business day of the
week preceding withdrawal on the same U.S. Treasury Notes included in the
Deposit Period Yield.
In the event that no U.S. Treasury Notes which mature in the last three months
of the Guaranteed Term exist, Aetna reserves the right to use the U.S. Treasury
Notes that mature in a following quarter.
Surrenders and transfers made in connection with the Sum Payable at Death
provision (see 5.05) within six months of the date of the Participant's death
will be the greater of:
o The aggregate MVA amount which is the sum of all market value adjusted
amounts calculated due to a withdrawal of amounts (for Surrender or
transfer) from Terms prior to the end of those Terms. The aggregate MVA
may be either positive or negative; or
o The applicable portion of the Current Value in the GAA.
After the six month period, the Surrender or transfer will be the aggregate MVA
amount (i.e., including all MVAs).
The greater of the aggregate MVA amount or the applicable portion of the
Current Value in the GAA is applied to amounts withdrawn from the GAA for
payment of a premium under Annuity Options 3 or 4 (see 6.06).
7.04 SURRENDER CHARGE:
The Surrender Charge, if any, will be determined according to the number of
Contract Years between the date the first Purchase Payment is applied to this
Contract and the date of
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7.04 SURRENDER CHARGE
(CONT'D):
the Surrender. If a Surrender Charge applies, a table of Surrender Charge
percentages will be in the Specifications.
The amount Surrendered will be multiplied by the applicable percentage from the
table of Surrender Charge percentages to determine the Surrender Charge.
The Surrender Charge, if any, will be applied at the time of the Surrender,
regardless of the method elected for payment of the Fixed Account Surrender
Value (see 7.02).
7.05 REINSTATEMENT:
All or a portion of the proceeds of a full Surrender of this Contract may be
reinvested within 30 days after the Surrender if allowed by law. Any Surrender
Charge deducted at the time of Surrender on the amount being reinvested will be
included in the reinstatement. Any Market Value Adjustment(s) deducted from
Surrenders will not be included in the reinstatement.
Amounts will be reinstated among the Fixed Account, the GAA, and the Separate
Account in the same proportion as they were at the time of Surrender. Any
amounts reinstated to the GAA will be credited to the current Deposit Period.
The number of Record Units reinstated will be based on the Record Unit Value(s)
next computed after receipt at Aetna's Home Office of the reinstatement request
and the amount to be reinstated.
Reinstatement is permitted only once.
7.06 TERMINATION OR TRANSFER TO ANOTHER CONTRACT:
After 5 completed Contract Years Aetna shall have the right, in accordance with
its existing administrative practices and procedures, to:
(a) Pay out the Current Value, without application of an MVA (see 7.02(b) and
7.03(b)) or Surrender Charge (see 7.04) under the Contract to the Contract
Holder in full provided Aetna gives the Contract Holder 90 days written
notice, and further provided that Aetna takes the same action with respect
to all contracts of the same class and risk characteristics.
(b) If agreed to by the Contract Holder, to transfer the Current Value, which
may be subject to an MVA (See 7.02(b) and 7.03(b)) or Surrender Charge (see
7.04) to another Contract issued by Aetna or one of its affiliates.
VIII. GENERAL PROVISIONS
8.01 CHANGE OF CONTRACT:
This Contract may be changed at any time by written mutual agreement of the
Contract Holder and Aetna. Aetna may change the terms of this Contract when, in
its opinion, such change is necessary to protect it from (a) the adverse
financial effects of any change in Plan provisions, the administrative practices
of the Plan, or investment options offered by the Plan, or (b) the action of any
legislative, judiciary, or regulatory body which affects the operation of the
Plan or this Contract.
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8.01 CHANGE OF CONTRACT (CONT'D):
Only a Vice President or above of Aetna or any officer acting pursuant to a
written delegation of authority from such person may change the terms of this
Contract. No other employee, agent, or representative of Aetna may make any
change in this Contract. Aetna will notify the Contract Holder in writing at
least 30 days before the effective date of any change. Any change will not
affect the amount or terms of any Annuity which begins before the change.
Aetna may make any change that affects the Fixed Account Market Value
Adjustment (see 7.02(b)) with at least 30 days advance written notice to the
Contract Holder. Any such change shall become effective for any present or
future Participant.
Aetna may make any change that affects the GAA Market Value Adjustment (see
7.03(b)) with at least 30 days advance written notice to the Contract Holder.
Any such change shall become effective for any new Term for any present or
future Participant.
Except as otherwise expressly provided in the Contract, any change that affects
the following Sections of this Contract will not be applied to amounts in
existing Plan Accounts, but may apply to Purchase Payments made to such Accounts
after the change:
(a) 3.01, Net Purchase Payment(s);
(b) 4.01, Current Value;
(c) 4.02, Guaranteed Interest Rate -- Fixed Account;
(d) 4.03, Guaranteed Accumulation Account (GAA);
(e) 4.05, Net Return Factor(s) -- Separate Account; and
(f) 4.09, Maintenance Fee.
Any change that affects the Annuity Options and the tables for such options may
be made:
(a) No earlier than 12 months after the Effective Date; and
(b) No earlier than 12 months after the date on which any such prior change was
effective.
New Participants covered, and Purchase Payments made, under this Contract on or
after the date any change is effective will be subject to the change. If the
Contract Holder does not agree to any change under this provision no new
Participants will be covered under this Contract. Additionally, Aetna reserves
the right, following written notice to an objecting Contract Holder, to stop
accepting Purchase Payments for the Participants covered under this Contract
before the change.
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8.02 SUBSTITUTION, ELIMINATION, AND ADDITION OF FUND(S):
When deemed desirable by Aetna to accomplish the purpose of the Separate
Account, Aetna or the Separate Account may:
(a) Change the Fund(s) which may be invested in by the Separate Account;
(b) Make additional Fund(s) available through the Separate Account;
(c) Discontinue offering any Fund(s) through the Separate Account; and
(d) Replace the shares of any Fund(s) held in a Separate Account with shares of
any other Fund(s), where such replacement is approved by a majority vote of
persons having an interest in the Separate Account Fund(s) being replaced.
Aetna will notify the Contract Holder of any such action.
8.03 NONPARTICIPATING
CONTRACT:
The Group Trust Contract Holder, Contract Holder, Participants, or beneficiaries
will not have a right to share in the earnings of Aetna, other than as provided
herein.
8.04 PAYMENTS:
Aetna will make Annuity payments as and when due. Aetna will make other payments
within 7 days of the Valuation Period in which the written claim for payment is
received in Good Order at Aetna's Home Office, except as provided in Section
7.01.
8.05 STATE LAWS:
This Contract complies with the laws of the state in which it is delivered. Any
cash, death, or Annuity payments are equal to or greater than the minimum
required by such laws. Annuity tables for legal reserve valuation shall be as
required by state law. Such tables may be different from Annuity tables used to
determine Annuity payments.
8.06 CONTROL OF CONTRACT:
Except as otherwise expressly provided, all rights in this Contract rest with
the Contract Holder. The Contract Holder, or authorized designee of the Contract
Holder (as allowed by law), may make any choices allowed by this Contract with
respect to Plan Accounts, except that in order to affect a full Surrender of
this Contract under the provisions of Part VII, the Sub-Contract Holder must
obtain the consent of the Group Trust Contract Holder. A SubContract Holder's
rights as Contract Holder hereunder may only be exercised with respect to Plan
Accounts maintained with respect to, and Participants in, the Plan for which the
Sub-Contract Holder acts as trustees.
Any choices under this Contract must be in writing or in a form satisfactory to
Aetna. Until receipt of such choices in its Home Office, Aetna may rely on any
prior choices made. This Contract and its Plan Accounts are not subject to
claims of any creditors except to the extent permitted by law.
Any payment(s) made under this Contract to other than the Contract Holder must
be in compliance with the provisions of the Retirement Equity Act (REA). At the
time payment is requested or an Annuity Option is elected by the Contract
32
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8.06 CONTROL OF CONTRACT (CONT'D):
Holder, Aetna will require the Contract Holder to certify that it is elected in
compliance with REA. In the absence of such certification or at Aetna's
discretion, payment will be made to the Contract Holder.
8.07 DESIGNATION OF BENEFICIARY:
The beneficiary of Plan Accounts shall be the Contract Holder.
8.08 MISSTATEMENTS AND
ADJUSTMENTS:
If Aetna finds the age of any payee to be misstated, the correct facts will be
used to adjust payments. Aetna reserves the right to correct any informational
or administrative errors.
8.09 INCONTESTABILITY:
Aetna cannot cancel this Contract because of any error of fact on the
application, after the second Contract Year.
8.10 GRACE PERIOD:
This Contract will remain in effect even if Purchase Payments are not continued,
unless canceled by Aetna pursuant to section 7.06 or 8.09.
8.11 NONWAIVER:
Aetna may, in its sole discretion, elect not to exercise a right or reservation
specified in this Contract. Such election shall not constitute a waiver of the
right to exercise such right or reservation at any subsequent time.
8.12 AGGREGATING OF CONTRACTS:
The Daily Asset Charge described in the Specifications varies by the Current
Value of Plan Accounts. In determining such Current Value, Plan Accounts of the
following contracts will be aggregated:
(a) this Contract, and
(b) contracts of the same class as this Contract covering employees of the
employer maintaining the Plan.
For purposes of determining the Daily Asset Charge under this Contract, where
such other contract comes into existence after the Effective Date, the
aggregation will commence in accordance with Aetna's existing administrative
practice, but in no event later than the first day of the next succeeding
Contract Year. Where such other contract is in existence prior to, or on the
Effective Date, the aggregation will commence on the Effective Date.
8.13 CONVERSION OF CONTRACTS:
Where the Purchase Payments applied to this Contract are derived, in whole or in
part, from the cancellation of a policy or contract (issued by Aetna or any of
its affiliates) pursuant to a conversion offer; Aetna may vary the provisions of
this Contract to comply with the terms of such conversion offer. For purposes of
this Section 8.13, a "conversion offer" is a program under which Aetna allows
contract holders of a given class to convert their policies or contracts to
contracts of the same series as this Contract. Such variations will be of a
nature that will preserve, or substitute for, the rights surrendered by reason
of the cancellation of the former policy or contract.
33
114
AETNA (LOGO)
AETNA MAP V APPLICATION PENSION/PROFIT SHARING GROUP CONTRACT
Aetna Life Insurance and Annuity Company Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000-0000
CONTRACT
HOLDER
INFORMATION
1. Name of Contract Holder [X] Single Plan [ ] Group Trust
TRUSTEES OF
Information Analysis Inc. 401(k) Profit Sharing Plan
2. Address [ ] Multiple locations (ATTACH INSTRUCTIONS)
0000 Xxxxxxx Xxxx. Xxxxx 000
Xxxx Xxxxx ZIP Code
Xxxx Xxxxxx Virginia 22027
3. Tax Identification No.: 00-0000000
ACCOUNT
INFORMATION
4. Type of entity qualified under section 401 of the Internal Revenue Code:
[X] Corporation [ ] Self Employed Individuals [ ] Other (specify)
5. Type of Contract: [X] Allocated [ ] Unallocated
6. Will this contract change or replace any existing life insurance or annuity
contract? [ ] Yes [X] No If yes, piease provide carrier name, account number,
and date to be cancelled.
7. Installation Charge: [ ] Is attached [ ] Will be mailed prior
to or included with the initial Purchase Payment [X] Does not apply
8. Surrender Charge: [X] Is for 5 Contract Years [ ] Is for 3 Contract Years
[ ] Does not apply
RIGHT OF
INVESTMENT
SELECTION
9. Complete the following only if Participants have full or partial rights to
elect investment allocations in Participant Accounts for: [ ] Employer Purchase
Payments only [ ] Employee Purchase Payments [X] Both
10. Complete the following only if the Contract Holder has full or partial
rights to elect investment allocations in Participant Accounts for: [ ] Employer
and Employee Purchase Payments [ ] Employer Purchase Payments
SIGNATURES
I understand that amounts withdrawn from the Fixed Account or a GAA Term prior
to the maturity date of that Term, may be subject to a market value adjustment
as specified in the contract. I further understand THAT PAYMENTS AND ACCOUNT
VALUES, (IF ANY), WHEN BASED ON THE INVESTMENT experience of a separate ACCOUNT,
ARE VARIABLE AND NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
I acknowledge receipt of the current disclosure book for the Multiple Asset
Portfolio (MAP) V Group Contract and all current prospectuses pertaining to all
of the investment options under the contract. The effective date of the contract
is the Contract Holder's date of signature below.
Dated at Xxxx Xxxxxx, VA
City and State
this 10 day of November 1993
/s/ /s/
Witness Contract Holder
AGENT'S
NOTE
Do you have any reason to believe any existing life insurance or annuity
contracts will be modified or replaced if this contract is
issued? [ ] Yes [X] No
/s/
-----------------------------
Signature of Agent
PLAN
INFORMATION
If the Plan Name is different from the Contract Holder name (see line 1), please
add here:
Will the Plan Reporting Period (MM/DD TO MM/DD) [ ] Multiple reporting periods
required (ATTACH INSTRUCTIONS)
Release Plan Information to Third Party Administrator? [ ] Yes [X] No [ ] N/A
(self-administered)
Name of TPA:
Retirement Plan Administrative Service, Ltd.
Address
0000 Xxxxxxx Xxxx Xxxx
Xxxx Xxxxx ZIP Code
Richmod Virginia / 23228
Enrollment Support Level [ ] A [ ] B [X] C
Will the Plan be funded only with investment options offered in the MAP V Group
Contract? [X] Yes [ ] No If no, please identify alternative investment options:
Does the Plan provide for In Service Withdrawals prior to age 59 1/2? [ ] Yes
[X] No If yes, what is the minimum age? Loans & hardships only
Special Requests:
PRODUCER
INFORMATION
Aetna Field Office Name
Falls Church VA
Social Security ALIAC ALIAC Percentage of
Producer Name* Number Office Code Producer Code Participation
Xxxx X. Xxxxx, RHU 000 00 0000 086 087 100%
o (Florida only) Add license number below name. (HOME OFFICE USE ONLY)
Edition no.
COMMENTS
Corrections and amendments (HOME OFFICE USE ONLY). Errors and omissions may be
corrected by the Company but no change in plan, classification, amount, or extra
benefits shall be made without written consent of the Contract Holder. (N/A in
X.Xx.)
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AETNA (logo)
Aetna Life Insurance and Annuity Company
Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000
Multiple Asset Portfolio (MAP) V Allocated
Group Annuity Contract
Nonparticipating
ALL PAYMENTS AND VALUES PROVIDED BY THE GROUP CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THIS CONTRACT CONTAINS MARKET VALUE ADJUSTMENT FORMULAS.
APPLICATION OF A MARKET VALUE ADJUSTMENT TO THE GAA MAY RESULT IN EITHER AN
INCREASE OR DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA
DOES NOT APPLY TO A GUARANTEED TERM AT THE TIME OF ITS MATURITY. APPLICATION OF
A MARKET VALUE ADJUSTMENT TO THE FIXED ACCOUNT MAY RESULT IN A DECREASE IN THE
CURRENT VALUE.
118
