Exhibit 4
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY
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A Stock Company
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0000 Xxxx Xxxxxxx Xxxx Xxxxxxxxx Xxxxxxx, XX 00000
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For service, call 0-000-000-0000 (extension 73343)
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Group Fixed and Variable
Deferred Annuity Contract
Non-Participating
GROUP CONTRACTHOLDER
GROUP ANNUITY CONTRACT NUMBER
GROUP ANNUITY CONTRACT DATE
The Company agrees to pay the annuity benefits on behalf of Participants who
become eligible for coverage under this Group Fixed and Variable Deferred
Annuity Contract ("Group Annuity Contract"). The provisions on the following
pages, together with the Application for this Group Annuity Contract, are part
of this Group Annuity Contract.
For the purposes of this Group Annuity Contract, "Plan" means the plan(s) that
the Group Contractholder has designated in the Application.
Signed for Great-West Life & Annuity Insurance Company on the issuance of the
Group Annuity Contract on the Group Annuity Contract Date.
Secretary President and Chief Executive Officer
This Group Annuity Contract is a legal contract between the Group Contractholder
and Great-West Life & Annuity Insurance Company. PLEASE READ THIS GROUP ANNUITY
CONTRACT CAREFULLY.
THIS GROUP ANNUITY CONTRACT MAY PROVIDE PAYMENTS OR VALUES WHICH ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT BUT MAY INCREASE OR DECREASE ACCORDING TO
THE INVESTMENT EXPERIENCE OF A VARIABLE ACCOUNT OR SEPARATE ACCOUNT.
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TABLE OF CONTENTS
SECTION 1. DEFINITIONS..............................................................................2
SECTION 2. OWNERSHIP PROVISIONS.....................................................................2
2.1 Ownership of the Group Annuity Contract.........................................................2
2.2 Ownership of the Series Acount..................................................................6
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2.3 Transfer and Assignment.........................................................................2
SECTION 3. GENERAL PROVISIONS.......................................................................2
3.1 Group Annuity Contract..........................................................................7
3.2 Entire Contract.................................................................................2
3.3 Contract Modification...........................................................................2
3.4 Modification of Accounts........................................................................7
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3.5 Non-Participating...............................................................................2
3.6 Currency and Contributions......................................................................2
3.7 Notice and Proof................................................................................2
3.8 Disclaimer......................................................................................8
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3.9 Representations.................................................................................2
3.10 Deemed IRAs....................................................................................8
3.11 Force Majeure..................................................................................8
SECTION 4. SERIES ACCOUNT..........................................................................2
4.1 Series Account..................................................................................2
4.2 Changes within the Series Account...............................................................9
SECTION 5. PARTICIPANT ANNUITY ACCOUNT VALUE........................................................2
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5.1 Fixed Account Value.............................................................................9
5.2 Variable Account Value.........................................................................10
5.3 Accumulation Unit Value.........................................................................2
5.4 Net Investment Factor..........................................................................10
5.5 Separate Account Value.........................................................................10
SECTION 6. PURCHASE PROVISIONS......................................................................2
6.1 Commencement and Termination of Coverage........................................................2
6.2 Contributions...................................................................................2
6.3 Accumulation Unit..............................................................................11
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6.4 Allocation of Contributions.....................................................................2
6.5 Contribution Cessation Date.....................................................................2
SECTION 7. CONTRACT CHARGES AND FEES...............................................................12
7.1 Contract Maintenance Charge....................................................................12
7.2 Mortality and Expense Risk Charge..............................................................12
7.3 Contingent Deferred Sales Charge...............................................................12
SECTION 8. TRANSFERS AMONG INVESTMENT OPTIONS OFFERED BY THE PLAN...................................2
8.1 Participant Directed Transfers and Transfers within the Group Annuity Contract..................2
8.2 Transfers to Other Investment Providers under the Plan..........................................2
8.3 Excessive Trading...............................................................................2
SECTION 9. DISTRIBUTIONS............................................................................2
9.1 Distribution Requirements.......................................................................2
9.2 In-Service Withdrawals..........................................................................2
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9.3 Rollovers......................................................................................13
9.4 Distributions during the Participant's Lifetime.................................................2
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9.5 Establishment of Alternate Payee Account........................................................2
9.6 Distributions after the Participant's Death....................................................14
9.7 Amount Payable on Death of Participant.........................................................14
9.8 Requests for Distributions to a Participant....................................................14
9.9 Proof of Age and Death........................................................................2
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9.10 Conditions of Payment to Payee.................................................................2
SECTION 10. LUMP SUM PAYMENT OPTION.................................................................2
10.1 Election of Lump Sum Payment Option............................................................2
10.2 Total or Partial Lump Sum Payment.............................................................15
SECTION 11. ANNUITY PAYMENT OPTION..................................................................2
11.1 Election of Annuity Payment Option.............................................................2
11.2 Fixed Dollar Annuity Payment Options..........................................................15
SECTION 12. PERIODIC PAYMENT OPTIONS................................................................2
12.1 Election of Periodic Payment Option............................................................2
12.2 Periodic Payment Options......................................................................16
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12.3 Frequency and Amount of Payments...............................................................2
12.4 Deductions from Participant Annuity Account....................................................2
12.5 Payments to a Beneficiary......................................................................2
[GROUP ANNUITY CONTRACT SCHEDULE OF TERMS AND FEES..................................................1
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FIXED ACCOUNTS......................................................................................
SEPARATE ACCOUNTS...................................................................................
SERIES ACCOUNTS.....................................................................................
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SECTION 1. DEFINITIONS
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Accumulation Period - the period between the Participant Effective Date and the
Payee's Payment Commencement Date.
Accumulation Unit - an accounting measure used to determine the Variable Account
Value during the Accumulation Period.
Administrative Offices - 0000 Xxxx Xxxxxxx Xxxx, Xxxxxxxxx Xxxxxxx, XX 00000.
Alternate Payee - any spouse, former spouse, child or other dependent of a
Participant who is recognized by a Qualified Domestic Relations Order as having
a right to receive all or a portion of the benefit payable under a Plan with
respect to such Participant.
Annuitant - the person upon whose life the payment of an annuity is based.
Beneficiary - a person or entity named by the Participant as being entitled to
receive all or a portion of the Participant's account at his or her death.
Business Day - any day on which the New York Stock Exchange is open for trading.
Code - the Internal Revenue Code of 1986, as amended from time to time, or any
future United States Internal Revenue law that replaces the Internal Revenue
Code of 1986. References herein to specific section numbers shall be deemed to
include Treasury regulations and Internal Revenue Service guidance thereunder,
and to corresponding provisions of any future Internal Revenue law that replaces
the Internal Revenue Code of 1986.
Company - Great-West Life & Annuity Insurance Company, located at 0000 Xxxx
Xxxxxxx Xxxx, Xxxxxxxxx Xxxxxxx, XX 00000.
Contributions - purchase payments, eligible rollovers, transfers, payroll
deductions and other amounts received and allocated to a Participant Annuity
Account.
Distributions - amounts paid out of the Group Annuity Contract pursuant to the
terms of the Plan.
Eligible Fund - a mutual fund, unit investment trust or other investment
portfolio in which a Variable Account invests all of its assets.
Fixed Account - one or more accounts selected by the Group Contractholder on the
Group Annuity Contract Application, as amended from time to time, into which
Contributions may be allocated or a Participant Annuity Account Value may be
transferred. The assets of each Fixed Account are part of the General Account of
the Company.
Fixed Account Value - the sum of the Fixed Accounts.
General Account - the Company's assets other than those held in any segregated
investment account.
Group Annuity Contract Date - The Group Annuity Contract Date is the effective
date indicated by the Group Contractholder on the Application for this Group
Annuity Contract or such other date acceptable to the Company.
Group Contractholder - the employer, the named trustee of the Plan, or other
entity sponsoring the Plan, who is also the applicant for this Group Annuity
Contract.
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Guaranteed Interest Rate - the minimum interest rate applicable to Fixed
Accounts and Separate Account on an annual effective basis.
Participant - an employee or former employee: (1) who has met the eligibility
requirements under the Group Contractholder's Plan; (2) for whom an application
for coverage has been made; and (3) for whom a Contribution has been received by
the Company and a Participant Annuity Account has been established by the
Company.
Participant Annuity Account - a separate record in the name of each Participant,
which reflects his or her share in the Variable Accounts, Separate Account, and
Fixed Accounts.
Participant Annuity Account Value - the sum of the Variable Account Value and
the Fixed Account Value credited to the Participant Annuity Account.
Participant Effective Date - the date on which the first Contribution is
credited to a Participant Annuity Account.
Payee - the Group Contractholder or the person, including the Participant,
Beneficiary, or Alternate Payee designated to receive the value of the
Participant Annuity Account.
Payment Commencement Date - the date payments commence pursuant to the terms of
the Plan under a Lump Sum Payment Option, Annuity Payment Option or Periodic
Payment Option selected by the Payee.
Payment Period - the period during which the Payee receives payments under this
Group Annuity Contract.
Plan - the underlying plan document of the Group Contractholder written in
accordance with the applicable sections of the Code. Although the Company may
have knowledge of certain provisions of the Plan, the legal sufficiency of the
Plan remains solely the responsibility of the Group Contractholder. For purposes
of Code section 403(b) annuity programs which do not have a plan document, Plan,
when used herein, will mean the provisions and/or rules of the Group
Contractholder's Code section 403(b) annuity program.
Premium Tax - the amount of tax, if any, charged by a state or other
governmental authority.
Qualified Domestic Relations Order - a domestic relations order that creates or
recognizes the existence of an Alternate Payee's right to, or assigns to an
Alternate Payee the right to receive all or a portion of the benefits payable
with respect to a Participant and that complies with the requirements of the
Code and ERISA, if applicable, and is approved by the Plan.
Request - an inquiry or instruction in a form satisfactory to the Company. A
valid Request must be: (1) received by the Company at its Administrative
Offices; (2) approved by the Group Contractholder, or the Group Contractholder's
designee; and (3) submitted in accordance with the provisions of this Contract,
or as required by the Company.
Rollover - amounts distributed from or transferred into a Variable Account,
Separate Account or Fixed Account on behalf of a Participant Annuity Account in
connection with an eligible plan under the Code. Such amounts shall be
distributed or transferred only upon request of the Group Contractholder or the
Participant, as applicable under the Plan.
Separate Account - a segregated investment account established under Colorado
law by the Company from time to time, as selected on the Application.
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Series Account - a segregated investment account established by the Company into
which Contributions may be invested or the Participant Annuity Account Value may
be transferred as designated by the Group Contractholder on the Application. The
Series Account consists of the individual Variable Accounts.
Transaction Date - the date the Company processes a Contribution or Request. All
Contributions and Requests received at the Company's Administrative Offices
prior to the close of business of the New York Stock Exchange are processed as
of the date of receipt provided the Contribution or Request is accompanied by
complete and accurate records. Contributions and Requests received after the
close of business of the New York Stock Exchange shall be deemed to have been
received, and will be processed, on the next Business Day provided the
Contribution or Request is accompanied by complete and accurate records.
Valuation Date - the date on which the net asset value of each Variable Account
is determined for the Variable Accounts.
Valuation Period - the period between successive Valuation Dates.
Variable Account - divisions of the Series Account, one for each Eligible Fund.
Each Variable Account has its own Accumulation Unit Value.
Variable Account Value - the sum of Variable Accounts and Separate Accounts.
SECTION 2. OWNERSHIP PROVISIONS
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2.1 Ownership of the Group Annuity Contract
The Group Contractholder is the owner of the Group Annuity Contract, and has all
rights, remedies and recourses given in this Group Annuity Contract. The Group
Annuity Contract shall be treated as a trust for purposes of Code sections
401(a), 401(f) and 457(g), and no portion of the amount contributed to the Group
Annuity Contract, including earnings thereon, may be used for or diverted to any
purpose other than the exclusive benefit of Plan Participants and their
Beneficiaries prior to the satisfaction of all liabilities with respect to
Payees. The Group Annuity Contract and the Participant Annuity Accounts are held
in respect of the Plan, and there is no contractual relationship between the
Company and the Participants.
2.2 Ownership of the Series Account
The Company has absolute ownership of the assets of the Series Account. All
moneys invested in the Series Account, however, are held separate and apart from
the Company's General Account. The assets of such separate account which are
equal to the reserves and other Contract liabilities with respect to such
account (e.g. the Participant Annuity Account invested in the Variable Account)
shall not be chargeable with liabilities arising out of any other Company
business.
2.3 Transfer and Assignment
The interest of the Group Contractholder in this Group Annuity Contract may not
be transferred, sold, assigned, pledged, charged, encumbered, or in any way
alienated without the prior written consent of the Company.
SECTION 3. GENERAL PROVISIONS
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3.1 Group Annuity Contract
The Company has issued this Group Annuity Contract to the Group Contractholder
in consideration of the Application and payment of the initial Contribution.
3.2 Entire Contract
This Group Annuity Contract, Group Annuity Contract Schedule of Terms and Fees,
amendments, endorsements, certificates and Fixed and Separate Account pages, if
any, and the Application, a copy of which is attached, constitute the entire
Contract between the Group Contractholder and the Company. All statements in the
Application, in the absence of fraud, have been accepted as representations and
not warranties. Only the President, Vice-President, or the Secretary of the
Company, or their authorized designees, can modify or waive any provisions of
this Group Annuity Contract.
3.3 Contract Modification
This Group Annuity Contract may be amended at any time without consent of the
Group Contractholder or any Participant or other person as necessary to conform
it to changes in tax or other law, including applicable regulations and rulings.
The Company will provide notice and a copy of the amendment to the Group
Contractholder prior to the date such modification becomes effective.
Any other modification to this Group Annuity Contract may be made only by
written agreement between the Company and the Group Contractholder subject to
the approval of the appropriate state department of insurance, if applicable. No
such modification will, without the written consent of the Group Contractholder,
affect the terms, provisions, or conditions of this Group Annuity Contract,
which are or may be applicable to Contributions paid in respect of Participants
prior to the date of such modification.
3.4 Modification of Account Options
The Company may offer new or cease offering existing account options, or make
other changes to the account options as deemed necessary by the Company, and
subject to the approval of the state insurance department, if applicable. If the
Company alters its account options, adequate notice will be given to the Group
Contractholder. The absence of an objection by the Group Contractholder to such
notice will be considered consent to the change(s).
If the Company does not receive an objection from the Group Contractholder,
transfers across accounts as disclosed in the notice will be completed by the
Company as of the effective date of the change. Such allocation will be in
effect until such time as a Request for a different allocation, which is clear
and complete, is received by the Company.
3.5 Non-Participating
This Group Annuity Contract is Non-Participating, meaning that it is not
eligible to share in the Company's divisible surplus.
3.6 Currency and Contributions
All amounts to be paid to or by the Company must be in currency of the United
States of America. All Contributions to this Group Annuity Contract must be made
payable to the Company or a designee acceptable to the Company.
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3.7 Notice and Proof
Any notice or demand by the Company to or upon the Group Contractholder or any
Payee may be given by mailing it to that person's last known address as stated
in the Company's file via the United States Postal Service or last known email
address or facsimile number on file.
An application, report, Request, election, direction, notice or demand by the
Group Contractholder or Payee will be made in a form satisfactory to the
Company. When the Company requires it, the Group Contractholder will obtain the
signature of the Payee on forms provided by the Company.
The Company must first approve any written materials developed by the Group
Contractholder to describe this Group Annuity Contract.
3.8 Disclaimer
Nothing contained in this Group Annuity Contract shall be construed to be tax or
legal advice and the Company assumes no responsibility or liability for any
costs, including but not limited to taxes, penalties or interest incurred by the
Plan, the Group Contractholder, or any other Payee arising out of a
determination of liability. The Company shall not be held liable for the
negligence, willful misconduct, or failure to perform of any third party.
3.9 Representations
The Company shall be entitled to rely and act solely on the reports, directions,
proofs, notices, elections, and other information furnished to it by the Group
Contractholder or its agent, and such acts shall be conclusive and binding as to
all Participants and other persons or corporations claiming an interest
hereunder.
3.10 Deemed IRAs
In the event that a Plan has been amended to establish Deemed IRA(s), including
traditional, Xxxx or both, as part of the Plan effective on or after January
2003, all Contributions to the Deemed IRA(s) will be treated as a Contribution
under the terms of this Group Annuity Contract and will be administered pursuant
to Code section 408(q).
3.11 Force Majeure
None of the parties hereto shall be liable to the other for any and all losses,
damages, costs, charges, counsel fees, payments, expenses or liability due to
any failure, delay or interruption in performing its obligations hereunder, and
without the fault or negligence of such party, due to causes or conditions
beyond its control including, without limitation, labor disputes, riots, war and
war-like operations including acts of terrorism, epidemics, explosions,
sabotage, acts of God, failure of power, fire or other casualty, natural
disasters or disruptions in orderly trading on any relevant exchange or market,
including disruptions due to extraordinary market volume that result in
substantial delay in receipt of correct data.
SECTION 4. SERIES ACCOUNT
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4.1 Series Account
The Series Account is a separate investment account maintained and held apart
from the General Account and any other investment account the Company may have.
The Series Account being utilized is shown in the attached Application and/or
Group Annuity Contract Schedule of Terms and Fees, as amended from time to time.
The portion of the assets of the Series Account equal to the reserves and other
contract liabilities of the Series Account will not be charged with liabilities
that arise from any other business conducted by the Company. Income, gains or
losses, realized and unrealized, on assets in each Variable Account are credited
or charged against that Variable Account without regard to other income, gains
or losses in the other fixed or variable accounts or the Company's other income,
gains or losses.
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The laws of the Company's state of domicile govern the Series Account.
4.2 Changes within the Series Account
The Company may make additional Variable Accounts available to the Group
Contractholder within the Series Account. These accounts will invest in
investment portfolios suitable for the Group Annuity Contract. The Company
reserves the right to eliminate accounts, to combine two or more accounts or to
substitute a new investment portfolio for the portfolio in which an account
invests. Such an action may become necessary if, in the Company's judgment, a
portfolio or account no longer suits the purposes of the Group Annuity Contract.
This may happen due to a change in laws or regulations, or a change in a
portfolio's or account's investment objectives or restrictions, or because the
portfolio or account is no longer available for investment, or for some other
reason.
Subject to any required regulatory approvals, the Company reserves the right to
transfer assets in the Variable Accounts to another Variable Account.
If any of the above actions result in a material change in the underlying
investments of a Variable Account in which the Group Contractholder and
Participants are invested, the Company will notify the Group Contractholder of
the change at the Group Contractholder's last known address on file with the
Company. In the event of a change in the investment options available under the
Plan, the Company will notify the Group Contractholder at the Group
Contractholder's last known address on file with the Company.
SECTION 5. PARTICIPANT ANNUITY ACCOUNT VALUE
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5.1 Fixed Account Value
The Fixed Account Value on any date during the Accumulation Period will be the
value of the Participant's interest in the Fixed Account(s).
The Fixed Account Value is calculated as follows:
(a) all Contributions made by or on behalf of the Participant that are
allocated to a Fixed Account option; plus
(b) all interest credited to the Fixed Account on an annual effective basis
pursuant to the Guaranteed Interest Rate applicable to the Fixed Account
selected on behalf of the Participant; less
(c) any amounts transferred or distributed from the Fixed Account; less
(d) any applicable charges described in the Group Annuity Contract Schedule
of Terms and Fees.
5.2 Variable Account Value
The Variable Account Value on any date during the Accumulation Period will be
the sum of the values of the Participant's interest in the Variable Accounts and
the Separate Account. The value of a Participant's interest in a Variable
Account will be determined by multiplying the number of Accumulation Units held
for the Participant for that Variable Account by the Accumulation Unit Value for
that Variable Account. The Separate Account Value is determined as described in
the attached Separate Account, as selected by the Group Contractholder.
5.3 Accumulation Unit Value
The Accumulation Unit Value of a Variable Account on any Valuation Date is equal
to: (a) the Accumulation Unit Value of that Variable Account as of the
immediately preceding Valuation Date;
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multiplied by (b) the Net Investment Factor for the Valuation Period ending on
the Valuation Date on which the Accumulation Unit Value is being determined.
The Accumulation Unit Value may increase, decrease, or remain unchanged as a
result of the value of the Net Investment Factor.
5.4 Net Investment Factor
The Net Investment Factor for a Variable Account is a calculated value that
measures the investment performance of that account from one Valuation Period to
the next. The Net Investment Factor for any Valuation Period is determined by
dividing (a) by (b), and then subtracting (c) from the result where:
(a)is the net result of:
(i) the net asset value per share of the investment portfolio share
in which the account invests determined at the end of the current
Valuation Period; plus
(ii) the per share amount of any dividend (including a deduction for
an investment advisory fee) or capital gains distribution made by
that investment portfolio on shares held in the account if the
"ex-dividend" date occurs during the current Valuation Period;
and plus or minus
(iii) a per share charge or credit for any taxes reserved for, which is
determined by the Company to have resulted from the operations of
that account;
(b)is the net asset value per share of the investment portfolio share in
which the sub-account invests determined at the end of the
immediately preceding Valuation Period; and
(c) is the daily Mortality and Expense Risk Charge shown in the attached
Group Annuity Contract Schedule of Terms and Fees, as amended from
time to time, adjusted for the number of days in the Valuation
Period.
5.5 Separate Account Value
If the Group Contractholder has selected a Separate Account attached hereto and
made part of this Group Annuity Contract, information regarding the Separate
Account Value is contained in the attached Separate Account.
SECTION 6. PURCHASE PROVISIONS
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6.1 Commencement and Termination of Coverage
The Group Contractholder may make application for coverage of any employee,
provided: (a) the Company is then accepting applications for coverage under this
Group Annuity Contract; and (b) a Contribution Cessation Date has not been
declared under Section 6.5.
An employee for whom an adequate application has been made becomes covered as a
Participant as of the Participant Effective Date. Coverage of a Participant
terminates upon a distribution resulting in a Participant Annuity Account Value
of $0.
6.2 Contributions
Unless a Contribution Cessation Date has been declared under Section 6.5, the
Group Contractholder may make additional Contributions at any time in respect to
a Participant until the earlier of: (a) the Participant's death; (b) Payment
Commencement Date; (c) election of a Periodic Payment option, if applicable; or
(d) the termination of the Participant Annuity Account.
The amount of Contributions to be paid by the Group Contractholder in respect of
any Participant will be determined by the Group Contractholder.
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Rollovers or Transfers from another eligible Plan will be accepted insofar as
they are permitted under the terms of the Plan and applicable Code sections.
The Group Contractholder will report the amount paid as Contributions in a
method acceptable to the Company. The Group Contractholder's report is
conclusive and binding on it and any person or entity claiming an interest under
the Group Annuity Contract. When the Group Contractholder's report does not
coincide with the Contribution received and the inconsistency is not resolved
within a period of time required under the law, the Company will return the
Contribution to the payor.
The Company's prior approval may be required before the Group Contractholder
makes a Contribution that causes a Participant Annuity Account Value to exceed
$1,000,000.
6.3 Accumulation Unit
Contributions received at the Administrative Offices of the Company before the
close of a Valuation Period will be allocated as requested and applied as of
that date based upon the Accumulation Unit Value for that Variable Account.
The number of Accumulation Units credited for each Participant to a Variable
Account is determined by: (a) the dollar amount allocated to that Variable
Account; divided by (b) the value of the Accumulation Unit for that Variable
Account for the Valuation Date on which the Contribution or transferred amount
is allocated to that Variable Account.
The number of Accumulation Units will not change because of a later change in
the Accumulation Unit Value. However, the Accumulation Unit Value will vary to
reflect the investment experience of the Variable Account.
6.4 Allocation of Contributions
Contributions, less Premium Tax, if any, will be allocated in the Participant
Annuity Account: (a) after an account has been established on behalf of the
Participant; and (b) the Contribution is received by the Company at its
Administrative Offices.
Contributions made on behalf of a Participant will be allocated among any number
of currently offered Variable Account, Separate Account and Fixed Account
options selected by the Group Contractholder and as directed by the Participant.
If the Group Contractholder changes the offered Variable Account, Separate
Account or Fixed Account options, or selects additional or different Variable
Account or Fixed Account options to be offered under the Plan, Contributions may
be redirected and the account balance may be reallocated subject to the terms of
the accounts selected.
6.5 Contribution Cessation Date
The Group Contractholder or the Company may declare a Contribution Cessation
Date upon written Request to the other. The Contribution Cessation Date should
be specified in the Request and must be at least 90 days from the date of the
Request. If a Contribution Cessation Date is not specified in the Request, the
Contribution Cessation Date shall be the next Business Day on after the 90th day
after the date the Request is received by the Company. After a Contribution
Cessation Date is declared: (a) no further Contributions will be made to the
Group Annuity Contract; and (b) no new Participant Annuity Account will be
established. The Participant Annuity Account Value will be maintained until the
Payment Commencement Date or as described below.
If the Group Contractholder directs the Company in a Request to pay the
Participant Annuity Accounts, the Company will pay the Variable Accounts to the
designee of the Plan or to the Group Contractholder within 7 calendar days after
the Contribution Cessation Date. The Company will pay the Separate and
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Fixed Accounts to the designee of the Plan or to the Group Contractholder
according to the specific requirements of each Separate and Fixed Account.
SECTION 7. CONTRACT CHARGES AND FEES
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7.1 Contract Maintenance Charge
A Contract Maintenance Charge will be deducted from each Participant Annuity
Account at the rate and in the manner described in the attached Group Annuity
Contract Schedule of Terms and Fees. No refund of this charge will be made.
The deduction of the Contract Maintenance Charge will be pro-rated among the
Variable Accounts, Separate Account and/or Fixed Accounts based upon their
respective values on the date of deduction. Whenever a deduction for a Contract
Maintenance Charge is to be made from a Variable Account, the Company will
cancel Accumulation Units having a total value equal to the amount of the
deduction. Whenever a deduction for a Contract Maintenance Charge is to be made
from the Separate or Fixed Account, the Company will reduce the Participant
Annuity Account Value in an amount equal to deduction. The Contract Maintenance
Charge applicable to each Fixed Account, if any, will be assessed as described
in the Fixed Account option page attached to this Group Annuity Contract. The
Group Contractholder may elect to pay such Contract Maintenance Charge to the
Company separately. If such an election has been made, then no charge will be
made against the Variable Accounts, Separate Account or Fixed Accounts unless
payment is not received within 30 days of the date of the invoice.
7.2 Mortality and Expense Risk Charge
A mortality and expense risk charge is deducted to compensate the Company for
bearing certain mortality and expense risks under the Contract.
The Company will deduct the Mortality and Expense Risk Charge for expense and
mortality guarantees in the calculation of the Net Investment Factor described
in Section 5.4. This charge is calculated on the daily net asset value of each
Variable Account and is equal to the annual rate described in the Group Annuity
Contract Schedule of Terms and Fees. In no event will the Mortality and Expense
Risk Charge exceed an annual effective rate of 1.25% of the assets in the
Variable Accounts.
7.3 Contingent Deferred Sales Charge
A Contingent Deferred Sales Charge, as described in the Group Annuity Contract
Schedule of Terms and Fees, will be deducted from any total or partial Transfer
to another company under Section 8, distribution or single sum payment from the
Participant Annuity Account under Sections 9 and 10, and periodic payments under
Section 11 as described in the Group Annuity Contract Schedule of Terms and
Fees.
The Contingent Deferred Sales Charge will be equal to a percentage of the amount
distributed as indicated in the attached Group Annuity Contract Schedule of
Terms and Fees. In no event shall the Contingent Deferred Sales Charge at any
point in time exceed 8.5% of Contributions made by the Participant to this Group
Annuity Contract.
SECTION 8. TRANSFERS AMONG INVESTMENT OPTIONS OFFERED BY THE PLAN
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The Group Contractholder or Payee may make Transfers among the Fixed, Variable
and Separate Accounts under this Group Annuity Contract or another investment
provider under the Plan.
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8.1 Participant Directed Transfers and Transfers within the Group Annuity
Contract
Participant Directed Transfers will be based upon the Participant Annuity
Account Value. These Participant Directed Transfers will take effect on the
Transaction Date and Transfers within the Group Annuity Contract may be made at
any time, subject to the restrictions of the attached Fixed Account, Separate
Account and/or Variable Account pages, as selected by the Group Contractholder
on the Group Annuity Contract Schedule of Terms and Fees.
8.2 Transfers to Other Investment Providers under the Plan
All or a portion of the Participant Annuity Account Value may be transferred to
an account currently offered by another investment provider under the Plan.
Transfers will be permitted provided:
(a) The Transfer satisfies the terms of the Plan in accordance with the
appropriate provisions of the Code.
(b) Individual Participant Transfers will be based upon the Participant
Annuity Account Value.
(c) No Transfers are permitted after the Payment Commencement Date.
(d) The Company receives satisfactory Request for such Transfer.
(e) The restrictions and fees, if any, of the attached Fixed Account, Separate
Account and/or Variable Account selected by the Group Contractholder on
the Application, as amended from time to time, will apply.
8.3 Excessive Trading
Upon notification from a mutual fund company or its detection, or upon a
determination by the Company, of excessive trading, market timing or fraud, the
Company reserves the right to cancel or rescind any Transfer Request upon notice
within 5 Business Days of its receipt of the Transfer Request.
================================================================================
SECTION 9. DISTRIBUTIONS
9.1 Distribution Requirements
Notwithstanding any provision herein to the contrary, Distributions to a Payee
may only be made in accordance with the terms of the Plan and applicable Code
sections, and will be tax reported under the applicable rules in effect on the
date of distribution.
9.2 In-Service Withdrawals
The Group Contractholder may Request that the Company make an In-Service
Withdrawal from the Participant Annuity Account payable to the Participant. The
In-Service Withdrawal will be effective on the later of the date elected and the
date the Request is received by the Company at its Administrative Offices.
9.3 Rollovers
Eligible Payees may Request that eligible rollover distributions be paid
directly to any other specified eligible retirement plan that accepts such
rollovers or to an IRA.
9.4 Distributions during the Participant's Lifetime
Participants are required by the Code to begin receiving required minimum
distributions as of their required beginning date, which is April 1 of the
calendar year following the later of: (a) attainment or age 70 1/2; or (b)
severance of employment, or such other date as may be prescribed in the Code.
The minimum distribution amount is determined by using the account balance at
the end of the prior
Page 13
calendar year, the Participant's age in the current year, and the applicable
Table set forth in the federal Treasury regulations. Participants whose sole
beneficiary is their surviving spouse who is more than 10 years younger may
elect a joint and survivor calculation.
Required minimum distributions made under this Group Annuity Contract will only
be made in a manner consistent with Code section 401(a)(9). It is the
Participant's responsibility to Request payments in accordance with the minimum
distribution requirements and to pay any penalties resulting from a failure to
Request timely payments in the proper amount.
9.5 Establishment of Alternate Payee Account
In the event that the Company receives a Request in connection with a Qualified
Domestic Relations Order (QDRO) approved by the Group Contractholder, the
Company will make a payment to the Alternate Payee and/or establish a separate
account on behalf of the Alternate Payee named in such order. The Alternate
Payee's separate account will be administered in accordance with the provisions
of the Plan.
9.6 Distributions after the Participant's Death
The Code requires Distributions made after the Participant's death to be made on
or before the designated Beneficiary's required beginning date in a manner and
amount consistent with section 401(a)(9) of the Code as it is in effect at the
time of the distribution.
It is the Beneficiary's responsibility to Request payments in accordance with
the minimum distribution requirements and to pay any penalties resulting from a
failure to Request timely payments in the proper amount.
9.7 Amount Payable on Death of Participant
If the Participant dies before the Payment Commencement Date, the amount payable
on death will be:
(a) Where death occurs before the Participant's age 70th birthday, the greater
of:
(i) The Participant Annuity Account Value, less Premium Tax, if any; or
(ii) The sum of Contributions paid to, less any amounts distributed or
transferred from, the Participant Annuity Account, less Premium Tax, if
any.
(b) Where death occurs on or after the Participant's 70th birthday, the
Participant Annuity Account Value, less Premium Tax, if any.
9.8 Requests for Distributions to a Participant
At any time prior to the 30-days preceding the Payment Commencement Date, a
proper Request may be made to:
(a) Elect an Annuity Payment Option or Periodic Payment Option.
(b) Elect the Participant's Payment Commencement Date. If any Payment
Commencement Date would be less than 30 days from the date the Request is
received, the Company may delay the Payment Commencement Date elected by 30
days.
(c) If no Annuity Payment Option or Periodic Payment Option is elected within 30
days of the Payment Commencement Date, the Company will reject the Request.
A Request is required to elect or change a Lump Sum Payment Option, Annuity
Payment Option or Periodic Payment Option, as applicable.
Page 14
9.9 Proof of Age and Death
The Company may require adequate proof of the age and death of any Payee before
it admits a claim for or makes any payment.
If the age of the Payee has been misstated, the payments established for him/her
under the Participant Xxxxxxx Account will be made on the basis or his/her
correct age.
If payments made pursuant to the election of an Annuity Payment Option were too
large because of a misstatement of age, the Company may deduct the difference
from the next payment or payments with interest. If payments were too small, the
Company may add the difference to the next payment with interest. Any interest
payable will be made at the rate required by law.
9.10 Conditions of Payment to Payee
Subject to the provisions of Section 9.8, payments will only be made if then
available to the Payee under the terms and provisions of the Plan and the Code
sections governing the Plan as determined by the Group Contractholder. Approved
distributions shall be effective on the later of: (a) the date elected; or (b)
the date the Request is received at the Administrative Offices of the Company.
Such payment will be distributed to the Payee, transferred to another eligible
plan, or directly rolled over to an eligible retirement plan or IRA as indicated
on the approved distribution form.
SECTION 10. LUMP SUM PAYMENT OPTION
================================================================================
10.1 Election of Lump Sum Payment Option
If the Payee is entitled to a Distribution under the applicable terms and
provisions of the Plan and the Code sections governing the Plan as determined by
the Group Contractholder, all or a portion of a Participant Annuity Account may
be applied to a Lump Sum Payment Option selected by the Payee.
10.2 Total or Partial Lump Sum Payment
Subject to the provisions of the Fixed Account(s), the amount to be distributed
is: (i) the amount requested as a lump sum; less (ii) the Premium Tax, if any,
as of the date the amount is distributed, and (iii) any fees described in the
attached Group Annuity Contract Schedule of Terms and Fees.
SECTION 11. ANNUITY PAYMENT OPTIONS
================================================================================
11.1 Election of Annuity Payment Options
If the Payee is entitled to a Distribution under the applicable terms and
provisions of the Plan and the Code sections governing the Plan as determined by
the Group Contractholder, all or a portion of a Participant Annuity Account may
be applied to an Annuity Payment Option selected by the Payee.
11.2 Fixed Dollar Annuity Payment Options
The amount to be applied to an Annuity Payment Option is: (i) the Participant
Annuity Account Value; less (ii) Premium Tax, if any, as of the Payment
Commencement Date; less (iii) any fees described in the attached Group Annuity
Contract Schedule of Terms and Fees.
Available Fixed Dollar Annuity Payment Options are Income of an Amount Certain
at 12, 6, 3 or 1- month intervals, Income for a Period Certain at 12, 6, 3 or
1-month intervals, Fixed Life Annuity with Guaranteed Period (monthly payments
for a 5, 10, 15 or 20 year period), Fixed Life Annuity, and any
Page 15
other form of a Fixed Dollar Annuity Payment Option acceptable to the Company.
Allowable Fixed Dollar Annuity Payment Options are set forth in the Plan. The
Annuity Payment Option that will always be available is the Fixed Life Annuity
if allowed under the Plan. If this Annuity Payment Option is elected, the
Company will pay a monthly payment during the Payee's lifetime. Payments will
cease with the last payment preceding the death of the Payee.
The Company will rely on the Group Contractholder's determination with respect
to the timing and amount of any benefit payable to the Participant or Payee
under this Contract.
If any payments to be made under the elected Annuity Payment Option will be less
than $50, the Company may make the payments in the most frequent interval that
produces a payment of at least $50. The minimum amount that may be applied under
the elected Payment Option is $5,000. If the amount is less than $5,000, the
Company may pay it in one sum.
Minimum Monthly Payment for Each $1,000 of Participant Annuity Account Value
Applied to Purchase a Lifetime Monthly Payment
Age of Lifetime Monthly
Payee Payment
50 $3.99
55 4.31
60 4.71
65 5.28
70 6.07
75 7.22
SECTION 12. PERIODIC PAYMENT OPTIONS
================================================================================
12.1 Election of Periodic Payment Option
If the Payee is entitled to a Distribution under the applicable terms and
provisions of the Plan and the Code sections governing the Plan as determined by
the Group Contractholder, all or a portion of a Participant Annuity Account may
be applied to a Periodic Payment Option selected by the Payee. Charges and fees,
if any, as described in the Group Annuity Contract Schedule of Terms and Fees,
will continue to apply. Periodic Payment elections are subject to the
administrative procedures of the Company in effect at the time of the election.
12.2 Periodic Payment Options
Option 1: Income for a Period Certain of at least 36 months.
Option 2: Income of an Amount Certain for at least 36 months.
Option 3: Minimum Distribution. Payments will be made as required to meet the
minimum distribution requirements of Code section 401(a)(9).
Payments will cease when the Participant Annuity Account Value is zero.
12.3 Frequency and Amount of Payments
The Request must specify:
(a) the payment frequency of either 12, 6, 3, or 1-month intervals; (b) the
payment amount; a minimum of $100 is required.
(c) the month, day and year on which payments are to begin (payments shall not
begin on the 29th, 30th or 31st of the month); and
Page 16
(d) the Periodic Payment Option.
12.4 Deductions from Participant Annuity Account
The amount of each payment made under this Periodic Payment Option on behalf of
each Payee will be deducted from the Participant Annuity Account.
12.5 Payments to a Beneficiary
If the Participant is receiving Periodic Payments, any Periodic Payments
remaining to be paid as of the Participant's date of death will be paid to the
Participant's Beneficiary. The Beneficiary will receive payments remaining under
the payment option in effect as of the date of the Participant's death unless a
lump sum is elected on the appropriate death claim request form.
Page 17
SEPARATE ACCOUNT
================================================================================
Stable Asset Fund
================================================================================
The Stable Asset Fund is a Separate Account. All or a portion of the
Participant's Contributions and Participant Annuity Account may be allocated to
the Stable Asset Fund.
Assets within the Stable Asset Fund will be invested according to the investment
guidelines agreed upon by the Group Contractholder and the Company.
Definitions
Competing Fund is any of the following types of funds offered by the Group
Contractholder:
a) any fund with a known or periodically declared rate of interest; or
b) any money market fund; or
c) any bond fund with a duration of 3 years or less.
Interest Rate(s) means an annual effective rate of interest determined by the
Company prior to the last day of each calendar quarter, effective for the Stable
Asset Fund Account balance the next calendar quarter. This annual effective rate
will be compounded daily. The Interest Rate will never be less than the Minimum
Guaranteed Interest Rate.
If the Company modifies the interest crediting method, the Company will provide
the Group Contractholder with a notice of the changes.
Minimum Guaranteed Interest Rate is an effective annual interest rate of [0% -
4%].
Limitations
================================================================================
The Group Contractholder may not offer Competing Funds, as defined above, unless
mutually agreed upon by the Company and the Group Contractholder.
Interest Calculation Method
Interest Rates are calculated as follows: (1) the current yield of the
investment portfolio is determined; (2) any difference between the Book Value of
the assets and the Book Value of the liabilities is calculated and the
difference is amortized over the expected remaining life of the assets in the
Stable Asset Fund, unless otherwise agreed to by the Company and the Group
Contractholder; (3) fees are deducted. The resulting rate is guaranteed and
applied to all Participant Annuity Accounts for the following quarter.
Stable Asset Fund Account Value
The Stable Asset Fund Account Value, at any given time, will either be the Book
Value or the Market Value of the Stable Asset Fund Account. The Book Value will
apply to Cessation Option 1 when it is elected under the Cessation Option
provision below. The Market Value will apply to Cessation Option 2 when it is
elected under the Cessation Option provision below.
Market Value of the Stable Asset Fund
The Market Value of the Stable Asset Fund is determined monthly or on the
Contribution Cessation Date. This value is based on the closing market price for
each security in the account, less the outstanding balance, if any, of amounts
borrowed from the Company's General Account and less the Investment Management
Fee.
Book Value of the Stable Asset Fund
================================================================================
The Book Value of the Stable Asset Fund is the amortized cost of the securities
owned by the Stable Asset Fund, plus cash, plus accrued interest, less the
outstanding balance, if any, of amounts borrowed from the Company's General
Account and less the Investment Management Fee.
Page 1
Loan From the General Account of the Company
If the amount of any transfer or distribution exceeds the cash balance in the
Stable Asset Fund, the Stable Asset Fund will borrow such deficiency from the
General Account of the Company. All subsequent Contributions and proceeds from
maturities of the Stable Asset Fund assets will first be applied to reduce the
outstanding balance of this loan. Interest will be charged monthly by the
Company's General Account at an annual effective rate equal to the 30 day LIBOR
rate, plus 0.35%.
Amortization of Defaults
In the event that any securities in the Stable Asset Fund default on their
obligation, the Book Value of the security will be reduced to its current Market
Value, if any. Any losses associated with the default will be amortized under
the Interest Crediting Method.
Investment Management Fee
An Investment Management Fee at the rate shown in the Group Annuity Contract
Schedule of Terms and Fees will be assessed and deducted against the Stable
Asset Fund each calendar quarter. In no event will the Investment Management Fee
exceed an annual effective rate of 1.50% of the assets in the Stable Asset Fund.
Transfers
================================================================================
A Transfer from the Participant's Stable Asset Fund account value is limited to
an amount shown in the Group Annuity Contract Schedule of Terms and Fees, if
any, and is a percentage of the Participant's Stable Asset Fund Account value at
December 31 of the preceding calendar year. If the Participant's Stable Asset
Fund Account value is $500 or less, a Transfer of the entire account value may
be made at any time.
When a Group Contractholder elects to transfer the aggregate of all Participant
Stable Asset Fund Account values to another carrier at one time, such Transfers
will be treated as an election of Cessation Option 2.
When and if a Group Contractholder encourages Participants to transfer out of
the Stable Asset Fund, such Transfers will be treated as an election of
Cessation Option 2.
Business Hardship Withdrawal
================================================================================
For Code section 401(a) and 401(k) Plans, in the event the Group Contractholder
experiences a 20% or more reduction in its work force in one calendar year, the
first 20% of the Book Value of the Stable Asset Fund on the first day of the
calendar year may be paid at the Book Value of the Stable Asset Fund. Transfers
in excess of the above noted 20% threshold will always by paid at the Market
Value of the Stable Value Fund. Reductions in the Group Contractholder's work
force of less than 20% in one calendar year will be paid at the Book Value of
the Stable Asset Fund.
Distributions
Distributions to a Participant are based on the Participant's Book Value and are
permitted for the purpose of paying a benefit to a Participant, which includes
death, severance of employment, hardship or unforeseeable emergency.
Applicability of State Guarantee Funds
Assets in the Stable Asset Fund are not covered by state guarantee funds.
Ownership
Amounts allocated to a Separate Account shall be owned by the Company. All
monies invested in the Separate Account are maintained and held separate and
apart from the Company's General Account and any other investment account the
Company may have. That portion of the assets of the Separate Account which is
equal to the reserves and other contract liabilities with respect to each
Separate Account shall not be chargeable with liabilities arising out of any
other business the Company
may conduct. Income, gains or losses, realized and unrealized, on assets in each
Separate Account are credited or charged against that Separate Account without
regard to other income, gains or losses in other fixed or variable accounts or
the Company's other income, gains or losses.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contributions
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Stable Asset account value until it is applied
to a Payment Option or distributed to a Participant or Beneficiary. When
such individual transactions are applied or paid, they will be
calculated at the Book Value of the Stable Asset Fund.
2. Market Value of the Stable Asset Fund - The Group Contractholder must
specify Option A or B below at the same time it notifies the Company it
is ceasing Contributions and the Company will pay the Market Value of
the Stable Asset Fund within 7 days after the Contribution Cessation
Date.
Option A: After notification of Cessation of Contributions, the
Company will sell all non-cash assets in the Stable Asset Fund
Account attributable to the terminating contract and convert them to
cash assets or short-term money market instruments. The time when all
non-cash assets have been converted to cash or short-term money
market instruments will be no later than the Contribution Cessation
Date. The Company will transfer the Market Value of the Stable Asset
Fund as of the Contribution Cessation Date attributable to the
terminating contract to the successor provider designated by the
Group Contractholder. If no designation is provided, the transfer
will be made to the Group Contractholder.
Option B: After notification of Cessation of Contributions is
received, the Company will value the Stable Asset Fund on the
Contribution Cessation Date and transfer the Market Value of the
Stable Asset Fund attributable to the terminating contract to the
successor provider designated by the Group Contractholder. If no
designation is provided, the transfer will be made to the Group
Contractholder.
Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
[Signed and accepted by the Group Contractholder and attached to the Group
Annuity Contract on _______________, 20____.
By:
-------------------------------
Title:
-------------------------------
Page 3
FIXED ACCOUNT
================================================================================
Guaranteed Portfolio Fund
The Guaranteed Portfolio Fund is part of the General Account of the Company. All
or a portion of the Participant's Contributions and Participant's Annuity
Account may be allocated to the Guaranteed Portfolio Fund, which is a Fixed
Account.
Guaranteed Interest Rate
Interest will be earned on the Guaranteed Portfolio Fund value and compounded
daily to the effective annual interest rate. The interest rate to be credited to
the entire value of the Guaranteed Portfolio Fund will be determined by the
Company prior to the last day of each calendar quarter and will remain in effect
until the end of the calendar quarter. The effective annual interest rate will
never be less than [0% - 4%].
As mutually agreed to by the Group Contractholder and the Company, the Group
Contractholder may elect to change the interest crediting method. If such an
agreement is made, an Endorsement that describes the new interest crediting
method will be attached to the Contract. Such Endorsement will be filed with and
approved by the insurance department of the state in which this Contract is
delivered and will not take effect until approved.
Transfers, Distributions
Amounts may be transferred from the Participant's account balance in the
Guaranteed Portfolio Fund at any time.
The value of the Guaranteed Portfolio Fund in respect of the Participant will be
determined as the value of (a) minus (b) where:
(a) is the sum of the Participant's Guaranteed Portfolio Fund Contributions
plus interest and Transfers to the Guaranteed Portfolio Fund; and
(b) is the sum of:
i. any amounts distributed; and
ii. any Transfers from the Guaranteed Portfolio Fund; and
iii. Premium Tax, if applicable.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contributions
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. Payment at Book Value - The Company will pay to the Group Contractholder
the sum of the Participant Annuity Account Value in the Guaranteed
Portfolio Fund. The Company reserves the right to defer payment of this
amount but not longer than 12 months from the Contribution Cessation
Date.
3. 20 Equal Quarterly Payments - The Company will pay to the Contractholder
the sum of the Participant Annuity Account Values in the Guaranteed
Fixed Fund in 20 equal quarterly payments of not less than $514.80 for
each $10,000 of the sum of the Participant Annuity Account Values. The
first payment will be made 30 days after the Contribution Cessation
Date.
Page 1
Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
[Signed and accepted by the Group Contractholder and attached to the Group
Annuity Contract on _______________, 20____.
By:
-------------------------------
Title:
-------------------------------
Page 2
FIXED ACCOUNT
================================================================================
Managed Guaranteed Fund
================================================================================
The Managed Guaranteed Fund is part of the General Account of the Company. All
or a portion of the Participant's Contributions and Participant Annuity Account
may be allocated to the Managed Guaranteed Fund, which is a Fixed Account.
Definitions
Managed Guaranteed Fund Account is established when a Participant's
Contributions are allocated or amounts are transferred to the Managed Guaranteed
Fund. The value of each Managed Guaranteed Fund Account is equal to the amount
allocated, increased by interest and reduced by any distributions or transfers
from, or charges and Premium Tax, as applicable, assessed against the Managed
Guaranteed Fund Account.
Initial Guaranteed Period is applicable to new Contributions to the Managed
Guaranteed Fund Account. This period begins on the date the Company receives the
Contribution or on the date monies are transferred into this account. The
Initial Guaranteed Period continues until the end of the calendar year of the
Contribution or Transfer and continues until the end of the subsequent calendar
year.
Renewal Guaranteed Period is applicable to monies that have gone through the
Initial Guaranteed Period and will continue for a minimum of one year.
Guaranteed Interest Rate is the minimum effective annual interest rate to be
credited to Contributions allocated to the Managed Guaranteed Fund Account. The
Guaranteed Interest Rate will never be less than [0% - 4%].
Interest Rates
The Company will declare Interest Rates for the Initial and Renewal Guaranteed
Period. These rates will be compounded daily and will remain in effect until
changed by the Company, but not less than the duration of the respective
Guarantee Periods. The interest rates will never be less than the Guaranteed
Interest Rate.
The interest rates applicable to an Initial Guaranteed Period may be different
than those applicable to a Renewal Guaranteed period.
Free Amount
================================================================================
The Free Amount on any Partial Surrender or Surrender is based on the total
amount invested in all FutureFunds options. The Free Amount is equal to ten
percent (10%) of the sum of the Participant Annuity Account Value at December 31
of the preceding calendar year. Only one Free Amount is available to a
Participant in each calendar year beginning after the first calendar year the
Participant is covered under this Group Annuity Contract. That Free Amount will
be applied on the Surrender or the first Partial Surrender made in that year. No
portion of the Free Amount will be available from the Managed Guaranteed Fund
balance until account balances in all other Fixed Accounts and Variable
Accounts, if any, have first been exhausted.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
Page 1
2. 20 Equal Quarterly Payments - The Company will pay to the Contractholder
the sum of the Participants Annuity Account Values in the Managed
Guaranteed Fund in 20 equal quarterly payments of not less than $514.80
for each $10,000 of the sum of the Participant Annuity Account Values.
The first payment will be made 30 days after the Contributions Cessation
Date.
Surrender and Partial Surrenders
================================================================================
Subject to the Distributions provisions of the Group Annuity Contract and the
Plan, a Participant may, by Request, elect a Surrender or Partial Surrender at
any time after the account balances in all other Fixed Accounts and Variable
Accounts, if any, have been exhausted. Any Surrender or Partial Surrender will
be deducted from the Participant's Managed Guaranteed Fund Account on a
last-in-first-out basis. The Surrender or Partial Surrender will take effect on
the later of the date elected or the date the Request is received at the
Administrative Offices of the Company.
Transfers
================================================================================
A Transfer from the Participant's Managed Guaranteed Fund Account is limited to
an amount equal to ten percent (10%) of the Participant's Managed Guaranteed
Fund Account balance at December 31 of the preceding calendar year. Only one
Transfer from the Participant's Managed Guaranteed Fund Account may be made in a
calendar year unless the Participant's Managed Guaranteed Fund Account balance
is $500 or less. In this case, a Transfer of the entire balance may be made at
any time.
Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
[Signed and accepted by the Group Contractholder and attached to the Group
Annuity Contract on _______________, 20____.
By:
-------------------------------
Title:
-------------------------------
Page 2
--------------------------------------------------------------------------------
Endorsement for Section 457(b) Non-governmental Tax-Exempt Employer Plans
--------------------------------------------------------------------------------
Attached to and Forming a Part of
================================================================================
The Group Annuity Contract
This Endorsement is made a part of the Group Annuity Contract to which it is
attached. It is effective on the Group Annuity Contract Date. It is subject to
all the exclusions, definitions and provisions of the Group Annuity Contract
that are not inconsistent with this Endorsement.
The Group Annuity Contract and Application are intended to conform to section
457(b) of the Code.
The following changes shall be made to the Group Annuity Contract:
Section 2.1 is deleted in its entirety and is replaced with the following:
Ownership of the Group Annuity Contract
The Group Contractholder is the owner of the Group Annuity Contract, and has
all rights, remedies and recourses given in this Group Annuity Contract
subject to the claims of the Group Contractholder's general creditors. The
Group Annuity Contract and the Participant Annuity Accounts are held by the
Group Contractholder, and there is no contractual relationship between the
Company and the Participants.
Section 3.10, Deemed IRAs, is deleted in its entirety.
Section 6.2 is deleted in its entirety and is replaced with the following:
Contributions
Unless a Contribution Cessation Date has been declared under Section 6.5,
the Group Contractholder may make additional Contributions at any time in
respect to a Participant until the earlier of: (a) the Participant's death;
(b) Payment Commencement Date; (c) election of a Periodic Payment option, if
applicable; or (d) the termination of the Participant Annuity Account.
The amount of Contributions to be paid by the Group Contractholder in
respect of any Participant will be determined by the Group Contractholder.
The Group Contractholder will report the amount paid as Contributions on
forms acceptable to the Company. The Group Contractholder's report is
conclusive and binding on it and any person or entity claiming an interest
under the Group Annuity Contract. When the Group Contractholder's report
does not coincide with the Contribution received and the inconsistency is
not resolved within a period of time required under the law, the Company
will return the Contribution to the payor.
The Company's prior approval may be required before the Group Contractholder
makes a Contribution that causes a Participant Annuity Account Value to
exceed $1,000,000.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Section 9.3, Rollovers, is deleted in its entirety.
Page 1
Section 9.10 is deleted in its entirety and is replaced with the following:
9.10 Conditions of Payment to Payee
Subject to the provisions of Section 9.8, payments will only be made if then
available to the Payee under the terms and provisions of the Plan and the Code
sections governing the Plan as determined by the Group Contractholder. Approved
distributions shall be effective on the later of: (a) the date elected; or (b)
the date the Request is received at the Administrative Offices of the Company.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Signed for Great-West Life & Annuity Insurance Company on the Group Annuity
Contract Date.
President and Chief Executive Officer
Page 2
--------------------------------------------------------------------------------
Endorsement for Section 457(b) Non-governmental Tax-Exempt Employer Plans
--------------------------------------------------------------------------------
Attached to and Forming a Part of
================================================================================
The Group Annuity Contract
This Endorsement is made a part of the Group Annuity Contract to which it is
attached. It is effective on the Group Annuity Contract Date. It is subject to
all the exclusions, definitions and provisions of the Group Annuity Contract
that are not inconsistent with this Endorsement.
The Group Annuity Contract and Application are intended to conform to section
457(b) of the Code.
The following changes shall be made to the Group Annuity Contract:
Section 2.1 is deleted in its entirety and is replaced with the following:
Ownership of the Group Annuity Contract
The Group Contractholder is the owner of the Group Annuity Contract, and has
all rights, remedies and recourses given in this Group Annuity Contract
subject to the claims of the Group Contractholder's general creditors. The
Group Annuity Contract and the Participant Annuity Accounts are held by the
Group Contractholder, and there is no contractual relationship between the
Company and the Participants.
Section 3.10, Deemed IRAs, is deleted in its entirety.
Section 6.2 is deleted in its entirety and is replaced with the following:
Contributions
Unless a Contribution Cessation Date has been declared under Section 6.5,
the Group Contractholder may make additional Contributions at any time in
respect to a Participant until the earlier of: (a) the Participant's death;
(b) Payment Commencement Date; (c) election of a Periodic Payment option, if
applicable; or (d) the termination of the Participant Annuity Account.
The amount of Contributions to be paid by the Group Contractholder in
respect of any Participant will be determined by the Group Contractholder.
The Group Contractholder will report the amount paid as Contributions on
forms acceptable to the Company. The Group Contractholder's report is
conclusive and binding on it and any person or entity claiming an interest
under the Group Annuity Contract. When the Group Contractholder's report
does not coincide with the Contribution received and the inconsistency is
not resolved within a period of time required under the law, the Company
will return the Contribution to the payor.
The Company's prior approval may be required before the Group Contractholder
makes a Contribution that causes a Participant Annuity Account Value to
exceed $1,000,000.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Section 9.3, Rollovers, is deleted in its entirety.
Page 1
Section 9.7, Amount Payable on Death of Participant, shall be deleted in its
entirety and replaced with the following:
9.7 Amount Payable on Death of Participant
If the Participant dies before the Payment Commencement Date, the amount payable
on death will be the Participant Annuity Account Value net of any outstanding
loan balance, less Premium Tax, if any.
Section 9.10 is deleted in its entirety and is replaced with the following:
9.10 Conditions of Payment to Payee
Subject to the provisions of Section 9.8, payments will only be made if then
available to the Payee under the terms and provisions of the Plan and the Code
sections governing the Plan as determined by the Group Contractholder. Approved
distributions shall be effective on the later of: (a) the date elected; or (b)
the date the Request is received at the Administrative Offices of the Company.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Signed for Great-West Life & Annuity Insurance Company on the Group Annuity
Contract Date.
President and Chief Executive Officer
Page 2
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Endorsement for Non-Qualified Deferred Compensation Plans
--------------------------------------------------------------------------------
Attached to and Forming a Part of
the Group Annuity Contract
================================================================================
This Endorsement is made a part of the Group Annuity Contract to which it is
attached. It is effective on the Group Annuity Contract Date. It is subject to
all the exclusions, definitions and provisions of the Group Annuity Contract
that are not inconsistent with this Endorsement.
The Group Annuity Contract and Application are intended to conform to the Group
Contractholder's Non-Qualified Deferred Compensation Plan.
The following changes shall be made to the Group Annuity Contract:
Section 2.1 is deleted in its entirety and is replaced with the following:
Ownership of the Group Annuity Contract
The Group Contractholder is the owner of the Group Annuity Contract, and has
all rights, remedies and recourses given in this Group Annuity Contract
subject to the claims of the Group Contractholder's general creditors. The
Group Annuity Contract and the Participant Annuity Accounts are held by the
Group Contractholder, and there is no contractual relationship between the
Company and the Participants.
Section 3.10, Deemed IRAs, is deleted in its entirety.
Section 6.2 is deleted in its entirety and is replaced with the following:
Contributions
Unless a Contribution Cessation Date has been declared under Section 6.5,
the Group Contractholder may make additional Contributions at any time in
respect to a Participant until the earlier of: (a) the Participant's death;
(b) Payment Commencement Date; (c) election of a Periodic Payment option, if
applicable; or (d) the termination of the Participant Annuity Account.
The amount of Contributions to be paid by the Group Contractholder in
respect of any Participant will be determined by the Group Contractholder.
The Group Contractholder will report the amount paid as Contributions on
forms acceptable to the Company. The Group Contractholder's report is
conclusive and binding on it and any person or entity claiming an interest
under the Group Annuity Contract. When the Group Contractholder's report
does not coincide with the Contribution received and the inconsistency is
not resolved within a period of time required under the law, the Company
will return the Contribution to the payor.
The Company's prior approval may be required before the Group Contractholder
makes a Contribution that causes a Participant Annuity Account Value to
exceed $1,000,000.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Section 9.3, Rollovers, is deleted in its entirety.
Page 1
Section 9.10 is deleted in its entirety and is replaced with the following:
Conditions of Payment to Payee
Subject to the provisions of Section 9.8, payments will only be made if then
available to the Payee under the terms and provisions of the Plan and the
Code sections governing the Plan as determined by the Group Contractholder.
Approved distributions shall be effective on the later of: (a) the date
elected; or (b) the date the Request is received at the Administrative
Offices of the Company.
In no event shall rollovers be allowed either into or out of a non-qualified
deferred compensation plan.
Signed for Great-West Life & Annuity Insurance Company on the Group Annuity
Contract Date.
President and Chief Executive Officer
Page 2
FIXED ACCOUNT
================================================================================
Systematic Withdrawal Fund
The Systematic Withdrawal Fund is part of the General Account of the Company.
All or a portion of the Participant's Contributions and Participant Annuity
Account may be allocated to the Systematic Withdrawal Fund, which is a Fixed
Account.
All or a portion of the Participant Annuity Account Value may be allocated to
the Systematic Withdrawal Fund at any time. Transfers of amounts held by or for
the benefit of the Participant in another plan similar to the Plan under this
Group Annuity Contract with another company may be deposited or caused to be
deposited by the Participant directly into the Systematic Withdrawal Fund
Account.
Election of the Systematic Withdrawal Fund
================================================================================
A Request is required for the Participant to elect the Systematic Withdrawal
Fund. The Request must be received by the Company at least 30 days before this
option is to become effective and while the Participant is alive.
Systematic Withdrawal Fund Account
================================================================================
When the Systematic Withdrawal Fund is elected and the first deposit is made, a
separate Systematic Withdrawal Fund will be established for the Participant. A
deposit consists of Contributions allocated or funds transferred from another
company to the Systematic Withdrawal Fund.
Minimum Deposit
================================================================================
The minimum initial deposit must be at least twenty thousand dollars
($20,000.00). All subsequent deposits must be at least two thousand dollars
($2,000).
Interest Rate
================================================================================
New Money Interest Rate - All amounts deposited to the Participant's Systematic
Withdrawal Fund within a calendar quarter will earn interest at the New Money
Interest Rate that is the effective annual interest rate determined by the
Company for that quarter. Interest will accrue from the date of receipt of the
deposit through the last Business Day of the next calendar year. The effective
annual interest rate for each calendar quarter will be determined by the Company
before the end of the prior calendar quarter and will not be less than the
Minimum Guaranteed Interest Rate. The Company reserves the right to declare
different New Money Interest Rates for different classes of Contractholders in
compliance with applicable law.
Portfolio Interest Rate - On the first day of January of each year, all amounts
remaining in the Participant's Systematic Withdrawal Fund Account that have been
the result of deposits made prior to the preceding January 1 will no longer earn
the New Money Interest Rate. These amounts will earn the Portfolio Interest Rate
effective for the current calendar year. The Portfolio Interest Rate may be
different than the New Money Interest Rate. The Portfolio Interest Rate is the
effective annual interest rate determined by the Company before the end of each
calendar year to be effective for the next calendar year. The Portfolio Interest
Rate will not be less than the Minimum Guaranteed Interest Rate. The Company
reserves the right to declare different Portfolio Interest Rates for different
classes of Contractholders in compliance with applicable law.
Minimum Guaranteed Interest Rate - The Minimum Guaranteed Interest Rate is an
effective annual interest rate of [0% - 4%].
Page 1
Systematic Withdrawal Payments
================================================================================
Payment Frequency - The Participant must designate the frequency of payments
when electing the Systematic Withdrawal Fund. Payments may be made monthly,
quarterly, semi-annually or annually. The Participant may change the payment
frequency once in a calendar year.
Beginning of Payments - Payments to the Participant or his/her designated payee
must begin no later than one year from the date of the first allocation or
transfer of monies to the Systematic Withdrawal Fund.
Amount of Payments - Each payment must not be less than the greater of:
1. one hundred dollars ($100.00); or
2. the required minimum distribution and minimum incidental death benefit
amount required under the Code.
The Company reserves the right to make a lump sum payment of all of the entire
balance in the Systematic Withdrawal Fund Account if that balance is less than
one hundred dollars ($100.00). The Participant may change the amount of the
payment only once in a calendar year. The number of payments received may vary
depending upon the New Money Interest Rate and/or the Portfolio Interest Rate
credited.
Each payment made to a Participant or his/her designated payee will be deducted
from the Systematic Withdrawal Fund on a last in, first out basis.
Distributions
================================================================================
Distributions will be made on a last-in-first-out basis. Distributions will be
effective on the later of the date the Participant elects to have the
distribution paid or the date the Request is received by the Company.
Transfers from the Systematic Withdrawal Fund to other Fixed, Variable and/or
Separate Accounts will not be available.
Systematic Withdrawal Charges
================================================================================
A Systematic Withdrawal Charge will be deducted by the Company from all amounts,
less the Systematic Withdrawal Free Amount, paid or distributed. The charge is a
percentage of the amount paid or distributed in excess of the Systematic
Withdrawal Free Amount as indicated in the attached Group Annuity Contract
Schedule of Terms and Fees. Upon the death of the Participant no charge will be
assessed against any payment or distribution made from the Systematic Withdrawal
Fund.
Systematic Withdrawal Free Amount
================================================================================
The Systematic Withdrawal Free Amount is an amount of the payment or
distribution against which the charge will not be assessed. After one year has
elapsed from the date of the initial deposit, this free amount is equal to
twenty percent (20%) of the Systematic Withdrawal Fund Account Value as of
December 31 of the preceding calendar year. During the first partial year before
any December 31 anniversary, the free amount is equal to twenty percent (20%) of
the initial deposit made to the Systematic Withdrawal Fund Payment Option
Account. The free amount will be applied to each payment and distribution made
in a calendar year until the free amount is exhausted. A new free amount will be
available as of January 1 of each year. Any unused free amount from one calendar
year may not be applied to any other calendar year.
Cessation Options
Page 2
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contributions
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value and continue Systematic
Withdrawal Payments until the Participant Annuity Account Value has been
distributed to a Participant or Beneficiary.
20 Equal Quarterly Payments - The Company will pay to the Contractholder
the sum of the Participant Annuity Account Values in the Systematic
Withdrawal Fund in 20 equal quarterly payments of not less than $514.80
for each $10,000 of the sum of the Participant Annuity Account Values.
The first payment will be made 30 days after the Contribution Cessation
Date.
[Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 3
GROUP ANNUITY CONTRACT SCHEDULE
================================================================================
OF TERMS AND FEES
GROUP CONTRACTHOLDER:
GROUP ANNUITY CONTRACT NUMBER:
GROUP ANNUITY CONTRACT DATE:
TYPE OF PLAN: [{ERISA, NonERISA} 401(a), 401(k), 403(b), Governmental 457(b)
{with Deemed IRA}, Non-governmental 457(b), 457(f), Non-Qualified Deferred
Compensation, 415(m) Governmental Excess Benefit Arrangement, Corporate Excess
Benefit Plan [Deemed IRA applicable to X Plan]]
This Schedule is effective on [X] and sets forth terms, charges and fees that
relate to the provisions in this Group Annuity Contract with the corresponding
headings. The terms and fees described herein shall remain in effect [for a [X]
year period from [X] to [X]] [for a [X] year period from [X] to [X] with
automatic renewal for successive [X] year periods unless a [X] day written
notice is provided by either the Company or the Group Contractholder prior to
the expiration of the period] [for a period commencing on [X] and continuing
until a prior [X] day written notice is provided by either the Company or the
Group Contractholder] [for as long as the Company is acting in its current
capacities as the exclusive [investment, recordkeeping and communication]
provider for the Group Contractholder's Plan]. This Schedule supersedes and
replaces any other previous Schedule.
SERIES ACCOUNT
The Series Account for this Group Annuity Contract is the [FutureFundsI,
FutureFundsII Series Account effective on [X]].
TRANSFERS AMONG ACCOUNTS
[The minimum amount that can be transferred from a Fixed Account is [$X].
However, if less remains in a Fixed Account for a Participant Annuity Account,
that amount may be transferred. If a Transfer request would reduce the
Participant Annuity Account Value remaining in a Fixed Account below [$X], the
Company will treat the Transfer request as a request to transfer the entire
amount.]
[A Request for Transfer must clearly state the Fixed, Separate or Variable
Account from which and to which Transfers are to be made.]
[The Company reserves the right to limit, upon notice, the maximum number of
Transfers per Participant Annuity Account. Such limitation may be limited to
[X#] per calendar month or [X#] per Participant Annuity Account per year.]
[Stable Asset Fund Transfer Restriction - [If the Plan includes [X] competing
investment option(s), Transfers from the Stable Asset Fund are limited to [X%]
of the Book Value of the Stable Asset Fund balance at December 31 of the
preceding calendar year.]
WITHDRAWALS FROM THE PARTICIPANT ANNUITY ACCOUNT VALUE
[The minimum amount that can be withdrawn from a Fixed Account is [$X]. If a
withdrawal request would reduce the Participant Annuity Account Value remaining
in a Fixed Account below [$X], the Company will treat the withdrawal request as
a request to withdraw the entire amount.
If a requested withdrawal would reduce the Participant Annuity Account Value
below [$X], the Company reserves the right to treat the request as a withdrawal
of only the excess over [$X].
[A Request for a Transfer must clearly state the Fixed, Separate or Variable
Account from which and to which the Transfer is to be made.]
Page 1
Unless specified otherwise by the Group Contractholder, the Company will make
withdrawals [proportionately from all Fixed, Separate or Variable Accounts in
which the Participant Annuity Account Value is invested.]
CONTRACT CHARGES AND FEES
[Contract Maintenance Charge - A Contract Maintenance Charge of [$X] per year
will be [deducted annually from each Participant Annuity Account during the
first calendar quarter each year] [billed on a(n) [annual] [quarterly] [monthly]
basis to the Group Contractholder]. [However, if a Participant Annuity Account
is established after January 1, the initial Contract Maintenance Charge will be
[deducted] [billed] during the next calendar quarter and will be pro-rated for
the remainder of the year.] [However, if a Participant Annuity Account is
established after January 1, the initial Contract Maintenance Charge will be
[deducted] [billed] during the calendar quarter after the Participant's one-year
anniversary (calculated from the Participant's Effective Date) and will be
pro-rated for the remainder of the year.]]
[Stable Asset Fund Investment Management Fee - [X%] per annum.]
[Mortality and Expense Risk Charge - [X%] per annum.]
[Contingent Deferred Sales Charge
Except as provided below, a Contingent Deferred Sales Charge will be deducted
from any amount transferred, distributed or otherwise paid. In no event shall
the Contingent Deferred Sales Charge at any point in time exceed 8.5% of
Contributions made by the Participant to this Group Annuity Contract.
Situations under which Contingent Deferred Sales Charge is waived - The
Contingent Deferred Sales Charge on any total or partial Transfer to another
company, distribution or single sum payment from the Participant Annuity Account
or from an Alternate Payee Account will be waived in the following situations:
a. [the Participant dies; or b. the Participant xxxxxx employment; or
c. the Participant suffers a Plan approved hardship or unforeseeable emergency;
or
d. the Participant elects an Annuity Payment Option with a life contingent or an
annuity payment period or periodic payment period of at least thirty-six (36)
months; or
e. the Participant elects an In-service Withdrawal to another investment
provider [except [x] investment provider], a loan or a QDRO.
[Additionally, the Contingent Deferred Sales Charge "Free Amount" is an amount
against which the Contingent Deferred Sales Charge will not be assessed. The
Contingent Deferred Sales Charge "Free Amount" shall not exceed 10% of a
Participant Annuity Account Value at December 31 of the previous calendar year
and will be applied on the first Transfer, distribution or payment made under
the Participant Annuity Account in that year. All further Transfers,
distributions or payments during that calendar year will be subject to a
Contingent Deferred Sales Charge without the application of any "Free Amount."]
[Contingent Deferred Sales Charge Schedule -
[Number of Years Participant
Covered Under This Contract] [and
Previous Contract] [Number of Years from
the Effective Date of the Group Annuity The Contingent Deferred Sales Charge
Contract] Shall Be
---------------------------------------- ------------------------------------
Page 2
[0-15] [16 or more] [0%-6% of the amount withdrawn]
[0% to 8.5%] [of Contributions] [of
the last 72 months' Contributions]]
[Transfer Charge - The Company reserves the right to charge a maximum of [$25]
for each Transfer [within the Group Annuity Contract] [to other investment
options under the Plan] after the [X] in a calendar year. Each request is
considered to be one Transfer regardless of the number of Fixed, Variable or
Separate Accounts affected by the Transfer. The Transfer Charge will be deducted
proportionately from all from which Fixed, Variable or Separate Accounts the
Transfer is made.]
[Premium Tax Charge - The amount of any state and local taxes levied by any
governmental entity on Contributions may be deducted from the Participant
Annuity Account Value when such taxes are incurred. The Company reserves the
right to defer the collection of this charge and deduct it against the
Participant Annuity Account Value on the surrender of the Participant's interest
in this Group Annuity Contract or application of the Participant Annuity Account
Value to a Payment Option.]
[Charge Deduction Rules - Unless otherwise specified above, charges are deducted
from the Participant Annuity Account Value [proportionately from all Accounts in
which the Participant is invested.]
[Start-up Cost Restorations - Start-up Cost Restorations are the amounts paid
into Participant Annuity Accounts to restore costs incurred by Participants in
transferring from a previous investment provider to the Plan. Upon receipt of
adequate documentation, the Company will credit to each respective Participant
Annuity Account the Start-up Cost Restorations, if any. Similarly situated Group
Contractholders of the same class will be treated substantially alike with
respect to Start-up Cost Restorations.
Start-up Cost Restoration Amount - [$X] [[X%] of the amount transferred to the
Group Annuity Contract] [the dollar amount necessary to restore the Start-up
Cost Restorations incurred by the Participant up to [X%] of the amount
transferred to the Group Annuity Contract].
Start-up Cost Restorations Recovery Schedule
Amount of Start-up Cost Restorations
Unrecovered at Termination and
Payable to the Company is Equal to
the following Percentage of the
Completed Years from the Start-up Cost Amount Withdrawn
Restoration Date
-------------------------------------- ----------------------------------------
[0-15 years] [0%- X%]
The Company will reduce the credited interest rate applicable to the [XX] Fixed
Account by [0% to 1.00%] per annum from the credited interest rate given to
other Group Contractholders in the same class for whom Start-up Cost
Restorations were not made. This [.X]% reduction of the credited interest rate
will remain in effect until the entire Start-up Cost Restoration amount has been
recovered by the Company. The interest rate credited under the [X] Fixed Account
will never be less than the Guaranteed Interest Rate applicable to the [X] Fixed
Account.]
[If the Contract is terminated before the Start-up Cost Restorations are
completely recovered by the Company, the Group Contractholder will pay the
difference between the original Start-up Cost Restoration Amount and the amount
recovered by the Company as of the termination date.]
Page 3
[Due to the initial difference between the Book Value of the Separate Account
and the Book Value of the Participant Annuity Accounts resulting from the
transfer of the previous provider's fund to the Group Annuity Contract, as set
forth in the Stable Asset Fund, the Group Contractholder hereby instructs the
Company to calculate an Interest Rate quarterly to equate the Book Value of the
Separate Account to the Book Value of the sum of the Participant Annuity
Accounts over a mutually agreed upon period of time. In the event the Group
Annuity Contract is terminated, the Book Value of the Participant Annuity
Account shall be payable according to Cessation Option 1 and the Market Value of
the Stable Asset Fund will be payable according to Cessation Option 2 of the
Stable Asset Fund.]
[Loss of Interest Penalty - [None.] [Amounts in a Certificate Account
surrendered for other than permitted Distributions prior to the Expiry Date
shall be subject to interest forfeiture, called the Loss of Interest Penalty.
The effective annual interest rate to be credited for the first 5 years of the
Guarantee Period of the Certificate Account will not be current annual interest
rate, but the interest rates as follows:
Interest Rate to be Applied to the
Certificate Account for the
Age of the Certificate Account Guarantee Period
------------------------------------ -------------------------------------
[0-5 Years] [0 to 5.25%]
The Loss of Interest Penalty shall apply for a maximum of 5 years for each
Certificate Account. After 5 years, the current annual interest rate for that
particular Certificate Account shall continue to apply.]
[STABLE ASSET FUND SEPARATE ACCOUNT
Market Value of the Stable Asset Fund Contract -The Group Contractholder and the
Company agree that the definition of the Stable Asset Fund Separate Account
shall include one separate account comprised of the following plans of the Group
Contractholder listed below:
[1. [X] Plan, (Group #X)
2. [X] Plan, (Group #X)]
The Stable Asset Fund shall be administered by the Company on a prorata basis so
that each plan will receive its proportional share of the market value according
to Cessation Option 2.] [In the event that the Group Contractholder elects to
make any Start-up Cost Restorations in the form of a market value adjustment
imposed by the prior investment provider, the Company shall provide an
accounting of the amortization of the market value adjustment, as set forth in
the Interest Calculation Method provision, separate from the accounting of the
other plan(s).]
Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 4
FUTUREFUNDS I SERIES ACCOUNT
================================================================================
In the event that the FutureFunds I Series Account is selected by the Group
Contractholder, the following changes shall be made to the Group Annuity
Contract:
Section 1. Definitions is amended as follows:
Series Account - a segregated investment account established by the Company into
which Contributions may be invested or the Participant's Account Value may be
transferred as designated by the Group Contractholder on the application. The
Series Account is registered as a unit investment trust under the Investment
Company Act of 1940 and consists of the individual Variable Accounts.
Section 4.2 Changes within the Series Account is deleted in its entirety and is
replaced with the following:
4.2 Changes within the Series Account
The Company may make additional Variable Accounts available to the Group
Contractholder. These accounts will invest in investment portfolios suitable for
the Group Annuity Contract. The Company reserves the right to eliminate
accounts, to combine two or more accounts or to substitute a new investment
portfolio for the portfolio in which an account invests. Such an action may
become necessary if, in the Company's judgment, a portfolio or account no longer
suits the purposes of the Group Annuity Contract. This may happen due to a
change in laws or regulations, or a change in a portfolio's or account's
investment objectives or restrictions, or because the portfolio or account is no
longer available for investment, or for some other reason. The Company will also
receive any required approval from the SEC and any other required approvals
before taking such an action.
Subject to any required regulatory approvals, the Company reserves the right to
transfer assets in the Variable Accounts to another Variable Account.
When permitted by law, the Company reserves the right to:
(a) Deregister the Series Account under the Investment Company Act of 1940;
(b) Operate the Series Account as a management company under the Investment
Company Act of 1940, if it is operating as a unit investment trust;
(c) Operate the Series Account as a unit investment trust under the Investment
Company Act of 1940, if it is operating as a managed separate account;
(d) Combine the Series Account with other separate investment accounts; and
(e) Combine a Variable Account with another Variable Account.
If any of the above actions result in a material change in the underlying
investments of a Variable Account in which the Group Contractholder and
Participants are invested, the Company will notify the Group Contractholder of
the change at the Group Contractholder's last known address on file with the
Company.
Page 1
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Endorsement for Section 457(b) Governmental Plans
--------------------------------------------------------------------------------
Attached to and Forming a Part of
================================================================================
The Group Annuity Contract
This Endorsement is made a part of the Group Annuity Contract to which it is
attached. It is effective on the Group Annuity Contract Date. It is subject to
all the exclusions, definitions and provisions of the Group Annuity Contract
that are not inconsistent with this Endorsement.
The Group Annuity Contract and Application are intended to conform to section
457(b) of the Code. To maintain eligibility under Code section 457(b) the Plan
must continue to hold Plan assets in trust.
Section 7.2, Mortality and Expense Risk Charge, is deleted in its entirety and
shall be replaced as follows:
7.2 Variable Asset Charge
The Company may deduct a Variable Asset Charge in the calculation of the
Accumulation Unit Value, based on a percentage of assets. [One three
hundred sixty-fifth of the per annum charge is deducted daily.]
Section 9.7, Amount Payable on Death of Participant, shall be deleted in its
entirety and replaced with the following:
9.7 Amount Payable on Death of Participant
If the Participant dies before the Payment Commencement Date, the amount payable
on death will be the Participant Annuity Account Value net of any outstanding
loan balance, less Premium Tax, if any.
Signed for Great-West Life & Annuity Insurance Company on the Group Annuity
Contract Date.
President and Chief Executive Officer
Page 1
FIXED ACCOUNT
================================================================================
Guaranteed Certificate Fund
================================================================================
The Guaranteed Certificate Fund is part of the General Account of the Company.
All or a portion of the Participant's Contributions and Participant Annuity
Account may be allocated to the Guaranteed Certificate Fund, which is a Fixed
Account.
Definitions
A Certificate is established when a Participant's Contributions are allocated or
amounts are transferred to the Guaranteed Certificate Fund. The value of each
Certificate is equal to the amount allocated, increased by interest and reduced
by any distributions or transfers from, or charges and Premium Tax, as
applicable, assessed against the Certificate. A separate Certificate is
established each calendar quarter for the Contributions and transferred amounts
received during each Certificate Accumulation Period and Term. Amounts invested
in a Certificate shall earn interest for the entire Guarantee Period at the
Guaranteed Interest Rate in effect for that particular Term on the date the
amounts are received. Terms available under the Contract will be determined by
the Company from time to time. Each Certificate will have its own Guaranteed
Interest Rate and Term.
When an existing Certificate matures on the Expiration Date, a new Certificate
will be established with its own Guaranteed Interest Rate and Guarantee Period.
The Guarantee Period of the Certificate shall commence on the day after the
Expiration Date. In the event that a Certificate is scheduled to mature on a
weekend or holiday, the Certificate will mature on the last Business Day of the
calendar quarter and will be reinvested at that time.
Certificate Accumulation Period is the portion of the calendar quarter ending
prior to the beginning of the Term during which Contributions, increased by
interest and reduced by any distributions or transfers from, or charges and
Premium Tax, as applicable, are allocated or amounts are transferred into the
Certificate.
Guarantee Period is comprised of the Certificate Accumulation Period and the
Term and is a period of time that a specified effective annual interest rate is
guaranteed by the Company. Interest is credited daily at a rate to yield the
declared annual Guaranteed Interest Rate. Each Certificate is guaranteed an
Interest Rate for the period that includes the Certificate Accumulation Period
and the Term referred to as a Guarantee Period. The Guaranteed Interest Rate for
a Certificate is effective for the entire Guarantee Period. The length of a
Guarantee Period is measured from the date the Contribution is allocated or the
end of the calendar quarter in which the amount is allocated to the Certificate.
The last day of the Guarantee Period is its Expiration Date.
Guaranteed Interest Rate is the effective annual interest rate to be credited
for a specified Guarantee Period. The Guaranteed Interest Rate will never be
less than [0% - 4%]. Periodically, the Company will declare Guaranteed Interest
Rates for then available Terms. These rates will be guaranteed for the duration
of the respective Guarantee Periods.
Expiration Date is the last Business Day of the Guarantee Period or the date of
distributions, whichever is earlier.
Term is the number of months as measured from the first day of the calendar
quarter after the Certificate Accumulation Period to the Expiration Date.
Within 30-days prior to an Expiration Date, the Participant may elect a new
Certificate with its own Term and Guaranteed Interest Rate from among those then
offered by the Group Annuity Contract, but excluding any that extend beyond the
Participant's Payment Commencement Date. The Participant will have 30 days from
the date of the election to rescind the election without penalty and reallocate
to elect any other investment option available under the Plan. The election will
become effective on the later of:
(1) the first day of the calendar quarter immediately following the
Expiration Date; or
Page 1
(2) the date the election, in a form satisfactory to the Company, is
received by the Company at its Administrative Office.
If the election is not received within the 30-day period, the value of the
expiring Certificate will be allocated to a new Certificate with the same Term
(with a different Guaranteed Interest Rate), but not extending beyond the
Participant's Payment Commencement Date. If the same Term is no longer available
under the Group Annuity Contract, the next shortest Term available under the
Group Annuity Contract will be used.
If the Guaranteed Certificate Fund is no longer available under the Group
Annuity Contract, the value of each of the Participant's Certificate, on each of
their Expiration Dates, will be transferred to another Fixed Account then
available under the Group Annuity Contract or default investment option chosen
by the Plan. In this case, amounts transferred to another Fixed Account will
earn the annual effective rate of interest applicable to that Fixed Account.
Distributions
================================================================================
A Distribution prior to the Expiration Date of a Certificate will only be
permitted as allowed under the applicable provisions of the Plan and/or the
Code.
The value of the Participant's interest in the Guaranteed Certificate Fund is
the sum of the values of the Participant's Certificates.
Cessation Options
================================================================================
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. Payment at Expiration Date - The Company will pay to the Group
Contractholder the value of the Participants' Certificate on the
Expiration Date of such Certificate Account that occurs after the
Contribution Cessation Date.
3. Lump Sum Payment at Market Value - The Company will pay to the
Contractholder within 30 days after the Contribution Cessation Date
the sum of the Guaranteed Certificate Fund account balances according
to a Market Value Adjustment Factor formula determined by the Company.
The market value adjustment of the Guaranteed Certificate Fund is the
balance of the Guaranteed Certificate Fund multiplied by the Market
Value Adjustment Factor. The Market Value Adjustment may be a positive
or negative adjustment. [The Group Contractholder may not elect this
Cessation Option unless the Group Annuity Contract has been effective
for [0 - 5] years.]
[Signed for Great-West Life & Annuity Insurance Company on [X] or [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 2
FIXED ACCOUNT
================================================================================
Guaranteed Certificate Fund
================================================================================
The Guaranteed Certificate Fund is part of the General Account of the Company.
All or a portion of the Participant's Contributions and Participant Annuity
Account may be allocated to the Guaranteed Certificate Fund, which is a Fixed
Account.
Definitions
A Certificate is established when a Participant's Contributions are allocated or
amounts are transferred to the Guaranteed Certificate Fund. The value of each
Certificate is equal to the amount allocated, increased by interest and reduced
by any distributions or transfers from, or charges and Premium Tax, as
applicable, assessed against the Certificate. A separate Certificate is
established each calendar quarter for the Contributions and transferred amounts
received during each Certificate Accumulation Period and Term. Amounts invested
in a Certificate shall earn interest for the entire Guarantee Period at the
Guaranteed Interest Rate in effect for that particular Term on the date the
amounts are received. Terms available under the Contract will be determined by
the Company from time to time. Each Certificate will have its own Guaranteed
Interest Rate and Term.
When an existing Certificate matures on the Expiration Date, a new Certificate
will be established with its own Guaranteed Interest Rate and Guarantee Period.
The Guarantee Period of the Certificate shall commence on the day after the
Expiration Date. In the event that a Certificate is scheduled to mature on a
weekend or holiday, the Certificate will mature on the last Business Day of the
calendar quarter and will be reinvested at that time.
Certificate Accumulation Period is the portion of the calendar quarter ending
prior to the beginning of the Term during which Contributions, increased by
interest and reduced by any distributions or transfers from, or charges and
Premium Tax, as applicable, are allocated or amounts are transferred into the
Certificate.
Guarantee Period is comprised of the Certificate Accumulation Period and the
Term and is a period of time that a specified effective annual interest rate is
guaranteed by the Company. Interest is credited daily at a rate to yield the
declared annual Guaranteed Interest Rate. Each Certificate is guaranteed an
Interest Rate for the period that includes the Certificate Accumulation Period
and the Term referred to as a Guarantee Period. The Guaranteed Interest Rate for
a Certificate is effective for the entire Guarantee Period. The length of a
Guarantee Period is measured from the date the Contribution is allocated or the
end of the calendar quarter in which the amount is allocated to the Certificate.
The last day of the Guarantee Period is its Expiration Date.
Guaranteed Interest Rate is the effective annual interest rate to be credited
for a specified Guarantee Period. The Guaranteed Interest Rate will never be
less than [0% - 4%]. Periodically, the Company will declare Guaranteed Interest
Rates for then available Terms. These rates will be guaranteed for the duration
of the respective Guarantee Periods.
Expiration Date is the last Business Day of the Guarantee Period or the date of
distributions, whichever is earlier.
Term is the number of months as measured from the first day of the calendar
quarter after the Certificate Accumulation Period to the Expiration Date.
Within 30-days prior to an Expiration Date, the Participant may elect a new
Certificate with its own Term and Guaranteed Interest Rate from among those then
offered by the Group Annuity Contract, but excluding any that extend beyond the
Participant's Payment Commencement Date. The Participant will have 30 days from
the date of the election to rescind the election without penalty and reallocate
to elect any other investment option available under the Plan. The election will
become effective on the later of:
(3) the first day of the calendar quarter immediately following the
Expiration Date; or
(4) the date the election, in a form satisfactory to the Company, is
received by the Company at its Administrative Office.
If the election is not received within the 30-day period, the value of the
expiring Certificate will be allocated to a new Certificate with the same Term
(with a different Guaranteed Interest Rate), but not extending beyond the
Participant's Payment Commencement Date. If the same Term is no longer available
under the Group Annuity Contract, the next shortest Term available under the
Group Annuity Contract will be used.
If the Guaranteed Certificate Fund is no longer available under the Group
Annuity Contract, the value of each of the Participant's Certificate, on each of
their Expiration Dates, will be transferred to another Fixed Account then
available under the Group Annuity Contract or default investment option chosen
by the Plan. In this case, amounts transferred to another Fixed Account will
earn the annual effective rate of interest applicable to that Fixed Account.
Distributions
================================================================================
A Distribution prior to the Expiration Date of a Certificate will only be
permitted as allowed under the applicable provisions of the Plan and/or the
Code.
The value of the Participant's interest in the Guaranteed Certificate Fund is
the sum of the values of the Participant's Certificates.
Cessation Options
================================================================================
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. Payment at Expiration Date - The Company will pay to the Group
Contractholder the value of the Participants' Certificate on the
Expiration Date of such Certificate Account that occurs after the
Contribution Cessation Date.
[Signed for Great-West Life & Annuity Insurance Company on [X] or [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 2
FIXED ACCOUNT
================================================================================
Guaranteed Certificate Fund
================================================================================
The Guaranteed Certificate Fund is part of the General Account of the Company.
All or a portion of the Participant's Contributions and Participant Annuity
Account may be allocated to the Guaranteed Certificate Fund, which is a Fixed
Account.
Definitions
A Certificate is established when a Participant's Contributions are allocated or
amounts are transferred to the Guaranteed Certificate Fund. The value of each
Certificate is equal to the amount allocated, increased by interest and reduced
by any distributions or transfers from, or charges and Premium Tax, as
applicable, assessed against the Certificate. A separate Certificate is
established each calendar quarter for the Contributions and transferred amounts
received during each Certificate Accumulation Period and Term. Amounts invested
in a Certificate shall earn interest for the entire Guarantee Period at the
Guaranteed Interest Rate in effect for that particular Term on the date the
amounts are received. Terms available under the Contract will be determined by
the Company from time to time. Each Certificate will have its own Guaranteed
Interest Rate and Term.
When an existing Certificate matures on the Expiration Date, a new Certificate
will be established with its own Guaranteed Interest Rate and Guarantee Period.
The Guarantee Period of the Certificate shall commence on the day after the
Expiration Date. In the event that a Certificate is scheduled to mature on a
weekend or holiday, the Certificate will mature on the last Business Day of the
calendar quarter and will be reinvested at that time.
Certificate Accumulation Period is the portion of the calendar quarter ending
prior to the beginning of the Term during which Contributions, increased by
interest and reduced by any distributions or transfers from, or charges and
Premium Tax, as applicable, are allocated or amounts are transferred into the
Certificate.
Guarantee Period is comprised of the Certificate Accumulation Period and the
Term and is a period of time that a specified effective annual interest rate is
guaranteed by the Company. Interest is credited daily at a rate to yield the
declared annual Guaranteed Interest Rate. Each Certificate is guaranteed an
Interest Rate for the period that includes the Certificate Accumulation Period
and the Term referred to as a Guarantee Period. The Guaranteed Interest Rate for
a Certificate is effective for the entire Guarantee Period. The length of a
Guarantee Period is measured from the date the Contribution is allocated or the
end of the calendar quarter in which the amount is allocated to the Certificate.
The last day of the Guarantee Period is its Expiration Date.
Guaranteed Interest Rate is the effective annual interest rate to be credited
for a specified Guarantee Period. The Guaranteed Interest Rate will never be
less than [0% - 4%]. Periodically, the Company will declare Guaranteed Interest
Rates for then available Terms. These rates will be guaranteed for the duration
of the respective Guarantee Periods.
Expiration Date is the last Business Day of the Guarantee Period or the date of
distributions, whichever is earlier.
Loss of Interest Penalty will be assessed for other than permitted Transfers and
Distributions.
Term is the number of months as measured from the first day of the calendar
quarter after the Certificate Accumulation Period to the Expiration Date.
Within 30-days prior to an Expiration Date, the Participant may elect a new
Certificate with its own Term and Guaranteed Interest Rate from among those then
offered by the Group Annuity Contract, but excluding any that extend beyond the
Participant's Payment Commencement Date. The Participant will have 30 days from
the date of the election to rescind the election without penalty and reallocate
to elect any other investment option available under the Plan. The election will
become effective on the later of:
Page 1
(5) the first day of the calendar quarter immediately following the
Expiration Date; or
(6) the date the election, in a form satisfactory to the Company, is
received by the Company at its Administrative Office.
If the election is not received within the 30-day period, the value of the
expiring Certificate will be allocated to a new Certificate with the same Term
(with a different Guaranteed Interest Rate), but not extending beyond the
Participant's Payment Commencement Date. If the same Term is no longer available
under the Group Annuity Contract, the next shortest Term available under the
Group Annuity Contract will be used.
If the Guaranteed Certificate Fund is no longer available under the Group
Annuity Contract, the value of each of the Participant's Certificate, on each of
their Expiration Dates, will be transferred to another Fixed Account then
available under the Group Annuity Contract or default investment option chosen
by the Plan. In this case, amounts transferred to another Fixed Account will
earn the annual effective rate of interest applicable to that Fixed Account.
Distributions
================================================================================
A Distribution prior to the Expiration Date of a Certificate will only be
permitted as allowed under the applicable provisions of the Plan and/or the
Code.
The value of the Participant's interest in the Guaranteed Certificate Fund is
the sum of the values of the Participant's Certificates.
For all other Transfers and Distributions made or taken prior to the Expiration
Date, the Company will deduct the Loss of Interest Penalty shown in the Group
Annuity Contract Schedule of Terms and Fees from any amounts distributed from
the Guaranteed Certificate Fund.
Cessation Options
================================================================================
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. Payment at Expiration Date - The Company will pay to the Group
Contractholder the value of the Participants' Certificate on the
Expiration Date of such Certificate Account that occurs after the
Contribution Cessation Date.
[Signed for Great-West Life & Annuity Insurance Company on [X] or [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 3
FIXED ACCOUNT
================================================================================
Guaranteed Fixed Fund
The Guaranteed Fixed Fund is part of the General Account of the Company. All or
a portion of the Participant's Contributions and Participant Annuity Account may
be allocated to the Guaranteed Fixed Fund, which is a Fixed Account.
Interest Rate
Contributions allocated to the Guaranteed Fixed Fund in a calendar quarter will
earn an initial annual effective rate of interest as determined by the Company
for that calendar quarter. Each initial interest rate will remain in effect to
the end of that calendar year. Each initial interest rate will never be less
than [0% - 4%].
After the first calendar year, all Contributions allocated and interest accrued
on those Contributions that remain in the Guaranteed Fixed Fund in a given
calendar year are credited with interest at an annual interest rate determined
by the Company. Such interest rate is called the renewal interest rate. Each
renewal interest rate will be effective for one calendar year and will never be
less than [0% - 4%]. The Company may declare a different renewal rate for
Contributions allocated to each calendar year.
Transfers, Distributions
The Group Contractholder, on behalf of the Participant, may transfer amounts
from the Participant's account balance in the Guaranteed Fixed Fund at any time.
Amounts transferred or distributed from the Guaranteed Fixed Fund are on a last
in, first out basis.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. 20 Equal Quarterly Payments - The Company will pay to the Contractholder
the sum of the Participant Annuity Account Values in the Guaranteed
Fixed Fund in 20 equal quarterly payments of not less than $514.80 for
each $10,000 of the sum of the Participant Annuity Account Values. The
first payment will be made 30 days after the Contribution Cessation
Date.
3. Lump Sum Payment at Market Value - The Company will pay to the
Contractholder within 30 days after the Contribution Cessation Date the
sum of the Guaranteed Fixed Fund account balances according to a Market
Value Adjustment Factor formula determined by the Company. The market
value adjustment of the Guaranteed Fixed Fund is the balance of the
Guaranteed Fixed Fund multiplied by the Market Value Adjustment Factor.
The Market Value Adjustment may be a positive or negative adjustment.
[The Group Contractholder may only elect this Cessation Option after the
Group Annuity Contract has been effective for [0-5] years.]
[Signed for Great-West Life & Annuity Insurance Company on [X] or [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 2
FIXED ACCOUNT
================================================================================
Guaranteed Fixed Fund
The Guaranteed Fixed Fund is part of the General Account of the Company. All or
a portion of the Participant's Contributions and Participant Annuity Account may
be allocated to the Guaranteed Fixed Fund, which is a Fixed Account.
================================================================================
Interest Rate
Contributions allocated to the Guaranteed Fixed Fund in a calendar quarter will
earn an initial annual effective rate of interest as determined by the Company
for that calendar quarter. Each initial interest rate will remain in effect to
the end of that calendar year. Each initial interest rate will never be less
than [0% - 4%].
After the first calendar year, all Contributions allocated and interest accrued
on those Contributions that remain in the Guaranteed Fixed Fund in a given
calendar year are credited with interest at an annual interest rate determined
by the Company. Such interest rate is called the renewal interest rate. Each
renewal interest rate will be effective for one calendar year and will never be
less than [0% - 4%]. The Company may declare a different renewal rate for
Contributions allocated to each calendar year.
Transfers, Distributions
================================================================================
The Group Contractholder, on behalf of the Participant, may transfer amounts
from the Participant's account balance in the Guaranteed Fixed Fund at any time.
Amounts transferred or distributed from the Guaranteed Fixed Fund are on a last
in, first out basis.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contribution
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of each Participant Annuity Account - The Company will
maintain each Participant Annuity Account Value until it is applied to a
Payment Option or distributed to a Participant or Beneficiary.
2. 20 Equal Quarterly Payments - The Company will pay to the Contractholder
the sum of the Participant Annuity Account Values in the Guaranteed
Fixed Fund in 20 equal quarterly payments of not less than $514.80 for
each $10,000 of the sum of the Participant Annuity Account Values. The
first payment will be made 30 days after the Contribution Cessation
Date.
[Signed for Great-West Life & Annuity Insurance Company on [X] or [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 1
SEPARATE ACCOUNT
================================================================================
Guaranteed Government Fund
================================================================================
The Guaranteed Government Fund is a Separate Account. All or a portion of the
Participant's Contributions and Participant Annuity Account may be allocated to
the Guaranteed Government Fund.
Definitions
Interest Rate(s) means an annual effective rate of interest determined by the
Company prior to the last day of each calendar quarter, effective for the
Guaranteed Government Fund Account balance the next calendar quarter. This
annual effective rate will be compounded daily. The Interest Rate will never be
less than the Minimum Guaranteed Interest Rate.
If the Company modifies the interest crediting method, the Company will provide
the Group Contractholder with a notice of the changes.
Minimum Guaranteed Interest Rate is an effective annual interest rate of [0% -
4%].
Participant Guaranteed Government Fund is equal to the amount allocated,
increased by interest and reduced by any distributions or transfers from, or
charges and Premium Tax, as applicable.
Interest Calculation Method
Interest Rates are calculated as follows: (1) the current yield of the
investment portfolio is determined; (2) any difference between the Book Value of
the assets and the Book Value of the liabilities is calculated and the
difference is amortized over the expected remaining life of the assets in the
Guaranteed Government Fund, unless otherwise agreed to by the Company and the
Group Contractholder; (3) fees are deducted. The resulting rate is guaranteed
and applied to all Participant Annuity Accounts for the following quarter.
Guaranteed Government Fund Contract Value
The Guaranteed Government Fund Contract Value, at any given time, will either be
the Book Value or the Market Value of the Guaranteed Government Fund Contract.
The Book Value will apply to Cessation Option 1 when it is elected under the
Cessation Option provision below. The Market Value will apply to Cessation
Option 2 when it is elected under the Cessation Option provision below.
Market Value of the Guaranteed Government Fund Contract
The Market Value of the Guaranteed Government Fund Contract is determined
monthly or on the Contribution Cessation Date. This value is based on the
closing market price for each security in the account, less the outstanding
balance, if any, of amounts borrowed from the Company's General Account and less
the Investment Management Fee. The Participant's pro-rata share of the
Guaranteed Government Fund Value is determined by dividing the Participant
Guaranteed Government Fund Value by the sum of all the Participant Guaranteed
Government Accounts and multiplying the result by the Guaranteed Government Fund
Value on the Contribution Cessation Date.
Book Value of the Guaranteed Government Fund Contract
================================================================================
The Book Value of the Guaranteed Government Fund Contract is the amortized cost
of the securities owned by the Guaranteed Government Fund, plus cash, plus
accrued interest, less the outstanding balance, if any, of amounts borrowed from
the Company's General Account and less the Investment Management Fee.
Loan from the General Account of the Company
If the amount of any transfer or distribution exceeds the cash balance in the
Guaranteed Government Fund, a loan will be made from the General Account of the
Company to the Guaranteed Government Fund to cover the deficiency. All
subsequent Contributions and proceeds from maturities of the
Page 1
Guaranteed Government Fund assets will first be applied to reduce the
outstanding balance of this loan. Interest will be charged monthly by the
Company's General Account at an annual effective rate equal to the 30 day LIBOR
rate, plus 0.35%.
Distributions
Distributions to a Participant are based on the Book Value and are permitted for
the purpose of paying a benefit to a Participant, which includes death,
severance of employment, hardship or unforeseeable emergency. Distributions from
the Guaranteed Government Fund for purposes other than paying a benefit to a
Participant will be restricted and will not be permitted until funds have been
distributed from all other Fixed or Separate Accounts under this Group Annuity
Contract. However, funds in the Guaranteed Certificate Fund which have not
reached Certificate Maturity Date will not be subject to this requirement.
Transfers
================================================================================
A Transfer from the Participant's Guaranteed Government Fund Account is set
periodically and will be no less than an amount equal to ten percent (10%) of
the Book Value of the Participant Guaranteed Government Fund balance at December
31 of the preceding calendar year. A Transfer of the entire Participant
Guaranteed Government Fund may be made at any time if the Participant Guaranteed
Government Fund balance is $500 or less.
There is no limit on the number of Transfers permitted in any calendar year. The
ten percent (10%) limitation noted above can be used to transfer assets to a
successor insurer outside the Group Annuity Contract, or to transfer assets to
any Fixed or Variable Account under the Group Annuity Contract, or any
combination of Transfers.
Applicability of State Guarantee Funds
Assets in the Guaranteed Government Fund are not covered by state guarantee
funds.
Ownership
Amounts allocated to a Separate Account shall be owned by the Company. All
monies invested in the Separate Account are maintained and held separate and
apart from the Company's General Account and any other investment account the
Company may have. That portion of the assets of the Separate Account which is
equal to the reserves and other contract liabilities with respect to each
Separate Account shall not be chargeable with liabilities arising out of any
other business the Company may conduct. Income, gains or losses, realized and
unrealized, on assets in each Separate Account are credited or charged against
that Separate Account without regard to other income, gains or losses in other
fixed or variable accounts or the Company's other income, gains or losses.
Cessation Options
On the Contribution Cessation Date, the Group Contractholder may elect a
Cessation Option. If no Option is elected within 30 days of the Contributions
Cessation Date, the Company is hereby instructed to comply with Cessation Option
1 below. The Cessation Options are:
1. Maintenance of Each Participant Annuity Account - The Company will
maintain each Participant Guaranteed Government Fund Account Value until
it is applied to a Payment Option or distributed to a Participant or
Beneficiary. When such individual transactions are applied or paid, they
will be calculated at the Book Value of the Guaranteed Government Fund
Account.
2. Market Value of the Guaranteed Government Fund - The Company will pay
the pro-rata share of the Market Value of the Guaranteed Government Fund
within 30 days after the Contribution Cessation Date. After notification
of Cessation of Contributions, the Company will sell all non-cash assets
in the Guaranteed Government Fund Account attributable to the
terminating contract and convert them to cash assets or short-term money
market instruments. The time when all non-cash assets have been
converted to cash or short-term money market instruments will be no
later than the Contribution Cessation Date.
Page 2
[Signed for Great-West Life & Annuity Insurance Company on [X] [the Effective
Date of the Group Annuity Contract].
/s/ X.X. XxXxxxxx
X.X. XxXxxxxx,
President and Chief Executive Officer
Page 3
--------------------------------------------------------------------------------
Endorsement for Corporate Section 401(k) Plans
--------------------------------------------------------------------------------
Attached to and forming a Part of the Group Annuity Contract
================================================================================
This Endorsement is made a part of the Group Annuity Contract to which it is
attached. It is effective on the Group Annuity Contract Date. It is subject to
all the exclusions, definitions and provisions of the Group Annuity Contract
that are not inconsistent with this Endorsement.
The Group Annuity Contract and Application are intended to conform to Code
sections 401(a) and 401(k). To maintain eligibility under Code sections 401(a)
and 401(k), if applicable, the Plan must continue to hold Plan assets in trust.
The following changes shall be made to the Group Annuity Contract:
Section 1. Definitions. The following definitions shall be added to this
Section:
Contract Termination Date - the date on which the Group Annuity Contract is
terminated and the surrender value is determined.
Forfeiture - that portion of the Participant's Annuity Account Value that is not
vested under the terms of the Plan as of the Valuation Date.
Section 7, Contract Charges and Fees, is deleted in its entirety and shall be
replaced as follows:
Section 7, Contract Charges and Fees
7.1 Variable Asset Charge
The Company may deduct a Variable Asset Charge in the calculation of the
Accumulation Unit Value, based on a percentage of assets. [One three
hundred sixty-fifth of the per annum charge is deducted daily.]
7.2 Contract Maintenance Charge
The Company may assess a Contract Maintenance Charge. The Contract
Maintenance Charge may vary according to the number of Participants and the
manner in which the Group Contractholder remits Participant information and
contributions. The Contract Maintenance Charge will be deducted quarterly
from Participant Annuity Accounts, unless the Employer elects to pay the
Contract Maintenance Charge, whereby the Company will annually bill the
Group Contractholder via an Automated Clearing House debit. If payment is
not received by the Company from Employer within 60 days of such billing,
the Company is instructed to deduct the Contract Maintenance Charge from
Participant Annuity Accounts. If a Participant Annuity Account is
established for a Participant after an assessment date, the Contract
Maintenance Charge will be deducted on the first day of the next quarter
and will be pro-rated for the remaining portion of the year.
If the Contract Maintenance Charge is deducted, the deduction will be
pro-rated among the Variable, Separate and Fixed Accounts based upon their
Variable, Separate and Fixed Account Values on the date of deduction.
Whenever a deduction for a Contract Maintenance Charge is to be made from a
Variable Account, Accumulation Units having a total value equal to the
amount of the deduction will be canceled.
Page 1
7.3 Plan Charges
At Contract initiation, the Company may bill the Employer for a one time
non-refundable set up fee to initiate the Contract. Additionally, annual
Plan Charges may apply depending upon the administrative services chosen by
the Plan and whether the Company, or its affiliates, provides group health
arrangements.
7.4 Administrative Participant Loan Charges
If the Plan allows loans, the Group Contractholder may Request on behalf of
a Participant that a loan, in an amount meeting the requirements of the
Plan, ERISA and section 72(p) of Code, as applicable, be paid to the
Participant upon completion of any documents required to comply with
applicable Plan loan rules. The Company will deduct Participant Loan
Charges from affected Participant Annuity Accounts, in addition to the
Participant loan.
7.5 Benefit Withdrawal Charge
When a Participant elects a withdrawal, the Participant or the Group
Contractholder on behalf of a Participant, may Request a benefit
withdrawal. Benefit withdrawals will be paid to the Participant upon
completion of any pertinent documentation required by the Company for such
withdrawals. A benefit withdrawal charge is a transactional charge that may
be applicable to each benefit withdrawal, including Contract termination
withdrawals, except:
(1) Minimum required distributions meeting the requirements of section 401(a)(9)
of the Code; (2) Participant loans; (3) Corrective distributions meeting the
requirements of section 401(a) of the Code (4) Distributions rolled into a
Company Individual Retirement Account meeting the requirements
of sections 402, 408 and 408A of the Code.
The Benefit Withdrawal Charge will be deducted from affected Participant Annuity
Accounts at the time of withdrawal unless the Employer pays the Benefit
Withdrawal Charge prior to the Participant's withdrawal.
7.6 Contract Termination Charge
The Contract Termination Charge, if any, is calculated according to a
percentage of the sum of the values of the Participant Annuity Accounts on
the Contract Termination Date, pursuant to the schedule below.
------------------------------- ------------------------
Number of Years Elapsed Since Maximum Contract
Group Annuity Contract Date Termination Charge
-----------------------
as a Percentage of
Total Plan Assets
=============================== ========================
[More than 9 months but less [x%]
than 1]
------------------------------- ------------------------
------------------------------- ------------------------
[1 but less than 2] [x%]
------------------------------- ------------------------
------------------------------- ------------------------
[2 but less than 3] [x%]
------------------------------- ------------------------
------------------------------- ------------------------
[3 but less than 4] [x%]
------------------------------- ------------------------
------------------------------- ------------------------
[4 but less than 5] [x%]
------------------------------- ------------------------
------------------------------- ------------------------
[5 or more] [x%]
------------------------------- ------------------------
Page 2
Section 9.7, Amount Payable on Death of Participant, shall be deleted in its
entirety and replaced with the following:
9.7 Amount Payable on Death of Participant
If the Participant dies before the Payment Commencement Date, the amount payable
on death will be the Participant Annuity Account Value net of any outstanding
loan balance, less Premium Tax, if any.
Section 13, Contract Termination, shall be added to the Contract as follows:
13.1 Contract Termination, Except at Plan Termination
The provisions of this Section will apply to Contract Termination for any
reason excluding termination of the Plan. Contract Termination will
automatically occur upon Plan termination. (See Section 13.3 for procedures
applicable to Plan Termination.)
Either party to the Group Annuity Contract may, upon 30 days advance
written notice to the other party, declare a Contract Termination Date,
which shall be any date on or after the expiration of the 30-day
notification period. If the parties fail to determine a mutually agreeable
Contract Termination Date, the Contract Termination Date will be 30 days
from the date written notice of Contract Termination is received by the
Company at its Administrative Office, or 30 days after the Company mails
notice of Contract Termination to the last known address of the Plan
sponsor. However, the Company may provide notice of Contract Termination
only if:
(A) The Group Contractholder adopts an amendment to the Plan or operates
the Plan in a manner which is unacceptable to the Company; or
(B) The Group Contractholder fails to comply with any provision contained
in this Group Annuity Contract; or
(C) The Plan fails to qualify or becomes disqualified under Code section
401(a); or
(D) The total amount of Contributions received by the Company in the
preceding 12 months is less than $25,000; or
(E) The sum of all Participant Annuity Account Values falls below $25,000;
or
(F) The Group Contractholder fails to make Contributions which have been
deducted from Participants' paychecks within 30 days following the end of
the month in which such deduction was made; or
(G) Transfers to investment vehicles outside the Group Annuity Contract
exceed [10%] of the accounts at the beginning of the calendar year; or
(H) The Company may terminate this Group Annuity Contract if the Group
Contractholder ceases doing business; or
(I) This Group Annuity Contract shall terminate if there are no remaining
Participant Annuity Accounts.
The Company will notify the Group Contractholder of the payment date and
valuation of the Participant Annuity Accounts will be determined as of the
payment date.
13.2 Procedures at Contract Termination Date, Except at Plan Termination
The provisions of this section will apply to Contract Termination for any
reason excluding termination of the Plan.
Page 3
After the Contract Termination Date has been declared, no benefit payment
will commence, no Transfers will be made, no payment option may be elected
by a Participant, and no Contributions will be accepted under the
provisions of the Group Annuity Contract.
If a Contract Termination Date has been declared and there are outstanding
charges and fees, if any, as set forth in the Group Annuity Contract
Section 7, Contract Charges and Fees and/or the Group Annuity Contract
Schedule of Terms and Fees, as applicable, the Company will on the Contract
Termination Date debit each account with its share of the amount of
outstanding expenses. No later than 30 days after the Contract Termination
Date, provided that the Company has received payment of the Loss of
Interest adjustment, if any, and the Contract Termination Charge, the
Company will pay to any one trustee or investment provider named by the
Group Contractholder one sum equal to the value of all moneys held in the
accounts.
Notwithstanding the above, if the Company is instructed to bill the Group
Contractholder for the Contract Termination Charge, if applicable, and the
Group Contractholder has not paid the Contract Termination Charges within
30 days of the instruction date, the Group Contractholder is deemed to have
instructed the Company to pay to any trustee or investment provider named
by the Group Contractholder one sum equal to:
(a) The value of all moneys held in the Variable Account; and
(b) The surrender value of all monies held in the Guaranteed
Certificate Fund relating to the Group Annuity Contract; less
(c) The Contract Termination Charge, the Contract Maintenance
Charges and Benefit Withdrawal Charges; if any.
In the event that either the Group Contractholder or the Company declared a
Contract Termination Date and the Group Contractholder fails to name the
payee to receive the Plan assets within 30 days, the Group Contractholder
hereby instructs the Company to pay such Plan assets to the named Plan
trustee.
In the event the Employer or successor refuses to act, the Company will
implement the procedures of this section, as specified above, at Contract
Termination.
13.3 Procedures at Contract Termination Due to Plan Termination
The provisions of this section will apply to Contract Termination due to
termination of the Plan for any reason.
In the event that the Employer terminates the Plan for any reason, the
Group Contractholder shall notify the Company of the Plan Termination Date
and the date upon which the final Plan contributions will be remitted to
the Company. The Contract Termination Charge as described in the Group
Annuity Contract Section 7, Contract Charges and Fees, and/or the Group
Annuity Contract Schedule of Terms and Fees will apply.
The Code requires all participant accounts to be 100% vested upon Plan
termination and the forfeiture account, if any, to be allocated in
accordance with the terms of the Plan upon termination. After the Company
has been notified of a Plan termination, no benefit payment will commence,
no Transfers will be made, no payment option may be elected by a
Participant, and no Contributions will be accepted under the provisions of
the Group Annuity Contract. All amounts under the Group Annuity Contract
shall be paid in a lump sum to each Participant or Beneficiary by reason of
Plan Termination upon the Company's receipt of certain representations and
instructions from the Group Contractholder, and all applicable charges and
fees, if any, as described in the Group Annuity
Page 4
Contract Section 7, Contract Charges and Fees, and/or the Group Annuity
Contract Schedule of Terms and Fees, will apply.
The Group Contractholder shall provide to the Company evidence or
representations that:
(1) The Plan is a qualified plan;
(2) The Plan has been properly terminated;
(3) All necessary notices, reports, disclosures, or filings with respect
to the Plan and its termination have been made;
(4) The Group Contractholder has submitted all contributions to the
Company;
(5) The Group Contractholder will make the final Form 5500 filing for the
Plan, and:
(6) The Group Contractholder will provide any other information that may
be required by the Company in order to make distributions to
Participants and to properly tax report such distributions.
The Group Contractholder shall provide specific instructions to the Company
as to the method of allocating the forfeiture account, if any, pursuant to
the terms of the Plan document.
The Group Contractholder shall also designate a final distribution date,
which shall be the Contract Termination Date, upon which the Company is to
make a lump sum distribution to each Participant equal to the balance of
each Participant Annuity Account as reflected in the records of the Company
as of the distribution date, less any required income tax withholding and
Premium Tax. Such payment is to be sent to the Participant's last known
mailing address unless, prior to that date, the Participant (i) has elected
a direct rollover, with clear and complete instructions, or (ii) has
elected payment in the form of an annuity, if such election was required by
law to be offered to the Participant.
Within 30 days of the Contract Termination Date, the Group Contractholder
shall pay any and all outstanding applicable charges to the Company as set
forth in Section 7, Contract Charges and Fees and/or the Group Annuity
Contract Schedule of Terms and Fees. If the Group Contractholder instructs
the Company to debit these charges, the Company will debit each account
with its share of the outstanding expenses as of the Plan Termination Date.
If the Group Contractholder is not reasonably available at the time of Plan
termination or fails to provide appropriate representations and
instructions to the Company in connection with Plan termination, the
Company is authorized to accept notices, representations and instructions
from the Plan administrator or trustee, the bankruptcy trustee for the Plan
sponsor, the U.S. Department of Labor or an authorized and appropriate
representative of the Group Contractholder.
In the absence of other representations or instructions from the Group
Contractholder received by the Company in writing within 30 days following
the Plan Termination Date, the Group Contractholder, for purposes of this
Contract the Group Contractholder will be deemed to have:
1. made the representations described in this Section 13.3;
2. instructed the Company to allocate the Forfeiture account in
accordance with the Plan, if the Plan document is available to the
Company. Otherwise, the Forfeiture account will be allocated in
proportion to Participant account balances;
3. caused Participant account balances to become 100% vested;
4. instructed the Company to debit each Participant Annuity Account in
proportion to Participant account balances for any and all outstanding
fees, if any, as set forth in the Group Annuity Contract Section 7,
Contract Charges and Fees, and/or the Group Annuity Contract Schedule
of Terms and Fees, as applicable; and
5. instructed the Company to provide distribution election forms to
Participants and Beneficiaries consistent with this Section 13.3 and
to distribute account balances in
Page 6
accordance with the elections made by Participants and Beneficiaries, all
based upon the Company's records.
Signed for Great-West Life & Annuity Insurance Company on the Group Annuity
Contract Date.
President and Chief Executive Officer
