AMENDMENT TO PARTICIPATION AGREEMENT
Exhibit 30(H)(13)(IV)
AMENDMENT TO PARTICIPATION AGREEMENT
Minnesota Life Insurance Company, Variable Insurance Products Fund, Variable Insurance Products Fund II And Variable Insurance Products Fund III Variable Insurance Products Fund IV, and Variable Insurance Products Fund V and Fidelity Distributors Company LLC hereby amend the Participation Agreement (“Agreement”) March 15, 2007, as amended, by doing the following:
| 1. | Schedule A. Schedule A of the Agreement is hereby deleted in its entirety and replaced with the attached Schedule A: |
| 2. | Except as modified and amended hereby, the Agreement is hereby ratified and confirmed in full force and effect in accordance with its terms. |
IN WITNESS WHEREOF, the parties have hereto affixed their respective authorized signatures, intending that this Amendment be effective as of May 1, 2023.
| MINNESOTA LIFE INSURANCE COMPANY | ||
| By: | /s/ Xxxxxxx Xxxxxxxx | |
| Name: | Xxxxxxx Xxxxxxxx | |
| Title: | VP, CFO & Actuary-Individual Solutions | |
| VARIABLE INSURANCE PRODUCTS FUND | ||
| VARIABLE INSURANCE PRODUCTS FUND II | ||
| VARIABLE INSURANCE PRODUCTS FUND III | ||
| VARIABLE INSURANCE PRODUCTS FUND IV | ||
| VARIABLE INSURANCE PRODUCTS FUND V | ||
| By: | /s/ Xxxx Xxxxx | |
| Name: | Xxxx Xxxxx | |
| Title: | Authorized Signatory | |
| FIDELITY DISTRIBUTORS COMPANY LLC | ||
| By: | /s/ Xxxxxx Xxxxxxx | |
| Name: | Xxxxxx Xxxxxxx | |
| Title: | EVP | |
SCHEDULE A
SEPARATE ACCOUNTS AND ASSOCIATED CONTRACTS
REGISTERED SEPARATE ACCOUNTS
Name of Separate Account and
Date Established by Board of Directors
Variable Annuity Account
September 10, 1984
Name of Contract Funded by
Separate Account and Form Number
MHC-92-9283
MHC-92-9284
MHC-94-9307
MHC-87-9154 Rev. 3-91
MHC-95-9326
99-70016, 99-70017
02-70067
02-70073
02-70074
02-70075
03-70083
03-70084
03-70085
03-70086
03-70090
06-70139
06-70147
Name of Separate Account and
Date Established by Board of Directors
Minnesota Life Variable Life Account
October 21, 1985
Name of Contract Funded by
Separate Account and Form Number
MHC-98-670
MHC-98-690
99-680
03-640
04-690
Name of Separate Account and
Date Established by Board of Directors
Minnesota Life Variable Universal Life Account
August 8, 1994
Name of Contract Funded by
Separate Account and Form Number
MHC-94-18660 Rev. 5-2001
MHC-96-18710T Rev. 5-2001
02-30436T
Name of Separate Account and
Date Established by Board of Directors
Minnesota Life Individual Variable Universal Life Account
June 11, 2007
Name of Contract Funded by
Separate Account and Form Number
07-660
ICC12-665
ICC15-20001
ICC22-20258
UNREGISTERED SEPARATE ACCOUNTS
Unregistered Separate Account Contracts - Various Dates of Inception
Group Annuity Contract forms to which this Agreement applies:
Group One - Minnesota Life Contracts:
Group Annuity Contract, Form 04-70126
Group Annuity Contract, Form 04-70128
Group Annuity Contract IAC I, Form 87-9173
Group Annuity Contract IAC I, Form 92-9274
Group Annuity Contract AIAC I, Form 90-9246
Group Annuity Contract IAC II, Form 89-9224
Group Annuity Contract AIAC II, Form 90-9247
Group Annuity Contract IAC I, Form 87-9166
Group Annuity Contract, Form MHC-95-9317
Group Annuity Contract, Form MHC-97-9388
Group Two - Contracts previously issued by Minnesota Life prior to the date of this contract:
Group Annuity Contract IAC I, Form F. 23412
Group Annuity Contract IAC I, Form F. 24415
Group Annuity Contract AIAC I, Form F .25150
Group Annuity Contract IAC I, Form F. 23411
Group Annuity Contract AIAC I, Form F. 25412
Group Annuity Contract PAC II, Form 89-9225
Group Annuity Contract RGC, Form 89-9084
Group Annuity Contract DA, Form 18084
Group Annuity Contract DA, Form 24595
Group Annuity Contract IPG, Form F. 21811
Group Annuity Contract IPG, Form F. 17283
Group Annuity Contract GAC, Form F. 18088
Group Annuity Contract GAC, Form F. 21713
Group Annuity Contract GAC, Form F. 24386
Group Annuity Contract, Form F. 24596
Group Annuity Contract, Form F. 24597
Group Annuity Contract, Form F. 18088-1
Group Annuity Contract, Form 89-9216 (UofM)
Group Three - Fort Dearborn Life Insurance Company Contracts reinsured by Minnesota Life pursuant to Assumption Reinsurance Transaction effective October 1, 1999:
Group Annuity Contract, Form 8-39-1091
Group Annuity Contract, Form 0-000-000
Group Annuity Contract, Form 8-39-1188
Group Four - First Allmerica Financial Life Insurance Company Contracts reinsured by Minnesota Life pursuant to Assumption Reinsurance Transaction effective July 1, 2001:
Group Annuity Contract, Form GA-AID-1.00-81
Group Annuity Contract, Form GA-PDC-1.00-90
Group Annuity Contract, Form GA-PDC-2.00-96
Group Annuity Contract, Form GA-PDC-3.00-96
Group Annuity Contract, Form GA-PDC-4.00-96
Group Annuity Contract, Form GA-PDC-5.00-96
Group Five - Pan-American Life Insurance Company Contracts reinsured by Minnesota Life pursuant to Assumption Reinsurance Transaction effective November 17, 2003:
Group Annuity Contract, Form A-2358
Group Annuity Contract, Form A-1634
Group Annuity Contract, Form A-1635
Group Annuity Contract, DC-79 Form A-885
Group Annuity Contract, DB-79 Form A-894
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| Certificate Of Completion | ||||
| Envelope Id: B0E866EB031E40F0B4811FD0EA163198
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Status: Completed | |||
| Subject: Minnesota Life -Amendment to PA.pdf
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| Source Envelope:
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| Document Pages: 5
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Signatures: 2 | Envelope Originator:
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| Certificate Pages: 2
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Initials: 0 | Xxxxxxxx Xxxxxx | ||
| AutoNav: Enabled
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000 Xxxxx Xx. | |||
| EnvelopeId Stamping: Enabled
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Smithfield, RI 02917 | |||
| Time Zone: (UTC-05:00) Eastern Time (US & Canada) | xxxxxxxx.xxxxxx@xxx.xxx | |||
| IP Address: 192.223.242.30 | ||||
| Record Tracking | ||||
| Status: Original
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Holder: Xxxxxxxx Xxxxxx |
Location: DocuSign | ||
| 2/7/2023 8:50:12 AM |
xxxxxxxx.xxxxxx@xxx.xxx |
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| Signer Events | Signature | Timestamp | ||
| Xxxx Xxxxx
xxxx.xxxxx@xxx.xxx
Assistant Treasurer
Security Level: Email, Account Authentication |
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Sent: 2/7/2023 8:55:05 AM
Viewed: 2/7/2023 9:05:19 AM
Signed: 2/7/2023 9:05:26 AM | ||
| (None) | Signature Adoption: Pre-selected Style | |||
| Using IP Address: 192.223.136.5 | ||||
| Electronic Record and Signature Disclosure: | ||||
| Not Offered via DocuSign | ||||
| Xxxxxx Xxxxxxx
xxx.xxxxxxx@xxx.xxx
EVP
Fidelity Distributors Company LLC |
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Sent: 2/7/2023 9:05:27 AM
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| Resent: 2/14/2023 12:29:41 PM
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| Viewed: 2/14/2023 12:31:40 PM
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| Signed: 2/14/2023 12:32:16 PM | ||||
| Signature Adoption: Pre-selected Style | ||||
| Security Level: Email, Account Authentication | ||||
| (None) | Using IP Address: 192.223.241.27 | |||
| Electronic Record and Signature Disclosure: | ||||
| Not Offered via DocuSign | ||||
| In Person Signer Events | Signature | Timestamp | ||
| Editor Delivery Events | Status | Timestamp | ||
| Agent Delivery Events | Status | Timestamp | ||
| Intermediary Delivery Events | Status | Timestamp | ||
| Certified Delivery Events | Status | Timestamp | ||
| Carbon Copy Events | Status | Timestamp | ||
| Witness Events | Signature | Timestamp | ||
| Notary Events | Signature | Timestamp | ||
| Envelope Summary Events | Status | Timestamps | ||
| Envelope Sent | Hashed/Encrypted | 2/7/2023 8:55:05 AM | ||
| Certified Delivered | Security Checked | 2/14/2023 12:31:40 PM | ||
| Signing Complete | Security Checked | 2/14/2023 12:32:16 PM | ||
| Envelope Summary Events | Status | Timestamps | ||
| Completed | Security Checked | 2/14/2023 12:32:16 PM | ||
| Payment Events | Status | Timestamps | ||
