THE PRUDENTIAL THE PRUDENTIAL
INSURANCE COMPANY OF
AMERICA
agrees to pay the benefits provided under this contract in accordance with and
subject to its terms.
Contract-Holder: Plan:
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Effective Date: Group Annuity Contract No.:
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Eligible Classification:
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Provisions and Schedules Jurisdiction:
attached:
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THE PRUDENTIAL INSURANCE COMPANY
OF AMERICA
By:
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Title: President /s/
Date: Secretary /s/
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Attest
------------------------------
Date:
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Group Annuity Contract providing for contributions on account of
Participants. Annual determination of participation in divisible surplus.
All subject to the provisions of this contract.
NOTICE - ALL CONTRACTUAL VALUES OR PAYMENTS PROVIDED BY THIS CONTRACT, WHEN
BASED ON THE INVESTMENT RESULTS OF A PRUDENTIAL SEPARATE ACCOUNT DESCRIBED IN
THIS CONTRACT. ARE VARIABLE, SUBJECT TO CHANGE BOTH UP AND DOWN, AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
GVA-120-87 (10/11)
19081
TABLE OF CONTENTS
PROVISION Serial Page
I. CONTRIBUTIONS - ACCOUNTS - CHARGES
1.1 Contributions. . . . . . . . . . . . . . . . . . . . . 100
1.2 Participant's Accounts . . . . . . . . . . . . . . . . 110
1.3 Annual Account Charge. . . . . . . . . . . . . . . . . 120
1.4 Reports. . . . . . . . . . . . . . . . . . . . . . . . 120
II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE
2.1 The Prudential Variable Contract
Account-10 (VCA-10). . . . . . . . . . . . . . . . . . 200
2.2 VCA-10 Unit Value. . . . . . . . . . . . . . . . . . . 200
2.3 VCA-10 Committee . . . . . . . . . . . . . . . . . . . 210
III. WITHDRAWALS AND TRANSFERS - DEATH PAYMENTS
3.1 Participant's Withdrawals. . . . . . . . . . . . . . . 300
3.2 Death Payments . . . . . . . . . . . . . . . . . . . . 310
3.3 Transfers between Related Contracts. . . . . . . . . . 330
3.4 Transfers to Another Financial Institution . . . . . . 330
3.5 Transfers Involving a Similar Contract
of Another Employer. . . . . . . . . . . . . . . . . . 350
IV. DISTRIBUTIONS
4.1 Distributions. . . . . . . . . . . . . . . . . . . . . 400
4.2 Required Distribution Date . . . . . . . . . . . . . . 400
4.3 Minimum Required Distributions . . . . . . . . . . . . 410
4.4 Terms of Payment of Annuities. . . . . . . . . . . . . 420
4.5 Small Annuities and Accounts . . . . . . . . . . . . . 430
4.6 Payees . . . . . . . . . . . . . . . . . . . . . . . . 430
V. CHANGES
5.1 Changes by Prudential. . . . . . . . . . . . . . . . . 500
5.2 Changes by Agreement . . . . . . . . . . . . . . . . . 500
5.3 Changes to Conform to Law. . . . . . . . . . . . . . . 500
5.4 Persons Empowered to Act for Prudential. . . . . . . . 500
VI. DISCONTINUANCE - TERMINATION OF CONTRACT
6.1 Discontinuance of Establishing Participants'
Accounts . . . . . . . . . . . . . . . . . . . . . . 600
6.2 Discontinuance of Contributions under
this Contract. . . . . . . . . . . . . . . . . . . . 600
6.3 Termination of Contract. . . . . . . . . . . . . . . . 600
VII. GENERAL TERMS
7.1 Contract-Holder. . . . . . . . . . . . . . . . . . . . 700
7.2 Communications . . . . . . . . . . . . . . . . . . . . 700
7.3 Place of Payment - Currency. . . . . . . . . . . . . . 700
7.4 Information - Records. . . . . . . . . . . . . . . . . 710
7.5 Misstatements. . . . . . . . . . . . . . . . . . . . . 710
7.6 Beneficiary. . . . . . . . . . . . . . . . . . . . . . 710
GVA-120-87 (as modified by Group Annuity Amendment Form GAA-7764)
TC-100 (10)
TABLE OF CONTENTS
(Continued)
Provision Serial Page
7.7 Plan Changes . . . . . . . . . . . . . . . . . . . . . 720
7.8 Divisible Surplus. . . . . . . . . . . . . . . . . . . 720
7.9 Limit on Assignment. . . . . . . . . . . . . . . . . . 720
7.10 Certificates . . . . . . . . . . . . . . . . . . . . . 730
7.11 Entire Contract - Construction . . . . . . . . . . . . 730
SCHEDULES
Schedule A Forms of Annuity Which May Be Purchased. . . . . A-100
Schedule B Life - Payment Certain Annuity . . . . . . . . . S-100
Schedule C Life - Contingent Annuity. . . . . . . . . . . . S-100
Schedule D Payment Certain Annuity. . . . . . . . . . . . . S-100
GVA-120-87 (10/11)
TC-110
Provision I. CONTRIBUTIONS - ACCOUNTS - CHARGES:
1.1 CONTRIBUTIONS:
(a) Regular Contributions:
The contributions which are payable under this contract for a
Participant are the payments made for him by his employer pursuant to
a Salary-Annuity Agreement and any amounts contributed for him under
the Plan, if any, and directed by the Participant for payment
hereunder. For each Participant, total contributions (including those
made pursuant to a Salary-Annuity Agreement) to this contract and any
companion contract must be made at the rate of at least $200 annually
during each twelve-month period. Contributions will be transmitted by
the Contract-Holder or the employer.
A Participant is a person for whom contributions have been paid under
this contract and whose Participant's Account (see section 1.2) has
not been cancelled.
A Salary-Annuity Agreement is an agreement between an employee in an
Eligible Classification and his employer. It is also an agreement
between a Participant who has ceased to be an employee in an Eligible
Classification and his new employer. Under the Agreement, the employer
agrees to pay amounts to purchase an annuity for the employee meeting
the conditions of Section 403(b) of the Federal Internal Revenue Code
of 1986, as amended (the "Code" ).
Contributions made pursuant to a Salary-Annuity Agreement may not
exceed $9,500 for the taxable year of the Participant or such other
amount as prescribed by the Internal Revenue Service under Section
402(g)(4) of the Code. This limitation shall not preclude any special
increases applicable under Section 402(g)(8) of the Code. If the
limitation described in this paragraph is exceeded in any taxable
year, the Participant may, not later than the March 1 following the
close of such taxable year, notify the Prudential, in writing, of such
excess and request that all or a portion of such excess and the income
or loss allocable thereto, be paid to him from the contract before the
April 15 following the close of the Participant's taxable year. Income
or loss allocable to a Participant's excess contributions shall be
determined in accordance with any applicable Regulations issued by the
Internal Revenue Service. Any distribution made pursuant to this
paragraph shall be made without regard to any restrictions or charges
otherwise applicable to withdrawals under section 3.1 of the contract.
(To save words, male pronouns are used in this contract to refer to
both men and women.)
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 100 1.1
(b) Transfer Contributions:
The following amounts may be transferred to and paid as contribution under
the contract for a Participant:
(1) an amount which qualifies as a rollover contribution pursuant to the
Code;
(2) an amount which arises from an exchange of annuity contracts pursuant
to the Code;
(3) an amount which arises from a Participant's interest in a Code Section
403(b)(7) custodial account; or
(4) an amount which arises from a Participant's interest in another Group
Annuity Contract issued to the Contract-Holder by Prudential.
Any amounts transferred to the contract pursuant to paragraph (b) of this
section 1.1. will be treated as a Salary-Annuity Agreement contribution
made after December 31, 1988 for purposes of the limitations on withdrawals
under section 3.1. of the contract. However, if any portion of such
transferred amount was not subject to the limitations of Code Section
403(b)(11) or Code Section 403(b)(7)(A)(ii) prior to transfer, then such
portion will be treated as a contribution made prior to December 31, 1988
for withdrawal purposes, if the following conditions are met:
(1) a record of the amount of contributions, and any income thereon, which
was not subject to the limitations of Code Section 403(b)(11) or Code
Section 403(b)(7)(A)(ii) prior to transfer must be furnished to
Prudential in a form satisfactory to it at the time such transfer is
made, and
(2) evidence that such amount was not subject to the limitations of Code
Section 403(b)(ii) or Code Section 403(b)(7)(A)(ii) prior to transfer
must be furnished to Prudential in a form satisfactory to it at the
time such transfer is made.
The Prudential may require proof that all amounts transferred to the
contract meet the requirements of the Code and any applicable Rulings or
Regulations issued by the Internal Revenue Service.
1.2 PARTICIPANT'S ACCOUNTS:
Prudential will establish a "Participant's Account" for each person for
whom a contribution is paid under this contract. This Account is expressed
in Units of the separate investment account described in section on 2.1
A number of Units will be added to the Participant's Account on each day a
contribution is received by Prudential for the Participant. This number is
determined by dividing the dollar amount of the contribution by the Unit
Value for the day the contribution is received (see section 2.2 for a
description of the Unit Value). A number of Units will be subtracted from
the Participant's Account on each day on which a withdrawal is made from
his Account. This number is equal to the number
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 110 1.1-1.2
requested for withdrawal or, if applicable, the number determined by
dividing the dollar amount to be withdrawn by the Unit Value for the day of
withdrawal.
A Participant's Account is the sum of the Units added to it, less the sum
of the Units subtracted from it. The dollar value of a Participant's
Account as of any day is the product of the number of Units in his Account
at the close of business on that day and the Unit Value for that day.
A Participant has a non-forfeitable interest in his Account. The Account is
subject to charges described later.
1.3 Annual Account Charge:
On the last business day (see section 2.2) of each calendar year an amount
will be withdrawn from each Participant's Account equal to the Annual
Account Charge. Also, on any other day on which a Participant's Account is
cancelled, an amount will be withdrawn from his Account equal to the Annual
Account Charge. However, no Charge will be withdrawn if the Participant's
Account is being cancelled on a January 1 to purchase an annuity for him
under this contract.
The Annual Account Charge is $20.
A Participant may have an Account for Salary-Annuity Agreement payments or
Plan payments, if any, under another group annuity contract issued to the
Contract-Holder by Prudential (a "companion contract"). If so, the total
Annual Account Charge that applies to all his Accounts will not exceed the
amount shown above. This charge will be shared among his Accounts as
Prudential determines. Also, no charge will be withdrawn from his Account
under this contract when it is cancelled unless no amounts remain in an
Account for him under a companion contract.
In addition to the Annual Account Charge, a charge may be made upon a
Participant's withdrawal (see section 3.1).
The Charge may be changed as provided in section 5.1.
1.4 REPORTS:
Prudential will periodically furnish a report with respect to each
Participant's Account which has not been cancelled. The report will show
the status of each Account as of the date of the report.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 120 1.2-1.4
Provision II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE:
2.1 THE PRUDENTIAL VARIABLE CONTRACT ACCOUNT - 10 (VCA-10):
VCA-10 is a separate investment account of Prudential established pursuant
to a resolution adopted by its Board of Directors. The resolution provides
that this account is to be used for contracts which state that certain
payments and values under them will vary to reflect the investment results
of this account.
The investments held in VCA-10 are intended to be composed primarily of
common stocks. Prudential will invest and reinvest the assets held in
VCA-10 in accordance with the investment objectives and policies
established for it.
The total market value of the assets held in VCA-10 at all times will be at
least equal to the total reserve liability required by law for all payments
or values which vary in dollar amount to reflect the investment results of
VCA-10. Assets held in VCA-10 equal in market value to that reserve
liability will be held for the sole benefit of all contracts which
participate in VCA-10. The amount, if any, by which the total market value
exceeds the total reserve liability will be subject to the exclusive
control of Prudential. Thus, Prudential may from time to time make
transfers between VCA-10 and its other investment accounts as in its
judgment, experience warrants. A transfer will not affect Prudential's
contractual liabilities under this contract.
2.2 VCA-10 UNIT VALUE:
The VCA-10 Unit Value for any Business Day is the dollar value of one
VCA-10 Unit for that Business Day. ("Business Day" means a day the New York
Stock Exchange is open for trading.) The initial VCA-10 Unit Value was
$1.00. The VCA-lO Unit Value for any subsequent Business Day is determined
as of the end of that Business Day by multiplying the VCA-lO Unit Change
Factor for that Business Day by the VCA-lO Unit Value for the immediately
preceding Business Day. The VCA-lO Unit Value for any day which is not a
Business Day is equal to the VCA-10 Unit Value for the next Business Day.
The VCA-1O Unit Value will go up or down in accordance with the VCA-10 Unit
Change Factor described below.
To determine the VCA-10 Unit Change Factor for any Business Day, Prudential
will proceed as follows:
(a) Increase $1.00 by the rate of investment results of VCA-10 for that
Business Day, taking into account investment income and market value
changes after provision for any taxes applicable to contracts of this
class arising from the operation of VCA-10.
(b) Subtract from the result found in (a) the VCA-10 Investment Management
Fee per $1.00 at the effective annual rate of 0.25% for the number of
calendar days in the period from the end of the prior Business Day to
the end of the current Business Day. The aggregate amount by which
VCA-10 is reduced in each year by the Investment Management Fee will
be deducted from investment income to the extent possible; any balance
will be deducted from principal.
GVA-120-87 (10)
Serial 200 2.1-2.2
(c) Provide for the Administrative Expense Charge at the effective annual
rate of 0.75%, against the assets of VCA-10. To do so, the result
found in (b) is divided by $1.00 increased at the effective annual
rate of 0.75% for the number of calendar days in the period from the
end of the prior Business Day to the end of the current Business Day.
The result found in (c) is the VCA-10 Unit Change Factor for that Business
Day.
The Investment Management Fee specified in item (b) above may be changed
from time to time pursuant to a change in the investment management
agreement between Prudential and the VCA-10 Account. Prudential will notify
the Contract-Holder of any such change.
In addition, this section may be changed as provided in section 5.1.
2.3 VCA-10 COMMITTEE:
The operation of VCA-10 will be supervised by The Prudential VCA-10
Committee (the "Committee"). The initial Committee members will be
appointed by Prudential. Thereafter, members will be elected by the
Participants.
GVA-120-87 (10) (as modified by GAA-7662)
Serial 210 2.2-2.3
Provision II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE:
2.1 THE PRUDENTIAL VARIABLE CONTRACT ACCOUNT - 11 (VCA-11):
VCA-11 is a separate investment account of Prudential established
pursuant to a resolution adopted by its Board of Directors. The
resolution provides that this account is to be used for contracts which
state that certain payments and values under them will vary to reflect
the investment results of this account.
The investments held in VCA-11 are intended to be composed of high-grade
money market instruments. Prudential will invest and reinvest the assets
held in VCA-11 in accordance with the investment objectives and policies
established for it.
The total market value of the assets held in VCA-11 at all times will be at
least equal to the total reserve liability required by law for all payments
or values which vary in dollar amount to reflect the investment results of
VCA-11. Assets held in VCA-11 equal in value to that reserve
liability will be held for the sole benefit of all contracts which
participate in VCA-11. The amount, if any, by which the total value
exceeds the total reserve liability will be subject to the exclusive
control of Prudential. Thus, Prudential may from time to time make
transfers between VCA-11 and its other investment accounts as, in its
judgment, experience warrants. A transfer will not affect Prudential's
contractual liabilities under this contract.
2.2 VCA-11 UNIT VALUE:
The VCA-11 Unit Value for any Business Day is the dollar value of one VCA-
11 Unit for that Business Day. ("Business Day" means a day the New York
Stock Exchange is open for trading.) The initial VCA-11 Unit Value was
$1.00. The VCA-11 Unit Value for any subsequent Business Day is
determined as of the end of that Business Day by multiplying the VCA-11
Unit Change Factor for that Business Day by the VCA-11 Unit Value for the
immediately preceding Business Day. The VCA-11 Unit Value for any day
which is not a Business Day is equal to the VCA-11 Unit Value for the next
Business Day. The VCA-11 Unit Value will go up or down in accordance with
the VCA-11 Unit Change Factor described below.
To determine the VCA-11 Unit Change Factor for any Business Day, Prudential
will proceed as follows:
(a) Increase $1.00 by the rate of investment results of VCA-11 for that
Business Day, taking into account investment income and changes in the
value of investments after provision for any taxes applicable to
contracts of this class arising from the operation of VCA-11.
(b) Subtract from the result found in (a) the VCA-11 Investment
Management Fee per $1.00 at the effective annual rate of 0.25% for the
number of calendar days in the period from the end of the prior
Business Day to the end of the current Business Day. The aggregate
amount by which VCA-11 is reduced in each year by the Investment
Management Fee will be deducted from investment income to the extent
possible; any balance will be deducted from principal.
GVA-120-87 (11)
Serial 200 2.1-2.2
(c) Provide for the Administrative Expense Charge at the effective annual
rate of 0.75%, against the assets of VCA-11. To do so, the result
found in (b) is divided by $1.00 increased at the effective annual
rate of 0.75% for the number of calendar days in the period from the
end of the prior Business Day to the end of the current Business Day.
The result found in (c) is the VCA-11 Unit Change Factor for that Business
Day.
Prudential may, upon notice to the Contract-Holder and Participants, change
the basis for determining the Unit Value. The changed basis would be one
designed to maintain a constant Unit Value, with investment results being
reflected through the number of Units in Participants' Accounts.
The Investment Management Fee specified in item (b) above may be changed
from time to time pursuant to a change in the investment management
agreement between Prudential and the VCA-11 Account. Prudential will notify
the Contract-Holder of any such change.
This section may also be changed as provided in section 5.1.
2.3 VCA-11 COMMITTEE:
The operation of VCA-11 will be supervised by The Prudential VCA-11
Committee (the "Committee"). The initial Committee members will be
appointed by Prudential. Thereafter, members will be elected by the
Participants.
GVA-120-87 (11) (as modified by GAA-7662)
Serial 210 2.2-2.3
Provision III. WITHDRAWALS AND TRANSFERS--DEATH PAYMENTS:
3.1 PARTICIPANT'S WITHDRAWAL:
A Participant may make withdrawals from his Participant's Account subject
to any conditions specified in the Plan, if any.
However, withdrawals attributable to (i) Salary-Annuity Agreement
contributions made on or after January 1, 1989 and (ii) income credited on
or after January l, 1989 to any Salary-Annuity Agreement contributions, may
not be made prior to the Participant's attainment of age 59 1/2, except
upon the occurrence of one of the following events:
. separation from service with the employer sponsoring the Plan or
Salary-Annuity Agreement arrangement under the contract;
. Disability Retirement, in accordance with Code Section 72(m)(7) or in
accordance with the terms of the Plan, if any; or
. Financial Hardship, in accordance with the terms of the Plan, if any
or on a basis mutually agreed upon between the Contract-Holder and
Prudential which will be uniformly applicable to all Participants
similarly situated.
Prudential may require proof, in a form satisfactory to it, that one of the
preceding events has occurred before honoring any request for a withdrawal
described in the preceding paragraph.
Withdrawals attributable to Salary-Annuity Agreement contributions made on
or before December 31, 1988 and any income credited to such contributions
as of December 31, 1988, will not be subject to the provisions of the
preceding two paragraphs.
Income attributable to Salary-Annuity Agreement contributions made on and
after January 1, 1989 may not be withdrawn in the case of Financial
Hardship.
The minimum withdrawal is $500, or the dollar value of the Participant's
Account if smaller. Payment to the Participant will normally be made within
seven days of Prudential's receipt of a duly completed request for it.
However, it may be paid at a later date if permitted under the Investment
Company Act of 1940.
The amount paid to the Participant will be the dollar value of the amount
withdrawn less the withdrawal charge determined from the following table
and the Annual Account Charge if it applies. The amount payable is also
referred to as the "Withdrawal Value."
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 300 3.1
TABLE
Withdrawals made in the months
indicated, counting from the day
the Participant's Account was Withdrawal Charge per $1.00
established* being withdrawn.**
--------------------------------- ---------------------------
First 24 months $0.07
Next 36 months 0.06
Next 60 months 0.04
Next 60 months 0.03
Thereafter 0.00
*Or, if earlier, the day an Account was established for him under a
companion contract (or under a similar contract if section 3.5 applies)
**No charge is made after the amount withdrawn equals the contributions
made for the Participant. In addition, no charge is made if the withdrawal
is made for reasons of Financial Hardship or Disability Retirement.
As of the first day no amounts remain in a Participant's Account or in an
Account for him under a companion contract, his Account is cancelled.
This section may be changed as provided in section 5.1.
3.2 DEATH PAYMENTS:
If a Participant dies before his Participant's Account has been cancelled,
the dollar value will be paid to his Beneficiary (see section 7.6.). Proof
of the Participant's death must be received by Prudential before any
payment will be made. Death benefits payable under the contract to a
Participant's Beneficiary prior to the date (i) on which an annuity has
been purchased for the Participant or (ii) on which minimum distributions
have commenced to the Participant pursuant to Code Section 401(a)(9) will
be paid as set forth in this section 3.2. Death benefits payable under the
contract to a Participant's Beneficiary after the date on which an annuity
has been purchased or on which minimum distributions have commenced to the
Participant pursuant to Code section 401(a) (9) will be paid as set forth
in section 4.1. of the contract.
The Beneficiary may elect payment in any of the following forms, unless the
Participant has directed otherwise or unless the Plan, if any, provides
otherwise:
(a) a lump sum;
(b) an annuity form described in section 4.4. of the contract, other than
one which provides for payment after the death of the Annuitant to a
Contingent Annuitant;
(c) any other settlement method to which Prudential consents and which is
not contrary to the terms of the Plan, if any; or
(d) a combination of all or any two of (a), (b) and (c) above.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 310 3.1-3.2
Any lump sum payment to a Beneficiary will be subject to the following:
- If the lump sum is payable to the Participant's spouse, payment of
such lump sum will be made no later than the later of the (i) the
December 31 of the calendar year following the one in which the
Participant's death occurred or (ii) the December 31 of the calendar
year in which the Participant would have attained age 70 1/2.
- If the lump sum is payable to a Beneficiary who is other than the
Participant's Spouse, payment of such lump sum will be made no later
than the December 31 of the calendar year in which the fifth
anniversary of the Participant's death occurs.
If a lump sum payment is made to the Beneficiary within one year of the
Participant's death, it will be at least equal to the contributions made
for him under this contract less any withdrawals and transfers.
If payments are to be made to a Beneficiary in a form other than a lump
sum, such payments will be subject to the following:
- If the Beneficiary is the Participant's spouse, payments must commence
no later than the later of (i) the December 31 of the calendar year
following the one in which the Participant's death occurred or (ii)
the December 31 of the calendar year in which the Participant would
have attained age 70 1/2. Such payments must be paid over the life of
the spouse or over a period not exceeding the life expectancy of the
spouse.
- If the Beneficiary is other than the Participant's spouse, payments
must commence no later than the December 31 of the calendar year
following the one in which the death of the Participant occurred. Such
payments must be paid over the life of the Beneficiary or over a
period not exceeding the life expectancy of the Beneficiary.
If:
(1) the Beneficiary does not elect a method of distribution,
(2) the Participant has not directed that a specific method of
distribution be provided for his Beneficiary, and
(3) the Plan, if any, does not provide for an automatic method of
distribution,
then any death benefits becoming payable under the contract shall be paid
in a lump sum commencing no later than the December 31 of the calendar year
in which the fifth anniversary of the Participant's death occurs.
Anything herein to the contrary notwithstanding, if any portion of the
Participant's Account, which becomes payable to a Beneficiary, consists of
(i) contributions made under the contract by or on behalf of the
Participant on or before December 31, 1986 and (ii) income credited to such
contributions as of December 31, 1986, then distribution of such portion
may be deferred until the Beneficiary attains age 70, if the Beneficiary so
elects and provided such election does not contravene any prior direction
from the Participant or any provision of the Plan, if any.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 320 3.2
All death benefits pursuant to this section 3.2. shall be made at the time
and in the manner prescribed in Code Section 401(a)(9) and the Regulations
issued thereunder.
If payments to a Beneficiary are to start at a future date, all or an
appropriate portion of the Participant's Account will be maintained in
accordance with the Beneficiary's election in the same manner as for the
Participant. No contributions may be made to an Account hereunder after the
Participant's death.
As of the first day no amounts remain in the Participant's Account or in an
Account with respect to the Participant under a companion contract, the
Participant's Account is cancelled. Section 3.1 does not apply.
3.3 TRANSFERS BETWEEN RELATED CONTRACTS:
A Participant may transfer an amount from his Participant's Account to an
Account maintained for him under a companion contract but only under the
conditions permitted by the Plan, if any. The minimum withdrawal to provide
a transfer is $500, or the dollar value of his Account if smaller. The
transfer will normally be made within seven days of Prudential's receipt of
a duly completed request for it. Section 3.1 does not apply to a withdrawal
for this purpose. Transfers are deemed to be made first from the
contributions paid for the Participant. Investment income is transferred
when there are no longer any contributions in the Participant's Account.
Amounts may be transferred to this contract from a companion contract. An
amount transferred to this contract for a Participant will be treated as
though it were a contribution made for him (see section 1.2). However in
determining any withdrawal charge, any part of the amount transferred which
is investment income will not be considered as a contribution.
Prudential may, upon notice to the Contract-Holder and Participants, limit
the frequency of transfers. This action will take effect on the date of the
notice.
This section may be changed as provided in section 5.1.
3.4 TRANSFERS TO ANOTHER FINANCIAL INSTITUTION:
(a) Total transfers at the Request of a Participant:
The Withdrawal Value of a Participant's Accounts may be transferred to
another financial institution but only under the conditions permitted
by the Plan, if any. The transfer may be made directly to that
institution or by a payment (or payments) to the Participant who then
makes payment to the institution. The transfer will normally be made
within seven days after Prudential's receipt of a duly completed
transfer request.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 330 3.2-3.4
The transfer will be a full settlement of Prudential's liability for the
Participant's Account.
(b) Partial Transfers at the Request of Participants:
A Participant may elect to have a portion of his Account transferred
to another financial institution if permitted by the terms of the
Plan, if any. The minimum withdrawal to provide a transfer is $500, or
the dollar value of the Participant's Account, if smaller.
The transfer will normally be made within seven days of Prudential's
receipt of a duly completed request for it.
Prudential may, upon notice to the Contract-Holder and Participants
limit the frequency of transfers. This action will take effect on the
date of the notice.
Any transfer amount will be subject to the provisions of section 3.1.
relating to withdrawal charges.
(c) At the Contract-Holder's Request:
The Contract-Holder may request Prudential to make transfer payments
to another financial institution named in the request. The transfer
payment will be made on the Transfer Date. The Transfer Date is the
later of the day specified in the request and the 9Oth day after its
receipt by Prudential.
Prudential will promptly notify each Participant, and each Beneficiary
of a deceased Participant whose Account has not been cancelled, that
the request has been received. Each notified person may elect, within
30 days following his receipt of the notice from Prudential, to have
his Account cancelled and included in the transfer payment to be made
but only under the conditions permitted by the Plan, if any. Each
person who does not make this election will have his Account retained
under this contract pursuant to its terms.
All Accounts of Participants and Beneficiaries who make the election
will be cancelled as of the Transfer Date and an amount equal to the
sum of the Withdrawal Values, expressed in Units of the cancelled
Accounts, times the Unit Value for the day of withdrawal will be
transferred within seven days thereafter.
Instead of making the transfer payment in cash, Prudential may make
all or a part of it in the form of securities representing a uniform
percentage of each holding of the separate investment account
described in section 2.1.
The Contract-Holder may notify Prudential that this section 3.4(c) is
to be inoperative.
This section may be changed as provided in section 5.1.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 340 3.4
3.5 TRANSFERS INVOLVING A SIMILAR CONTRACT OF ANOTHER EMPLOYER:
A Participant may cease to be employed by an employer who pays
contributions under this contract. He may become employed by an employer to
whom Prudential has issued a contract similar to this contract. If so, that
Participant may request a transfer to that similar contract from this
contract but only under the conditions permitted by the Plan, if any. The
transfer will normally be made within seven days of receipt of the request.
The dollar value of the Participant's Account will be the amount
transferred. The Account will be cancelled.
Also, this contract will accept a transfer from a contract similar to this
contract for a person covered thereunder who becomes employed by an
employer who pays contributions under this contract. The transferred amount
will be treated as a contribution paid for that person. However, in
determining any withdrawal charge, any part of the transferred amount which
is investment income will not be considered a contribution.
This section may be changed as provided in section 5.1.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 350 3.5
Provision IV. DISTRIBUTIONS
4.1 DISTRIBUTIONS:
A Participant may, subject to section 3.1 and in accordance with the terms
of the Plan, if any, elect to receive a distribution of the dollar value of
his Account under the contract in any of the following forms:
(a) a lump sum;
(b) an annuity form described in section 4.4;
(c) any other settlement method to which Prudential consents and which is
not contrary to the terms of the Plan, if any; or
(d) a combination of all or any two of (a), (b) and (c) above.
Any portion of a Participant's Account which is paid to him as a lump sum
will be subject to the provisions of section 3.1 relating to withdrawal
charges.
Any payments becoming due to the Beneficiary of a Participant who began
receiving a distribution pursuant to paragraph (c) may, unless the
Participant has directed otherwise or the Plan, if any, provides otherwise,
be paid in any of the forms described in this section 4.1. as elected by
the Beneficiary, except for an annuity which provides for payment after the
death of the Annuitant to a Contingent Annuitant.
Any payments becoming due to the Beneficiary of a Participant who began
receiving an annuity pursuant to paragraph (b) will, unless the Participant
has directed otherwise, be paid as provided in section 4.4.
Anything in the contract to the contrary notwithstanding, any payments made
to a Beneficiary in accordance with the two preceding paragraphs will meet
the requirements of Code Section 401(a)(9) and the Regulations issued
thereunder.
As of the first day no amounts remain in a Participant's Account or in an
Account for him under a companion contract, his Account is cancelled.
4.2 REQUIRED DISTRIBUTION DATE:
Distributions are required to commence to the Participant as of his
Required Distribution Date. A Participant's Distribution Date is defined
below:
(a) with respect to the portion of a Participant's Account under the
contract consisting of (i) contributions made by or on behalf of such
Participant on or before December 31, 1986 and (ii) income credited to
such contributions as of December 31, 1986, a Participant's Required
Distribution Date is the last day of the year in which the Participant
attains age 75, regardless of whether or not such Participant has
terminated his employment with the employer sponsoring the Plan or
Salary-Annuity Agreement arrangement under the contract
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GPA-7764)
Serial 400 4.1-4.2
(b) with respect to the remaining portion of a Participant's Account under the
contract, a Participant's Required Distribution Date is:
(i) with respect to any Participant who attained age 70 1/2 before January
1, 1988, the April 1 of the calendar year following the one in which
the later of (A) the Participant's termination of employment with the
employer sponsoring the Plan or Salary-Annuity Agreement arrangement
under the contract or (B) the Participant's attainment of age 70 1/2
occurs;
(ii) with respect to any Participant who attained age 70 1/2
during 1988 and who had not terminated employment with the
employer sponsoring the Plan or Salary-Annuity Agreement
arrangement under the contract as of January 1, 1989, April
1, 1990: and
(iii) with respect to all other Participants, the April 1 of the
calendar year following the one in which the Participant
attains age 70 1/2 regardless of whether or not such
Participant has terminated his employment with the employer
sponsoring the Plan or Salary-Annuity Agreement arrangement
under the contract.
If the plan funded under the contract is a church or governmental plan, as
defined in the Code, the Required Distribution Date for a Participant
covered under such plan with respect to the portion of his Account defined
in paragraph (b) above is the Required Distribution Date set forth in
subparagraph (b)(i) above.
If the Participant's Account includes a transfer contribution made pursuant
to paragraph (b) of section 1.1, the Required Distribution Date applicable
to such transfer contribution will be determined in accordance with
paragraph (b) above, except as provided in the following paragraph.
If any portion of the Participant's transfer contribution consists of (i)
contributions made by or behalf of the Participant on or before December
31, 1986 and (ii) income credited to such contributions as of December 31,
1986, the Required Distribution Date applicable to such portion will be the
Required Distribution Date applicable under the 403(b) program from which
such transfer was made, if the following conditions are met:
(1) a record of the amount of contributions made on or before December 31,
1986 and income credited to such contributions as of December 31,
1986, must be furnished to Prudential in a form satisfactory to it at
the time such transfer is made, and
(2) evidence of the Required Distribution Date under the 403(b) program
from which the transfer was made must be furnished to Prudential in a
form satisfactory to it at the time such transfer is made.
4.3 MINIMUM REQUIRED DISTRIBUTION:
Prior to a Participant's Required Distribution Date, as determined from the
records of Prudential on the basis of information furnished to it,
Prudential will notify such Participant that he may be required to
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 410 4.2-4.3
receive a minimum distribution from his Account under the contract in
accordance with Code Section 401(a)(9) and the Regulations issued
thereunder. Such notice will include information so as to assist the
Participant in computing the amount of his required distribution. Following
such notice, a Participant may request that the required minimum
distribution be paid to him from the contract before his Required
Distribution Date.
If the Participant does not request a distribution of any portion of his
Account pursuant to this section 4.3, Prudential shall be under no
obligation to make such distribution.
4.4 TERMS OF PAYMENT OF ANNUITIES:
If a Participant elects an annuity pursuant to paragraph (b) of section
4.1, all or a portion of the dollar value of the Participant's Account, as
specified by the Participant, will be applied to purchase an annuity in
accordance with Schedule A. The monthly amount of annuity is determined
from the schedule of purchase rates for that annuity.
Life annuities and Payment Certain annuities are available under this
contract. A Life form of annuity is one payable at least during the
lifetime of the person (referred to as the "Annuitant") for whom it was
purchased. Depending upon the existence and nature of any payment payable
after the death of the Annuitant, a Life annuity will be one of the
following forms: Life - Payment Certain, Life - Contingent, or Life -
Payment Certain Contingent annuity. A Payment Certain form of annuity may
be payable for a period less than the lifetime of the person for whom the
annuity was purchased. The terms of payment of each form of annuity are
described below.
(a) Life Form of Annuity:
The first monthly payment of a Life - Payment Certain annuity is
payable on the date the annuity is purchased. Monthly payments are
payable on the first day of each month thereafter throughout the
Annuitant's remaining lifetime. If the Annuitant dies before the
number of annuity payments made equals the number of Payments Certain
applicable to him, monthly annuity payments will be continued until
the total number of payments is so equal. These continued annuity
payments will each be in the same amount as was payable to the
Annuitant. The number of Payments Certain is established when the
annuity is purchased and may be 60, 120, 180, 240 or any other number
accepted by Prudential.
The first monthly payment of a Life - Contingent annuity is payable on
the date the annuity is purchased. Monthly payments are payable on the
first day of each month thereafter throughout the Annuitant's
remaining lifetime. If the Annuitant dies before the death of his
Contingent Annuitant, monthly Contingent Annuity payments will become
payable. The first payment of Contingent Annuity will be payable on
the first day of the month following the month in which the
Annuitant's death occurs. Monthly Contingent Annuity payments are
payable on the first day of each month
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 420 4.3-4.4
thereafter throughout the Contingent Annuitant's remaining lifetime.
The last monthly payment is payable for the month in which his death
occurs. The amount of each monthly Contingent Annuity payment will be
a percentage of the monthly annuity payment payable before the
Annuitant's death. The percentage is established when the annuity is
purchased and may be 33 1/3%, 50%, 66 2/3% or 100%, or any other
percentage accepted by Prudential. Under a Life - Payment Certain
Contingent annuity, a percentage payment will not take effect until
the end of the selected Payment Certain period.
(b) Payment Certain Annuity:
The first monthly payment of a Payment Certain annuity is payable on
the date the annuity is purchased. Monthly payments are payable on the
first day of each month thereafter until the total number of Payments
Certain specified when the annuity was purchased has been paid. The
number of Payments Certain may be 60, 120, 180, 240, or any other
number accepted by Prudential.
All annuities purchased under the contract will meet the requirements of
Code Section 401(a)(9) and, to the extent applicable, Code Sections
401(a)(11) and 417, and the Regulations issued thereunder.
4.5 SMALL ANNUITIES AND ACCOUNTS:
If the total monthly amount of annuity which would otherwise be purchased
on behalf of any person under this contract and the companion contracts is
less than $50, Prudential may, in lieu of an annuity under this contract,
make payment in a single sum. The single sum will be equal to the amount
that would otherwise be applied to purchase an annuity as described in
section 4.4.
If no contributions have been made under this contract or any companion
contract for a Participant for a period of 24 months and the dollar value
of his Accounts under all the contracts is $1,000 or less, Prudential may
cancel his Account under this contract. If the Account is cancelled, its
dollar value will be paid to the Participant unless he directs payment to a
named financial institution. The Annual Account Charge will be made only if
no Account remains for him under a companion contract.
4.6 PAYEES:
Each annuity payment will be made to the Annuitant, Contingent Annuitant or
Beneficiary entitled to receive it.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 430 4.4-4.6
Provision V. CHANGES:
5.1 CHANGES BY PRUDENTIAL:
Prudential may make changes in this contract as follows:
(a) The Annual Account Charge and the table of withdrawal charges may be
changed periodically on and after the second anniversary of the
Effective Date.
(b) The effective annual rate of the Administrative Expense Charge and the
terms and amounts (excluding the withdrawal charge table) of
withdrawals and transfers pursuant to Provision III may be changed
periodically on and after the fifth anniversary of the Effective Date.
(c) The schedules of annuity purchase rates may be changed periodically on
and after the tenth anniversary of the Effective Date.
Any change in the table of withdrawal charges and in Schedule D will apply
only to amounts added to Participants' Accounts on and after the date the
change takes effect. Any other change will apply to amounts in
Participants' Accounts whether added before or on and after the date the
change takes effect. Any change in the schedules of annuity purchase rates
will remain in effect for at least ten years.
Any change in accordance with this section will be made by giving notice to
the Contract-Holder at least 90 days before the date on which the change is
to take effect. Notice of changes, other than in the schedules of purchase
rates, will also be given to Participants.
5.2 CHANGES BY AGREEMENTS:
This contract may also be changed in any respect at any time or times by
agreement between the Contract-Holder and Prudential.
5.3 CHANGES TO CONFORM TO LAW:
Prudential may change this contract as, in its discretion, it deems
appropriate to satisfy the requirements of any law or regulation
administered by a governmental agency.
5.4 PERSONS EMPOWERED TO ACT FOR PRUDENTIAL:
No agent or other person except one of the following officers of Prudential
may change this contract or bind Prudential
Chairman and Chief Executive Officer Associate Actuary
President Secretary
Vice President Assistant Secretary
Actuary
GVA-120-87 (10/11)
Serial 500 5.1-5.4
Provision VI. DISCONTINUANCE - TERMINATION OF CONTRACT:
6.1 DISCONTINUANCE OF ESTABLISHING PARTICIPANTS' ACCOUNTS:
Prudential may notify the Contract-Holder that on and after a specified
date no new Participants' Accounts will be established under this contract.
The specified date may not be earlier than 90 days after the date of the
notice. Thereafter, only contributions for persons who are Participants on
the specified date will be accepted hereunder. In all other respects this
contract will continue to operate in accordance with its terms.
6.2 DISCONTINUANCE OF CONTRIBUTIONS UNDER THIS CONTRACT:
Contributions under this contract will be discontinued with respect to all
Participants:
(a) at any time after receipt by Prudential of notice thereof from the
Contract-Holder,
(b) if the Plan, if any, terminates,
(c) as of a date at least 90 days after notice to the Contract-Holder by
Prudential that no further contributions will be accepted hereunder,
or
(d) as of the effective date of any Plan change to which Prudential is
unable or unwilling to give its consent (see section 7.7).
After discontinuance the contract will continue to operate in accordance
with its terms with respect to Participants' Accounts.
6.3 TERMINATION OF CONTRACT:
This contract will terminate when all the following have occurred:
(a) no further contributions may be paid under this contract;
(b) no Participant's Account remains uncancelled; and
(c) no further annuity or transfer payments are payable from this
contract.
GVA-120-87 (10/11)
Serial 600 6.1-6.3
11/89
Provision VII. GENERAL TERMS:
7.1 CONTRACT-HOLDER:
Prudential will normally deal only with the Contract-Holder. However,
Prudential and the Contract-Holder may agree to do otherwise. Also, in some
cases the contract calls for dealing with another. Prudential will be
entitled to rely on any action taken or omitted by the Contract-Holder
pursuant to the terms of this contract.
The Contract-Holder may, from time to time, delegate to an agency certain
administrative powers and responsibilities which this contract assigns to
the Contract-Holder. Prudential is not bound to recognize any delegation
until it has received notice of it. The notice must specify those powers
and responsibilities and include evidence of acceptance by the agency. On
and after the date of receipt of the notice, Prudential will deal with the
agency with respect to those powers and responsibilities and will be
entitled to rely on any action taken or omitted by the agency with respect
thereto in the same manner as if dealing with the Contract-Holder. If any
agency fails or refuses to act with respect thereto, then the delegation
will be void for the purposes of this contract. Thereafter, Prudential will
deal only with the Contract-Holder. The Contract-Holder may give notice to
Prudential of delegation to another agency of specified powers and
responsibilities.
7.2. COMMUNICATION:
All communications to the Contract-Holder or to Prudential will be in
writing. They will be addressed to the Contract-Holder at its principal
office, or at such other address as it may communicate to Prudential. They
will be addressed to Prudential, c/o The Prudential Asset Management
Company, Inc., Defined Contribution Programs, ▇.▇. ▇▇▇▇▇▇▇▇ Office Park, 30
▇.▇. ▇▇▇▇▇▇ Drive, Moosic, Pennsylvania 18507-1796, or at such other
address as it may communicate to the Contract-Holder. All communications to
any other person or organization dealing with Prudential will be addressed
to that person or organization at the last address of record.
7.3 PLACE OF PAYMENT - CURRENCY:
All payments to Prudential under this contract will be payable at its
office described above or at an address or to a representative as may be
specified by Prudential by notice to the Contract-Holder.
All payments under this contract, whether to or by Prudential, will be in
lawful money of the United States of America. Dollars and cents, as
specified in this contract, means lawful dollars and cents of United States
currency.
GVA-120-87 (10/11)
Serial 700 7.1-7.3
7.4 INFORMATION - RECORDS:
The Contract-Holder will furnish all information which Prudential may
reasonably require for the administration of this contract. If the
Contract-Holder cannot furnish any required item of information, Prudential
may request the person concerned to furnish the information, Prudential
will not be liable for the fulfillment of any obligations in any way
dependent upon information unless and until it receives the information in
a form satisfactory to it.
Information furnished to Prudential may be corrected for demonstrated
errors in it unless Prudential has already acted to its prejudice by
relying on the information. Except for the corrections, information
furnished to Prudential will be regarded as conclusive. Prudential will
maintain the records necessary for its administration of this contract.
These records will be prepared from the information furnished to Prudential
and will constitute evidence as to the truth of the information in the
records.
7.5 MISSTATEMENTS:
If any relevant fact relating to any person is found to have been
misstated, the following will apply:
(a) The amount of annuity payable by Prudential will be that which would
be provided by the amount allocated to purchase the annuity on the
basis of the correct information, without changing the date of first
payment of the annuity.
Any adjustment by Prudential of the amount or terms of payment made in
accordance with this section will be conclusive upon any other person
affected by it.
(b) The amount of any underpayment by Prudential will be paid in full with
the next payment due. The amount of any overpayment by Prudential will
be deducted to the extent possible from amounts payable thereafter.
7.6 BENEFICIARY:
If, as to any person, this contract provides for the payment of an amount
or amounts after the person dies to other than the person's Contingent
Annuitant, payment will be made to the Beneficiary the person named. Any
spousal consent requirements of applicable Federal law (as it relates to
employee benefit plans) will apply in designating a Beneficiary. A person
for whom an Account is held or an annuity is being paid under this contract
may name a Beneficiary to replace one previously named provided the change
complies with any applicable Federal law (as it relates to employee benefit
plans). However, the Participant may instruct Prudential that his
Contingent Annuitant or Beneficiary is not to have this right to name a
Beneficiary.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 710 7.4-7.6
A Beneficiary may be named by filing a request with Prudential on a
form acceptable to it. It will become effective when entered on
Prudential's records. It will apply to any amounts payable after the
request was received by Prudential, except any withdrawals and
payments made before the request was entered on Prudential's records.
Prudential will acknowledge the naming of a Beneficiary.
The interest of any Beneficiary who dies before the Participant ceases
upon that Beneficiary's death. If there is no named Beneficiary when
an amount is payable to one, payment will be made to the estate of the
last to die of the Participant or Annuitant, his Contingent Annuitant,
and his Beneficiary. If a payment would be made to the estate of a
Participant or Annuitant, Prudential may make the payment to any one
or jointly to any number of his surviving relatives: spouse, children,
parents, brothers or sisters.
Prudential, in determining whether a person is a relative of a
Participant or Annuitant or is a Beneficiary entitled to payment, may
rely solely on any evidence it deems acceptable. Each payment
Prudential makes in reliance thereon will be a valid discharge of its
obligation under this contract as to that payment.
If a series of payments becomes payable to a Beneficiary and the first
payment is less than $50, Prudential may choose to make payment in one
sum. Also, if the payee is not a natural person and a series of
payments is payable, Prudential may choose to make a payment in one
sum. The one sum payment will be equal to the value of the series of
payments discounted at interest from each payment due date to the date
of the one sum payment. The discount interest rate will be the
interest rate in the schedule of annuity purchase rates used to
establish the series of payments.
7.7 PLAN CHANGES:
If the employer maintains a written Plan of benefits, the name of such Plan
is shown on the first page of this contract. This contract applies to the
terms of the Plan in effect on the Effective Date and to each Plan change
if Prudential consents. The Contract-Holder will furnish Prudential with a
copy of the Plan. While this contract is active, the Contract-Holder will
also furnish a copy of each Plan change.
7.8 DIVISIBLE SURPLUS:
The portion, if any, of the divisible surplus of Prudential accruing upon
this contract will be determined annually by the Board of Directors of
Prudential and credited to Participants' Accounts as determined by the
Board. (It is unlikely any divisible surplus will accrue upon this
contract.)
No annuity under this contract will be taken into account in the
determination of any divisible surplus to be credited to this contract.
7.9 LIMIT ON ASSIGNMENT:
To the extent applicable law requires, the interests in and payments from
this contract are not assignable or subject to the claims of any
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 720 7.6-7.9
creditor. For this purpose, compliance with the terms of a Qualified
Domestic Relations Order as defined in Code Section 414(p) will not be
considered an assignment of benefits.
7.10 CERTIFICATES:
Prudential will issue a certificate for each annuity which is effected
under this contract. If any law requires, Prudential will issue a
certificate to a Participant for whom an annuity has not yet been effected.
A certificate will be descriptive of the Participant's or Annuitant's
rights and duties under the contract.
7.11 ENTIRE CONTRACT - CONSTRUCTION:
This document constitutes the entire contract.
This contract will be construed according to the laws of the jurisdiction
set forth on the first page.
GVA-120-87 (10/11) (as modified by Group Annuity Amendment Form GAA-7764)
Serial 730 7.9-7.11
SCHEDULE A
FORMS OF ANNUITY WHICH MAY BE PURCHASED
Form of Payment Payable Applicable Schedule
1. Life - Payment Certain Annuity. 1. Use Schedule B for allocation.
2. Life - Contingent Annuity. 2. Use Schedule C for allocation.
3. Payment Certain Annuity. 3. Use Schedule D for allocation.
Prudential may provide monthly amounts of annuity larger than those shown in the
following schedules for annuities purchased during any period specified by
Prudential. Annuity purchase rates for other forms of annuity consented to by
Prudential will be furnished on request. The following schedules may be changed
as provided in section 5.1.
GVA-120-87 (10/11)
Serial A-100 Schedule A
1/90
SCHEDULES
Monthly amount of annuity purchased per $10,000 of a Participant's Account,
after deduction from it of any taxes on annuity considerations that apply.
SCHEDULE B - Life-Payment Certain Annuity (120 Payments Certain)
Monthly Amount
--------------
If date the annuity is purchased is in:
Age 1990 1991 1995 2000
--- ---- ---- ---- ----
60 $52.53 $41.36 $40.58 $39.85
65 57.51 46.57 45.60 44.68
70 63.85 53.19 51.98 50.82
SCHEDULE C - Life-Contingent Annuity
Monthly Amount
--------------
If Annuitant and Contingent Annuitant have same date of birth.
If the date the annuity is Purchased is in:
Age 1990 1991 1995 2000
--- ---- ---- ---- ----
If specified percentage to Contingent Annuitant is 100%:
60 $46.96 $35.91 $35.31 $34.78
65 50.70 39.88 39.10 38.39
70 56.00 45.36 44.32 43.32
If specified percentage to Contingent Annuitant is 50%:
60 $49.99 $38.71 $38.00 $37.34
65 54.69 43.53 42.61 41.75
70 61.25 50.15 48.92 47.71
SCHEDULE D - Payment Certain Annuity
Monthly Amount
---------------
Number of If date the annuity is purchased is in:
Payments Certain 1990 1991 1995 2000
------------------- ---- ---- ---- ----
60 $173.38 $165.44 $164.73 $164.73
120 97.22 88.83 88.45 88.45
180 72.32 63.48 63.20 63.20
* * * * *
The rates in these Schedules are to be used without adjustment only when the
facts that apply to the Participant and his annuity are as shown. Rates for
other facts will be furnished upon request.
GVA-120-87 (10/11)
Serial S-100 Schedules B-D