1
EXHIBIT 10.18
[CIGNA LOGO]
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
a CIGNA company
(a stock company)
GROUP ANNUITY CONTRACT NUMBER GA-36724 issued to:
TRUSTEES OF THE LASON SYSTEMS, INC.
401(k) PROFIT SHARING PLAN & TRUST
EFFECTIVE DATE: January 1, 1994 DATE OF ISSUE: March 15, 1994
The Insurance Company agrees to pay the benefits provided in accordance with
the terms of this Contract. This Contract is issued in consideration of the
Application and the payment of the Contributions provided for herein.
THE VARIABLE BENEFITS PROVIDED HEREUNDER WHICH ARE BASED ON THE INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE AND NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT.
This Contract is issued and accepted subject to all the terms set forth on this
page and on the following pages, which are hereby made a part of this Contract.
IN WITNESS WHEREOF Connecticut General Life Insurance Company has caused this
Contract to be executed at its Home Office on the Date Issued to take effect on
the Effective Date.
▇▇▇▇▇ ▇▇▇▇▇▇
---------------------------
Senior Vice President
GROUP ANNUITY CONTRACT
FIXED ANNUITY
GUARANTEED COST - SEPARATE ACCOUNT
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GROUP ANNUITY CONTRACT
TABLE OF CONTENTS
SECTION STARTING ON PAGE
1.............. Definitions............................................. 2
2.............. Incoming Amounts........................................ 3
3.............. Operational Agreements.................................. 5
4.............. Distributions........................................... 7
5.............. Discontinuance.......................................... 9
6.............. Miscellaneous........................................... 11
Contract Expense Schedule
Annuity Purchase Rate Table A
Annuity Purchase Rate Table B
Guaranteed Long Term Account Rider
Separate Account 55A Rider
Separate Account 55B Rider
Separate Account 55F Rider
Separate Account 55G Rider
Separate Account 55J Rider
Application
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SECTION I
DEFINITIONS
1.1 The CONTRACT is the group annuity Contract GA-36724 issued by Connecticut
General Life Insurance Company.
1.2 The CONTRACTHOLDER is Trustees of the Lason Systems, Inc. 401 (k) Profit
Sharing Plan & Trust.
The term CONTRACTHOLDER will also include any person designated by the
Contractholder or the Employer to carry out administrative functions.
1.3 The EMPLOYER is the corporation or firm named as employer in the Plan.
1.4 The INSURANCE COMPANY is the Connecticut General Life Insurance Company, a
legal reserve life insurance company incorporated in Connecticut.
1.5 The I.R.C, is the Internal Revenue Code of 1986, as amended from time to
time.
1.6 A PARTICIPANT is an individual having an account under the Plan.
1.7 The PLAN is Lason Systems, Inc, 401 (k) Profit Sharing Plan & Trust adopted
by the Employer effective September l, 1989, as constituted on January 1,
1994, as said Plan may be amended from time to time.
1.8 A RIDER is that section of the Contract describing the funding vehicle(s)
selected by the Contractholder.
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SECTION 2
INCOMING AMOUNTS
2.1 The Contractholder and the Insurance Company agree to the following:
(A) CONTRIBUTIONS. Contributions for investment under this Contract
will be transferred by the Contractholder and accepted by the
Insurance Company. The amount of Contributions for any contribution
period is equal to the amount to be contributed under the terms of the
Plan, after the effective date of this Contract, that are designated
for investment under this Contract. The amount of Contributions may
be reduced by subtracting, for such period, the amount of prospective
Plan distributions to Participants. Contributions for investment
under this Contract may not be less than one hundred fifty thousand
dollars ($150,000) in any one plan year unless the Insurance Company
agrees. Notwithstanding the above, in the event that the
Contractholder elects to have the Insurance Company provide
recordkeeping services, contributions under this Contract may not be
less than thirty five thousand dollars ($35,000) in any one plan year
unless the Insurance Company agrees. Contributions to the Guaranteed
Long Term Account may not exceed the Insurance Company's current
underwriting guidelines for such contributions for this product in any
one plan year unless the Insurance Company gives its prior written
consent.
(B) TRANSFERRED ASSETS. Amounts paid under the terms of the Plan
prior to the Effective Date of this Contract, that are designated for
investment under this Contract, will be transferred by the
Contractholder and accepted by the Insurance Company. Such amounts of
Transferred Assets combined with Contributions for the first plan year
may not exceed the Insurance Company's current underwriting guidelines
for such contributions for this product unless the Insurance Company
gives its prior written consent.
(C) PAYMENT. Such amounts will become due and payable at the
Insurance Company's home office address via the designated Insurance
Company lock box or the Pension Automated Transfer System or to any
designated agent of the Insurance Company within thirty (30) days of
the date specified in the Plan. A grace period of sixty (60) days, or
the time required by law for the contribution to be made, if less,
will be allowed for such payment. The Contractholder is responsible
for ensuring that the contributions due under the terms of the Plan
are made within the time required by law.
(D) TRANSFERS. Subject to the terms of the Plan, transfers from a
terminated plan or from a plan which qualifies under I.R.C. section
401(a) that is terminating or is being merged or consolidated into
the Plan, in accordance with I.R.C. section 401(a)(12), and which
are to be allocated to one of the funding vehicles represented by the
Rider(s), will be accepted by the Insurance Company.
Subject to the terms of the Plan, transfers from a plan which
qualifies under I.R.C. section 401(a) to the Plan, and which are to
be allocated to one of the funding vehicles represented by the
Rider(s), will be accepted by the Insurance Company.
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(E) ROLLOVERS. Subject to the terms of the Plan, amounts contributed to the
Plan by Participants pursuant to I.R.C. sections 402(a)(5) and (6), I.R.C,
section 403(a)(4) or I.R.C. section 408(d)(3)(A)(ii), and which are to be
allocated to one of the funding vehicles represented by the Rider(s), will
be accepted by the Insurance Company.
(F) With respect to any Incoming Amounts which may be payable to the
Insurance Company pursuant to this Section 2, the Insurance Company
expressly reserves the right not to accept such amounts if such acceptance
would cause the Insurance Company to take action contrary to its normal
rules and practices. The Insurance Company shall notify the
Contractholder if it will not accept Incoming Amounts hereunder, but any
such action by the Insurance Company shall not affect any other existing
obligations of the Insurance Company or the Contractholder under this
Contract as it is then in effect.
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SECTION 3
OPERATIONAL AGREEMENTS
3.1 The Contractholder agrees to the following:
(A) QUALIFICATION. The Contractholder will apply within one year
plus any filing extensions allowed by law of the Effective Date of the
Plan for a determination letter from the Internal Revenue Service that
the Plan meets the requirements of I.R.C. section 401(a). The
Contractholder will apply for a new determination letter from the
Internal Revenue Service with respect to Plan amendments within one
year plus any filing extensions allowed by law of the effective date
of any amendment which requires filing with the Internal Revenue
Service. A copy of the determination letter will be filed with the
Insurance Company within thirty (30) days of receipt by the
Contractholder.
(B) AMENDMENT. No Plan amendment will be made which would require the
Insurance Company to take action contrary to its normal rules
and practices. A certified copy of any change in or amendment to the
Plan will be filed with the Insurance Company within thirty (30) days
of its adoption by the Employer.
(C) DISQUALIFICATION. Notification will be sent to the Insurance Company
within thirty (30) days of the date the Employer receives
initial written notification from the Internal Revenue Service that
the Plan no longer meets the requirements of I.R.C. section 401(a).
When such determination becomes final, the terms of Section 5 shall
apply.
(D) COMPETING FIXED INCOME FUNDS. The Contractholder agrees not to offer
an investment vehicle which the Insurance Company considers a
competing fixed income fund, unless the use of such an investment
vehicle has been previously agreed to by the Insurance Company, or
unless the Insurance Company gives its prior written consent.
(E) TRANSFERS. When amounts are designated by Participants for transfer
between or among funding vehicles under this Contract, such
transfers represent the choice of Participants, free from corporate or
trustee announced or published suggestion or persuasion.
(F) INFORMATION. All information necessary to process Incoming Amounts,
Transfers between the funding vehicles, and Distributions will
be submitted by the Contractholder to the Insurance Company no more
frequently than monthly or every fourth week. Any information
required by the Insurance Company in order to perform any agreement or
obligation under this Contract will be properly authorized by the
Contractholder and promptly forwarded in writing to the Insurance
Company. In addition, any information required by the Insurance
Company to ensure compliance with the provisions of Sections 3.1(D)
and (E) will be promptly forwarded in writing by the Contractholder to
the Insurance Company upon the request of the Insurance Company.
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(G) EXPENSES. Expenses and charges described in the Contract Expense
Schedule attached hereto will be paid either by remitting to
the Insurance Company within thirty (30) days of the mailing date of
notice of such charges or by such other method as is otherwise
described. In the event such expenses and charges are not remitted
within thirty (30) days, the Insurance Company reserves the right to
deduct the amounts due from the Contractholder's Account upon written
authorization from the Contractholder.
(H) The Contractholder will operate its Plan to comply with all applicable
laws and regulations.
3.2 The Insurance Company agrees to the following:
(A) CONTRACTHOLDER'S ACCOUNT. An account will be established and
maintained for the Contractholder. Contributions and Transferred
Assets will be invested in accordance with the instructions filed with
the Insurance Company by the Contractholder and in accordance with the
terms of the Rider(s) selected by the Contractholder.
(B) TRANSFERS. Subject to the transfer limitations set forth in the
Rider(s), amounts may be transferred from one Plan funding
vehicle to another in accordance with the terms of the Plan.
(C) ALLOCATION DATE. Incoming Amounts will be allocated as of the
valuation date coinciding with or next following the date the
Insurance Company receives such Incoming Amounts. Transfers between
funding vehicles will be allocated as of the valuation date coinciding
with or next following the later of the date the Insurance Company
receives written instructions from the Contractholder regarding the
Transfer or the effective date of such Transfer. The determination of
the valuation date will be governed by the applicable Rider(s).
(D) REPORTS. Reports of the Contractholder's Account activity will be sent
to the Contractholder quarterly, unless the Insurance Company
agrees to report on a more frequent basis.
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SECTION 4
DISTRIBUTIONS
4.1 GENERAL DISTRIBUTIONS. The Insurance Company agrees to make
distributions from the Contractholder's Account, subject to the terms of
the Plan, and to the transfer limitations set forth in the Rider(s), in
the following manner:
(A) TRUSTEE. The Plan's trustee will be entitled to receive all cash
payments for further distribution.
(B) AMOUNT. A distribution from the Contractholder's Account will be in an
amount up to and including the value of such account on the
valuation date. The determination of the valuation date will be
governed by the applicable Rider(s).
(C) FORM. Distributions will be in one or both of the following forms:
(1) Any type of annuity which the Insurance Company agrees in writing
to issue, or
(2) A single sum cash payment.
Any distribution of $3,500 or less on behalf of a Participant will be
made in the form of a single sum cash payment.
(D) AMOUNT USED TO PURCHASE ANNUITY. The amount the Insurance Company
will apply to the purchase of an annuity will be reduced by any
amount necessary to pay applicable taxes and/or annuity purchase fees.
The annuity will be purchased at the rates then in effect for
all contracts in this class of business.
4.2 DISTRIBUTIONS AT DEATH. In the event a Participant dies prior to
distribution of his interest in the Plan, the Contractholder will
determine the appropriate beneficiary(ies), the amount of the death
benefit and the form in which it will be paid in accordance with the Plan
and applicable law, and will direct the Insurance Company to make proper
payment.
In the event a Participant dies after an annuity has been purchased on
his behalf, the death benefit, if any, will be made in accordance with the
terms of the annuity certificate.
4.3 LIMITATION. The Contractholder agrees that distributions under this
Section 4 will be subject to the limitation contained in this Section
4.3 as well as those contained in the Rider(s) attached to this Contract.
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A distribution for the benefit of a Participant from the Guaranteed
Long Term Account will not exceed a fraction of such Participant's total
share of Plan assets. The fraction will be determined by dividing-such
Participant's share of the Plan assets in the Guaranteed Long Term Account
as of the valuation date by such Participant's share of all Plan assets as
of such date. The determination of the valuation date will be governed by
the applicable Rider(s).
The determinations necessary for the limitation in this Section 4.3
will be made according to records maintained by the Contractholder.
4.4 GUARANTEES. The rates used for the purchase of a ten year certain and
life annuity will in no event be less than those in the applicable Annuity
Purchase Rate Table. Rates applied to purchase other forms of annuity
will in no event be less than the actuarial equivalent as determined by
the Insurance Company of the rates in the applicable Annuity Purchase Rate
Table.
4.5 DEFERRED PAYMENTS. The Contractholder and the Insurance Company agree
that the payment of any distribution pursuant to this Section may be
deferred for a period not exceeding six (6) months from the date otherwise
payable, subject to the appropriate Riders(s). No payment will be delayed
beyond the time permitted by applicable laws and regulations.
4.6 With this exception of Section 4.5, the distribution provisions described
in this Section 4 do not apply to disbursements made on account of
Contract Discontinuance as described in Section 5.
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SECTION 5
DISCONTINUANCE
5.1 DISCONTINUANCE. This Contract will be discontinued if:
(A) The Contractholder notifies the Insurance Company in writing that the
Contract will be discontinued; or
(B) The Insurance Company notifies the Contractholder in writing that the
Contractholder has breached a provision of Sections 2, 3, 4,
or 6 and that the Contract will be discontinued; or
(C) The Insurance Company determines that the class of business to which
this Contract belongs is no longer commercially feasible and
notifies the Contractholder in writing that the Contract will be
discontinued. This provision will not be exercised by the Insurance
Company in order to generate additional sources of income than
otherwise provided under the Contract.
5.2 DISCONTINUANCE DATE. The Discontinuance Date is the first day of the
month coinciding with or next following the date the Insurance
Company receives the notice specified in Section 5.1(A) or sends the
notice specified in Section 5.1(B) or (C). Upon discontinuance of the
Contract:
(A) The Insurance Company will no longer accept contributions as of the
Discontinuance Date; and
(B) The Insurance Company will timely notify the Contractholder of
expenses and charges due.
5.3 DISCONTINUANCE DISBURSEMENT DATE. Unless otherwise agreed,
discontinuance disbursements will be made as of the valuation date
coinciding with or next following the later of:
(A) Ninety (90) days after the date the Insurance Company receives all
information necessary to make the disbursement; or
(B) Ninety (90) days after the date the Insurance Company recovers all
expenses due under this Contract.
The determination of the valuation date will be governed by the
applicable Rider(s).
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5.4 DISBURSEMENTS. Disbursements made at discontinuance are subject to the
Discontinuance Transfer Limitation provisions contained in the Rider(s)
and the recovery of expenses and charges which are incurred up to the date
all assets under this Contract are disbursed in accordance with this
Section 5. The Insurance Company agrees to disburse the amount of each
Participant's Account attributable to Employer and Participant
contributions as follows:
(A) If the Plan continues to meet the requirements of I.R.C. section
401(a) but a new funding agent is selected, the Contractholder may
specify that such amount be transferred to the Plan's Trustees or new
funding agent. In order to transfer such amount, the Insurance
Company must receive evidence acceptable to it that the Plan will
continue to meet the requirements of I.R.C. section 401(a).
(B) If the Internal Revenue Service determines that the Plan
initially fails to meet the requirements of I.R.C. section 401(a),
such amounts will be disbursed to the Contractholder in a single sum
cash payment.
(C) If the Plan is terminated within the meaning of Income Tax
Regulations section 1.401-6 or the Internal Revenue Service determines
that the Plan no longer meets the requirements of the I.R.C. section
401(a), the Contractholder's Account will be distributed in a manner,
and at such time, as is mutually agreeable to the Contractholder and
the Insurance Company, provided appropriate governmental or regulatory
approval is first obtained.
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SECTION 6
MISCELLANEOUS
6.1 The Insurance Company and the Contractholder agree to the following:
(A) All communications will be in writing and will be submitted by first
class mail, postage prepaid.
(1) If to the Insurance Company, to:
Defined Contributions
CIGNA Retirement & Investment Services
Connecticut General Life Insurance Company
P.O. Box 2975
Hartford, CT 06104
(2) If to the Contractholder, to its principal place of business.
(B) All agreements under this Contract shall insure to the benefit of and
be binding upon the successors and assigns of the Insurance Company
and the Contractholder unless the Insurance Department of the State
of Connecticut determines that the Insurance Company has ceased doing
business of this class and kind.
(C) No distribution or disbursement payable to any Participant or
beneficiary is assignable except to the extent allowed by law and
all distributions or disbursements are exempt from the claims of
creditors to the maximum extent permitted by law.
(D) The Insurance Company may require proof that the recipient of annuity
payments is living as of each and every date on which any annuity
payment becomes payable. If such proof is not furnished when
requested, the Insurance Company may withhold payments until proof
has been received.
(E) The Insurance Company will issue an individual certificate to each
Participant for whom an annuity is purchased. If the state of issue so
requires, the Insurance Company will issue a certificate to each
Participant contributing to the Plan. Any certificate so issued will
in no way void or alter any of the terms of this Contract.
(F) If the age determining the annuity purchase rate, or any other fact
pertaining to the prurchase, of or the determination of the amount of
an annuity is found to have been misstated, or in the event of clerical
error, the following adjustments will be made:
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(1) The amount of annuity payable by the Insurance Company will be
that provided by the correct rate applied to purchase such
annuity, determined as of the date of purchase on the basis of
the correct information.
(2) Any overpayments by the Insurance Company resulting from any
misstatements or errors will be deducted from amounts thereafter
payable.
(3) Any underpayments by the Insurance Company resulting from any
misstatements or errors will be paid in full with the next payment
due.
(G) The Insurance Company agrees only to the provisions of this Contract
and is not a party to nor bound by any trust or plan. The Insurance
Company is not responsible for the status under any state or federal
revenue law of any contribution made pursuant to such Plan.
(H) Payment by the Insurance Company made pursuant to the terms of this
Contract will release the Insurance Company from all further liability
to the extent of such payment.
(I) Reports, notices, requests and other information submitted to the
Insurance Company by the Contractholder, its designated
representative, a Participant or a Beneficiary may be relied on
conclusively by the Insurance Company.
(J) If the Insurance Department or other authority of any state or other
jurisdiction determines that premium taxes are due and payable with
respect to amounts contributed prior to such determination, an
amount equal to the assessed taxes and interest may be deducted from
the Contractholder's account. If such Department or authority requires
the payment of such taxes on amounts contributed under this Contract
subsequent to such determination, the Insurance Company can deduct the
applicable amount from Incoming Amounts or in such other manner as
required by the taxing authority.
(K) In applying for the Contract, the Contractholder will select the
Riders(s) which become part of this Contract.
(L) Any change in this Contract will be subject to the following
provisions:
(1) No change will affect the amount of interest credited or accrued
prior to the effective date of such change.
(2) No change will affect the amount or terms of any annuity purchased
prior to the effective date of such change.
(3) Any change to this Contract can be made without notice to or the
consent of any Participant, beneficiary or annuitant.
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(4) The Insurance Company may, at any time, make any changes,
including retroactive changes to the provisions of this
Contract to the extent that such changes are required in order to
conform the Contract to the provisions of I.R.C. section 401(a),
any applicable law or any regulation issued by any governmental
agency to which the Plan or the Insurance Company is subject.
(5) Unless the Contractholder discontinues this Contract and selects
a new funding agent, the Insurance Company may annually review
the provisions of Sections 2, 3, 4, 5, the Contract Expense
Schedule and the Rider(s) and may change the Sections, Contract
Expense Schedule and/or the Rider(s) after ninety (90) days'
advance written notice to the Contractholder provided, however,
that any such change will apply to all contracts in the same
class of business as this Contract.
(M) For the purposes of this Contract, a copy of the death certificate, a
physician's written statement certifying as to the death of the
decedent, a copy of a certified decree of a court of competent
jurisdiction as to the finding of death or any other reasonable
evidence that may be required by the Insurance Company shall
constitute due proof of death.
(N) The laws of the State of Connecticut govern this Contract except
where its provisions may be more specifically governed by the laws of
its state of issuance.
(O) The singular includes the plural and the masculine pronoun includes
both the masculine and feminine gender unless the context indicates
otherwise.
(P) Two or more duplicate originals of this Contract constitute one and the
same instrument. The Application of the Contractholder together with
all Riders, Tables and Schedules, copies of which are attached to and
made a part of this Contract, constitute the entire Contract between
the Insurance Company and the Contractholder.
(Q) If the Insurance Company has reasonable cause to believe that any payee
is legally, physically or mentally incapable of personally receiving
and receipting for any payment due him, the Insurance Company may
make such payment or any part thereof to any person or institution
who, in the opinion of the Insurance Company, is then maintaining or
has custody of the payee, until claim is made by the duly appointed
guardian or other legal representative of the payee. Such payment
will constitute a full discharge of the liability of the Insurance
Company to the extent thereof.
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CONTRACT EXPENSE SCHEDULE
The expenses outlined in the Contract Expense Schedule of this Contract are
annual charges which will be billed in part at the end of each Plan Quarter.
Any charges based on assets or charges taken out of Participants' Accounts,
however will be billed on an annual basis.
The term, "Plan Quarter" in this Contract Expense Schedule means three (3)
months of the Plan Year or the period of time during which the Insurance
Company receives the expected number of contributions for three (3) months
based on, the frequency of contributions submitted by the Employer under the
Plan.
This Contract Expense Schedule will cover expenses and taxes incurred by the
Insurance Company in the establishment and maintenance of this Contract. In no
event will these charges cover or be amended so as to cover any fees, expenses,
taxes, or charges relating to the management of the assets held hereunder. The
Contract Expense Schedule is effective January 1, 1994, as follows:
1. ASSET CHARGE:
The Asset Charge for the coming Plan Year is determined annually as of
the asset charge valuation date and is based on the value of the
participant accounts. The charge is computed according to the following
schedule:
Asset and/or Contribution Level Asset Charge (Annual Rate)
------------------------------- --------------------------
Under $300,000 of assets and an annual 2.20%
contribution under $100,000
Over $300,000 and under $1.5 million of assets 1.85%
or annual contributions over $100,000
Over $1.5 million and under $3 million of 1.80%
assets
Over $3 million and under $5 million of 1.75%
assets
Over $5 million and under $10 million of 1.70%
assets
Over $10 million and under $15 million of 1.65%
assets
Over $15 million and under $20 million of 1.60%
assets
Over $20 million of assets 1.50%
The asset charge valuation date is the last day of the Plan Year
provided that the Insurance Company is open to transact normal business on
such day and the New York Stock Exchange is open for unrestricted trading.
Should the last day of the Plan Year fail to occur simultaneously with
both of these events, the valuation date will be the
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next normal business day on which the New York Stock Exchange is open
for unrestricted trading.
The Asset Charge, as determined above, shall not be applied to the
value of the Contractholder's account attributable to investments held in
the Fidelity Advisor and/or Warburg Pincus Separate Account. These
amounts are included in determining the annual rate applied to assets held
under the Contract,
2. FIDELITY ADVISOR AND/OR WARBURG PINCUS:
The Fidelity Advisor and/or Warburg Pincus asset charge for the coming
year is determined annually as of the asset charge valuation date and is
assessed on the value of the Contractholder's investment in the Fidelity
Advisor and/or Warburg Pincus Separate Account. The charge is an annual
rate of 1.30%.
3. INVESCO ACCOUNT:
The Invesco Account asset charge for the coming year is determined
annually as of the asset charge valuation date and is assessed on the value
of the Contractholder's investment in the Invesco Account. The charge is
an annual rate of 1.60%.
4. Annual Base Fee
$4,600 per year
Proper adjustment shall be made for a Plan Year that is not equal to twelve
(12) months.
5. BASIC ADMINISTRATION CHARGE
The annual Basic Administration Charge is based on the number of
accounts being maintained under the Plan with an account balance greater
than zero. The annual charge is $18.00 per Participant Account.
The annual Basic Administration Charge will be increased by $5.00 per
account if the Employer submits contribution data on hard copy.
If the Employer utilizes only one active source, the above schedule
will be reduced by $2.00 per account.
The above charge will be paid out of Participants' Accounts.
6. BENEFIT PROCESSING SERVICES:
The charge for each benefit processed is $40.00 per transaction.
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A Benefit Processing Charge will apply to any Plan disbursement,
including but not limited to payment of all or a portion of a Participant's
vested account balance because of termination, retirement, death,
withdrawal or disability. Annuity purchases are not subject to this
charge.
The above charge will be paid out of Participants' Accounts.
7. BASIC DISCONTINUANCE PROCESSING CHARGE:
The Basic Discontinuance Processing Charge is determined as of the date of
discontinuance. The charge is $18.00 per Participant Account.
8. MISCELLANEOUS:
This Expenses Schedule is subject to annual review by the Insurance
Company and may be changed effectively after ninety (90) days' written
notice to the Contractbolder. This schedule will not be changed within
the first twelve (12) months following the Contract's Effective Date nor
will it be changed more frequently than once in any twelve (12) month
period except by written agreement between the Insurance Company and the
Contractholder.
9. SPECIAL SERVICES:
In addition to the expenses for the services are listed below, if
applicable, any Special Services requested by the Contractholder which are
not specified below will be charged to the Contractholder in accordance
with the fee schedule then in effect.
Additional Inactive Source
$5.00 Administrative Charge - Per Source per number of Participants
utilizing the source.
The above charge will be paid out of Participants' Accounts.
Loan Charge
The Loan Charge for each loan processed is $75.00
The above charge will be paid out of Participants' Accounts.
5500 Preparation
$1000 per Plan Year
Compliance Testing Services
$80.00 per Service for either a) determining HCE or
b) performing ADP/ACP test,
$110.00 per Service for both a) determining HCE or
b) performing ADP/ACP test,
plus:
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1st 1,000 Employees $1.10 per Employee for each
service
Excess over 1,000 Employees $.70 per Employee for each
service
If data is submitted on floppy disk or tape:
1st 1,000 Employees $.55 per Employee for each
service
Excess over 1,000 Employees $.20 per Employee for each
service
Surrender Charge
In addition to the Basic Discontinuance Processing Charge there is a
Surrender Charge in accordance with the following schedule:
Year of Discontinuance Flat Charge
---------------------- -----------
Within First Year $30,000
Within Second Year $20,000
Within This Year $10,000
Case Setup and Installation Fee
$3,000
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ANNUITY PURCHASE RATE TABLE A
GUARANTEED MINIMUM FIRST MONTHLY ANNUITY PAYMENT
PURCHASED BY A PREMIUM OF $1,000
FORM OF ANNUITY: 100% FIXED TEN YEAR CERTAIN
AND LIFE ANNUITY
Participant's Age* Monthly Rate
----------------- ------------
55 4.82
56 4.91
57 5.01
58 5.11
59 5.21
60 5.32
61 5.43
62 5.55
63 5.68
64 5.81
65 5.95
66 6.10
67 6.25
68 6.41
69 6.57
70 6.74
71 6.91
72 7.08
73 7.26
74 7.44
* Age nearest birthday on annuity commencement date, with respect to an
annuity commencing prior to January 1, 1990. With respect to an
annuity commencing on or after January 1, 1990, the following
adjustment will be made.
Annuity commencement date Participant's age equals
---------------------------- -------------------------------
On or after 1/1/90 but prior Age nearest birthday or annuity
to 1/1/2000 commencement date minus 1
Rates for other ages and other forms of annuity will be furnished upon request.
This Table is subject to annual review by the Insurance Company and may be
changed after ninety (90) days' written notice to the Contractholder. This
Table will not be changed within the first twelve (12) months following the
Contract's Effective Date nor will it be changed more frequently than once in
any twelve (12) month period except by written agreement between the Insurance
Company and the Contractholder.
20
ANNUITY PURCHASE RATE TABLE B
GUARANTEED MINIMUM FIRST MONTHLY ANNUITY PAYMENT
PURCHASED BY A PREMIUM OF $1,000
FORM OF ANNUITY: 100% VARIABLE TEN YEAR CERTAIN
AND LIFE ANNUITY
ASSUMED INVESTMENT RETURN: 4.5%
Participant's Age* Monthly Rate
----------------- ------------
55 5.12
56 5.21
57 5.30
58 5.39
59 5.50
60 5.60
61 5.72
62 5.84
63 5.96
64 6.09
65 6.23
66 6.38
67 6.53
68 6.68
69 6.84
70 7.01
71 7.17
72 7.35
73 7.52
74 7.70
* Age nearest birthday on annuity commencement date, with respect to an
annuity commencing prior to January 1, 1990. With respect to an
annuity commencing on or after January 1, 1990, the following
adjustment will be made.
Annuity commencement date Participant's age equals
---------------------------- -------------------------------
On or after 1/1/90 but prior Age nearest birthday on annuity
to 1/1/2000 commencement date minus 1
Rates for other ages and other forms of annuity will be furnished upon request.
This Table is subject to annual review by the Insurance Company and may be
changed after ninety (90) days' written notice to the Contractholder. This
Table will not be changed within the first twelve (12) months following the
Contract's Effective Date nor will it be changed more frequently than once in
any twelve (12) month period except by written agreement between the
Insurance Company and the Contractholder.
21
GUARANTEED LONG TERM ACCOUNT RIDER
R1.1 GUARANTEED LONG TERM ACCOUNT. The term Guaranteed Long Term Account
refers to that portion of the Contractholder's Account invested in the
Insurance Company's general portfolio.
R1.2 CREDITED INTEREST. Interest will be credited to the Contractholder's
Guaranteed Long Term Account daily. Interest will be credited to each
dollar in the Guaranteed Long Term Account, pursuant to the Contract
Section 3.2(C), from the Valuation Date on which it is allocated to the
Guaranteed Long Term Account until the Valuation Date as of which it is
transferred, distributed or disbursed from the Guaranteed Long Term
Account.
The rate of Credited Interest for any period of time will be determined
by the Insurance Company and may be changed from time to time. Any such
change by the Insurance Company will be declared in advance and will
become effective as of the first day of the month immediately following
the date the Contractholder is mailed notice of such change. The rate
of Credited Interest will not be reduced by more than 2.10% during any
calendar year. The rate of Credited Interest shall never be less than
zero (0) percent.
R1.3 ASSET CHARGE. The annual Asset Charge, determined according to the
Contract Expense Schedule, is reduced to a daily equivalent and is
reduced from the Credited Interest being credited to the Contractholder's
Guaranteed Long Term Account in accordance with Section R1.2.
R1.4 VALUATION. The value of the Contractholder's Guaranteed Long Term
Account is an amount equal to:
(A) The sum of:
(1) Amounts contributed or transferred to the
Insurance Company and invested in the Contractholder's
Guaranteed Long Term Account, plus
(2) Amounts transferred to the Contractholder's
Guaranteed Long Term Account from any other funding vehicle
represented by a Rider attached to this Contract, plus
(3) Credited Interest on such account;
22
(B) Less:
(1) Expenses and charges, if any, plus
(2) Amounts transferred, distributed or disbursed from the
Contractholder's Guaranteed Long Term Account in accordance with
the terms of the Contract.
R1.5 VALUATION DATE. For purposes of valuing the Contractholder's Guaranteed
Long Term Account, the term Valuation Date refers to each day the
Insurance Company is open to transact normal business.
R1.6 ANNUITY PAYMENTS. To determine the amount of each fixed annuity payment,
the amount available to purchase an annuity pursuant to Contract Section
4.1(D) is multiplied by the annuity purchase rate then in effect for all
contracts in this class of business.
R1.7 DEFERRALS. Transfers, distributions or disbursements from the Guaranteed
Long Term Account may be deferred pursuant to Contract Section 4.5 if a
determination of the value of such transfer, distribution or disbursement
is not possible because the Securities and Exchange Commission has
suspended or otherwise restricted trading of securities or another
emergency situation outside the control of the Insurance Company exists.
During such deferral period amounts payable from the Guaranteed Long Term
Account will continue to receive Credited Interest.
R1.8 POOL TRANSFER LIMITATION. Whenever an amount to be transferred,
distributed or disbursed from the Contractholder's Guaranteed Long Term
Account together with all amounts previously or simultaneously
transferred, distributed or disbursed for any reason in the calendar year
of computation from the pool of Guaranteed Long Term Account assets to
which this Contract belongs would exceed ten percent (10%) of the total
assets in such pool on January 1 of the year of computation, the
transfer, distribution or disbursement may be deferred by the Insurance
Company.
This Contract belongs to the Guaranteed Long Term Account pool
established for all contracts containing this or a similar limitation
under which the initial contribution to be held in the Contractholder's
Account is received in the same calendar year. Such transfer,
distribution or disbursement will be subject to the following:
(A) No deferral will result in less than ten percent (10%)
of the Guaranteed Long Term Account portion of a Contractholder's
Account being transferred, distributed or disbursed in any one
calendar year.
(B) During a Guaranteed Long Term Account Pool Transfer Limitation
deferral, any amount deferred pursuant to this subsection will
continue to receive Credited Interest.
(C) Retirement, termination, and death or disability distributions
payable from the Guaranteed Long Term Account will be paid and not
deferred. Disbursements occurring as a result of the Plan's
termination or failure to meet the requirements of I.R.C. section
401(a) are also unaffected by this provision.
(D) This section shall not apply if the Contract discontinues pursuant to
Contract Section 5.
23
R1.9 DISCONTINUANCE TRANSFER LIMITATION. In the event this Contract
discontinues pursuant to Section 5, if the amount to be disbursed from the
Contractholder's Guaranteed Long Term Account together with all amounts
previously disbursed or transferred for any reason in the calendar year of
discontinuance from the pool of Guaranteed Long Term Account assets to
which this Contract belongs does not exceed ten percent (10%) of the total
assets in such pool on January 1 of the year of computation, all amounts
credited to the Contractholder's Guaranteed Long Term Account will be
disbursed as of the Discontinuance Disbursement Date, as defined in
Contract Section 5.3. If the amounts to be disbursed exceed said 10%, the
following limitations apply:
(A) An amount equal to the difference between said 10% and the amounts
previously disbursed or transferred from the pool of Guaranteed Long
Term Account assets to which this Contract belongs, or, if greater,
one-sixth (1/6) of the value of the Contractholder's Guaranteed Long
Term Account will be disbursed as of the Discontinuance Disbursement.
Date, as defined in Contract Section 5.3.
(B) ▇▇▇▇▇▇▇ remaining credited to the Contractholder's Guaranteed
Long Term Account will be disbursed in five (5) installments as
follows:
(1) The first installment being one-fifth (1/5) of the remaining
value of said Account;
(2) The second installment being one-fourth (1/4) of the remaining
value of said Account;
(3) The third installment being one-third (1/3) of the remaining
value of said Account;
(4) The fourth installment being one-half (1/2) of the remaining
value of said Account; and
(5) The fifth installment being the remainder of the value of said
Account.
The first installment will be made as of the January 1 following the
Discontinuance Disbursement Date, as defined in Contract Section 5.3,
and each succeeding installment as of each January 1 thereafter.
(C) The Insurance Company will issue a written guarantee of the
interest rate to be credited to the unpaid balance of the
Contractholder's Guaranteed Long Term Account. That interest rate
will be an annual rate equal to the Credited Interest rate at date of
discontinuance applicable to the Guaranteed Long Term Account pool of
which this Contract is a member (hereinafter "Pool Rate") minus fifty
percent (50%) of the difference between the Credited Interest rate at
date of discontinuance for the Guaranteed Long Term Account pool
established for the calendar year of Discontinuance and the Pool
Rate. In no event will the interest rate credited be less than zero
percent (0%) per annum, or greater than the Pool Rate.
24
(D) Retirement, termination, and death or disability disbursements
payable from the Guaranteed Long Term Account will be paid in
accordance with the terms of Contract Section 4 and not deferred under
this Section. Disbursements occurring as a result of plan termination
or the failure of the plan to meet the requirements of I.R.C. section
401(a) also will be paid in accordance with the terms of Contract
Sections 5.4(B) and (C) and not deferred under this Section.
(E) Notwithstanding the foregoing, the Insurance Company reserves
the right to disburse at any time the remaining balances of the
Contractholder's Guaranteed Long Term Account in a single lump sum.
(F) This Contract belongs to the Guaranteed Long Term Account pool
established for all contracts containing this or a similar limitation
under which the initial contribution to be allocated to the
Contractholder's Account is received in the same calendar year.
25
SEPARATE ACCOUNT 55A RIDER
R7.1 SEPARATE ACCOUNT 55A (Fidelity Advisor Growth Opportunities Fund Separate
Account) is a pooled separate account maintained by the Insurance Company
for a portion of its assets. The only amounts which may be allocated to
Separate Account 55A are amounts contributed in accordance with the terms
of pension or profit sharing plans qualified under section 401 of the
Internal Revenue Code, as amended, governmental plans as defined in
section 414(d) of the Internal Revenue Code, as amended, or eligible
deferred compensation plans as defined in section 457 of the Internal
Revenue Code, as amended. The assets of Separate Account 55A are
segregated from other assets of the Insurance Company, and are subject
only to the claims of contracts participating in this separate account.
Separate Account 55A is maintained and operated by the Insurance Company
in accordance with the following:
(A) INVESTMENTS. The assets of Separate Account 55A are invested in
shares of the Fidelity Advisor Growth Opportunities Fund, a mutual
fund offered by Fidelity Investments. In addition, from time to
time, the Insurance Company may invest such assets in short term
money market instruments, cash or cash equivalents. Any income,
gains or losses, realized or unrealized, from the assets in
Separate Account 55A shall be credited to or charged against said
account without regard to the other income, gains or losses of
Connecticut General.
(B) EXPENSES CHARGED TO SEPARATE ACCOUNT 55A. Separate Account 55A
may be charged with (1) an investment management charge, (2)
brokerage commissions, transfer taxes and other direct charges
arising from the purchase or sale of investments or futures
instruments thereunder, (3) other taxes, charges or expenses
directly attributable to the operation of, or the assets held in,
Separate Account 55A. and (4) any expenses (including reasonable
fees and expenses for the time spent by officers or employees of the
Insurance Company) which are incurred in the course of litigation,
representation on any creditors' committees, or any other action
which the Insurance Company determines is reasonably necessary or
required to preserve or enhance the value of the assets of Separate
Account 55A. The investment management charge determined by the
Insurance Company will be charged daily based upon the value of each
Contract's share of Separate Account 55A.
The maximum aggregate annual rate of investment management charge is
one percent (1.00%).
26
(C) SEPARATE ACCOUNT 55A UNIT. Separate Account 55A is divided
into units of participation with each unit being referred to as a
Separate Account 55A Unit. When an amount is allocated or
transferred to Separate Account 55A, the number of Separate Account
55A Units is increased and when an amount is withdrawn from Separate
Account 55A, the number of Separate Account 55A Units is decreased.
Such increase or decrease in the number of Separate Account 55A
Units is determined by dividing the amount allocated to or
withdrawn from Separate Account 55A by the then current Separate
Account 55A Unit Value.
(D) SEPARATE ACCOUNT 55A UNIT VALUE. A Separate Account 55A Unit
Value is determined by the Insurance Company on each Valuation Date
and is equal to the Market Value of Separate Account 55A divided by
the total number of Separate Account 55A Units on such date. The
Separate Account 55A Unit Value on any date is equal to the amount
so determined on the Valuation Date coinciding with or last
preceding such date.
(E) MARKET VALUE OF SEPARATE ACCOUNT 55A. The Insurance Company
will determine the Market Value of Separate Account 55A for each
Valuation Date. The Market Value on any Valuation Date is based
upon the market value of the assets in Separate Account 55A at the
close of the Insurance Company's business on the current day, as
determined in accordance with generally recognized accounting
procedures. The Market Value of the investments in the Fidelity
Advisor Growth Opportunities Fund will be determined by the NAV (net
asset value) of the shares plus the value of any dividends and
capital gain distributions.
R7.2 VALUATION. The value of the portion of a Participant's Account invested
in Separate Account 55A is an amount equal to the product of the number of
Accumulation 55A Units credited to such Account and the Accumulation 55A
Unit Value for the Valuation Date.
(A) ACCUMULATION 55A UNITS. When an amount is allocated to the
portion of a Contractholder's Account invested in Separate Account
55A, the Contractholder's Account is credited with the number of
Accumulation 55A Units equal to the amount allocated divided by the
Accumulation 55A Unit Value as of the Allocation Date determined
pursuant to Contract Section 3.2(C).
When an amount is transferred, distributed or disbursed from the
portion of a Contractholder's Account invested in Separate Account
55A, the Contractholder's Account is debited by the number of
Accumulation 55A Units equal to the amount transferred, distributed
or disbursed divided by the Accumulation 55A Unit Value as of the
later of the date the Insurance Company receives written
instructions from the Contractholder regarding the amounts to be
transferred or distributed or the effective date of such transfer or
distribution; or in the case of a disbursement, as of the
Discontinuance Disbursement Date determined pursuant to Contract
Section 5.3.
27
NOTE: If Plan benefits are integrated with Social Security benefits and an
amendment results in the exclusion of any employees or the reduction of
any participant's benefit to zero, and the amendment alters either
contributions to the Plan or the amount of benefits paid by the Plan, the
amendment is considered to alter the Plan's coverage provisions.
DATE OF DETERMINATION OF EMPLOYEES' STATUS
You must select a date for determining which employees are interested parties.
This date must be no earlier than 5 working days before the date you provide
the Notice to Interested Parties, and no later than that date.
WHEN YOU MUST NOTIFY INTERESTED PARTIES
- If you post the notice on a bulletin board or deliver it in person, it
must be given no less than 7 days and no more than 21 days before the date
the application is mailed to the IRS.
- If you mail the notice, it must be postmarked no less than 10 days and no
more than 24 days before the date the application is mailed to the IRS.
If the Plan is amended while the IRS is reviewing the application for
determination and the amendment increases coverage under the Plan so that
additional employees become interested parties, the application must be
resubmitted and all interested parties must be renotified.
COMPLETING THE NOTICE AND SUPPLYING INFORMATION
The enclosed sample notice should be adapted for your Plan. As the last
paragraph in the sample notice states, you must make certain additional
material available to interested parties who request this material, which
includes:
- An updated copy of the Plan and related trust agreement, if any.
- A copy of the application for determination.
- Information showing the number of individuals covered and not covered,
listed by compensation range. (You do not need to make a copy of Form
5302 available, because it shows salaries.)
- Any additional documents dealing with the application.
For additional guidance regarding the notification of interested parties, you
may want to refer to IRS Revenue Procedure 92-6, Sections 17 and 18 and
related Exhibits.
28
(B) ACCUMULATION 55A UNIT VALUE. The Accumulation 55A Unit
Value is the Separate Account 55A Unit Value adjusted to reflect
the investment management charge, if applicable.
(C) VALUATION DATE. A Valuation Date will occur on each day
that the New York Stock Exchange is open for unrestricted trading
and the Insurance Company is open to transact its normal business.
R7.3 LIMITATIONS.
(A) Any transfer, distribution or disbursement from Separate
Account 55A may be delayed for a period of up to thirty (30) days
if there is a negative cash flow into Separate Account 55A
considering all contracts with funds in Separate Account 55A on the
Valuation Date for such distribution or disbursement.
(B) Transfers, distributions or disbursements from Separate
Account 55A may be deferred pursuant to Contract Section 4.5 if
a determination of the value of such distribution or disbursement
is not possible because the Securities and Exchange Commission has
suspended or otherwise restricted trading of securities or another
emergency situation outside the control of the Insurance Company
exists.
R7.4 DISCONTINUANCE OF SEPARATE ACCOUNT 55A. Separate Account 55A may be
discontinued if the Fidelity Advisor Growth Opportunities Fund is no
longer offered by Fidelity Investments, if Fidelity Investments becomes
insolvent or files for voluntary or involuntary bankruptcy, or if
Connecticut General determines that Separate Account 55A is no longer
commercially feasible and notifies the Contractholder in writing that
the Separate Account will be discontinued.
As of the date Separate Account 55A is discontinued:
(A) No further contributions to Separate Account 55A will be
accepted by Connecticut General and no further withdrawals or
transfers will be honored except as provided in
(B) and (C) below;
(B) Connecticut General will determine an amount equal to the
expenses which are unpaid or due hereunder and withdraw such amount
from Separate Account 55A;
(C) The remaining value of this Contract's share of Separate
Account 55A will be distributed in accordance with the
Contractholder's written instructions to be effective as of the
date of discontinuance.
29
SEPARATE ACCOUNT 55B RIDER
R8.1 SEPARATE ACCOUNT 55B (Fidelity Advisor Income & Growth Fund Separate
Account) is a pooled separate account maintained by the Insurance Company
for a portion of its assets. The only amounts which may be allocated to
Separate Account 55B are amounts contributed in accordance with the terms
of pension or profit sharing plans qualified under section 401 of the
Internal Revenue Code, as amended, governmental plans as defined in
section 414(d) of the Internal Revenue Code, as amended, or eligible
deferred compensation plans as defined in section 457 of the Internal
Revenue Code, as amended. The assets of Separate Account 55B are
segregated from other assets of the Insurance Company, and are subject
only to the claims of contracts participating in this separate account.
Separate Account 55B is maintained and operated by the insurance Company in
accordance with the following:
(A) INVESTMENTS. The assets of Separate Account 55B are invested in
shares of the Fidelity Advisor Income & Growth Fund, a mutual
fund offered by Fidelity Investments. In addition, from time to
time, the Insurance Company may invest such assets in short term
money market instruments, cash or cash equivalents. Any income,
gains or losses, realized or unrealized, from the assets in Separate
Account 55B shall be credited to or charged against said account
without regard to the other income, gains or losses of Connecticut
General.
(B) EXPENSES CHARGED TO SEPARATE ACCOUNT 55B. Separate Account 55B may be
charged with (1) an investment management charge, (2) brokerage
commissions, transfer taxes and other direct charges arising from the
purchase or sale of investments or futures instruments thereunder,
(3) other taxes, charges or expenses directly attributable to the
operation of, or the assets held in, Separate Account 55B, and (4)
any expenses (including reasonable fees and expenses for the time
spent by officers or employees of the Insurance Company) which are
incurred in the course of litigation, representation on any
creditors' committees, or any other action which the Insurance
Company determines is reasonably necessary or required to preserve or
enhance the value of the assets of Separate Account 55B. The
investment management charge determined by the Insurance Company will
be charged daily based upon the value of each Contract's share of
Separate Account 55B.
The maximum aggregate annual rate of investment management
charge is one percent (1.00%).
30
(C) SEPARATE ACCOUNT 55B UNIT. Separate Account 558 is divided into
units of participation with each unit being referred to as a
Separate Account 55B Unit. When an amount is allocated or
transferred to Separate Account 55B, the number of Separate Account
55B Units is increased and when an amount is withdrawn from Separate
Account 55B, the number of Separate Account 55B Units is decreased.
Such increase or decrease in the number of Separate Account 55B Units
is determined by dividing the amount allocated to or withdrawn from
Separate Account 55B by the then current Separate Account 55B Unit
Value.
(D) SEPARATE ACCOUNT 55B UNIT VALUE. A Separate Account 55B Unit Value is
determined by the Insurance Company on each Valuation Date and
is equal to the Market Value of Separate Account 55B divided by the
total number of Separate Account 55B Units on such date. The
Separate Account 55B Unit Value on any date is equal to the amount so
determined on the Valuation Date coinciding with or last preceding
such date.
(E) MARKET VALUE OF SEPARATE ACCOUNT 55B. The Insurance Company will
determine the Market Value of Separate Account 55B for each
Valuation Date. The Market Value on any Valuation Date is based upon
the market value of the assets in Separate Account 55B at the close
of the Insurance Company's business on the current day, as determined
in accordance with generally recognized accounting procedures. The
Market Value of the investments in the Fidelity Advisor Income &
Growth Fund will be determined by the NAV (net asset value) of the
shares plus the value of any dividends and capital gain
distributions.
R8.2 VALUATION. The value of the portion of a Participant's Account invested
in Separate Account 55B is an amount equal to the product of the number of
Accumulation 55B Units credited to such Account and the Accumulation 55B
Unit Value for the Valuation Date.
(A) ACCUMULATION 55B UNITS. When an amount is allocated to the portion
of a Contractholder's Account invested in Separate Account 55B,
the Contractholder's Account is credited with the number of
Accumulation 55B Units equal to the amount allocated divided by the
Accumulation 55B Unit Value as of the Allocation Date determined
pursuant to Contract Section 3.2(C).
When an amount is transferred, distributed or disbursed from
the portion of a Contractholder's Account invested in Separate
Account 55B, the Contractholder's Account is debited by the number of
Accumulation 55B Units equal to the amount transferred, distributed
or disbursed divided by the Accumulation 55B Unit Value as of the
later of the date the Insurance Company receives written instructions
from the Contractholder regarding the amounts to be transferred or
distributed or the effective date of such transfer or distribution;
or in the case of a disbursement, as of the Discontinuance
Disbursement Date determined pursuant to Contract Section 5.3.
31
(B) ACCUMULATION 55B UNIT VALUE. The Accumulation 55B Unit Value
is the Separate Account 55B Unit Value adjusted to reflect the
investment management charge, if applicable.
(C) VALUATION DATE. A Valuation Date will occur on each day
that the New York Stock Exchange is open for unrestricted trading
and the Insurance Company is open to transact its normal business.
R8.3 LIMITATIONS.
(A) Any transfer, distribution or disbursement from Separate
Account 55B may be delayed for a period of up to thirty (30) days if
there is a negative cash flow into Separate Account 55B considering
all contracts with funds in Separate Account 55B on the Valuation
Date for such distribution or disbursement.
(B) Transfers, distributions or disbursements from Separate
Account 55B may be deferred pursuant to Contract Section 4.5 if a
determination of the value of such distribution or disbursement is
not possible because the Securities and Exchange Commission has
suspended or otherwise restricted trading of securities or another
emergency situation outside the control of the Insurance Company
exists.
R8.4 DISCONTINUANCE OF SEPARATE ACCOUNT 55B. Separate Account 55B may be
discontinued if the Fidelity Advisor Income & Growth Fund is no longer
offered by Fidelity Investments, if Fidelity Investments becomes insolvent
or files for voluntary or involuntary bankruptcy, or if Connecticut
General determines that Separate Account 55B is no longer commercially
feasible and notifies the Contractholder in writing that the Separate
Account will be discontinued.
As of the date Separate Account 55B is discontinued:
(A) No further contributions to Separate Account 55B will be
accepted by Connecticut General and no further withdrawals or
transfers will be honored except as provided in
(B) and (C) below;
(B) Connecticut General will determine an amount equal to the
expenses which are unpaid or due hereunder and withdraw such amount
from Separate Account 55B;
(C) The remaining value of this Contract's share of Separate
Account 55B will be distributed in accordance with the
Contractholder's written instructions to be effective as of the
date of discontinuance.
32
SEPARATE ACCOUNT 55F RIDER
R12.1 SEPARATE ACCOUNT 55F (the Warburg Pincus International Equity Fund
Separate Account) is a pooled separate account maintained by the Insurance
Company for a portion of its assets. The only amounts which may be
allocated to Separate Account 55F are amounts contributed in accordance
with the terms of pension or profit sharing plans qualified under section
401 of the Internal Revenue Code, as amended, governmental plans as
defined in section 414(d) of the Internal Revenue Code, as amended, or
eligible deferred compensation plans as defined in section 457 of the
Internal Revenue Code, as amended. The assets of Separate Account 55F
are segregated from other assets of the Insurance Company, and are
subject only to the claims of contracts participating in this separate
account.
Separate Account 55F is maintained and operated by the Insurance
Company in accordance with the following:
(A) INVESTMENTS. The assets of Separate Account 55F are invested in
shares of the Warburg Pincus International Equity Fund, a
mutual fund offered by Counsellors Securities, Inc. In addition,
from time to time, the Insurance Company may invest such assets in
short term money market instruments, cash or cash equivalents. Any
income, gains or losses, realized or unrealized, from the assets in
Separate Account 55F shall be credited to or charged against said
account without regard to the other income, gains or losses of
Connecticut General.
(B) EXPENSES CHARGED TO SEPARATE ACCOUNT 55F. Separate Account 55F may
be charged with (1) an investment management charge, (2)
brokerage commissions, transfer taxes and other direct charges
arising from the purchase or sale of investments or futures
instruments thereunder, (3) other taxes, charges or expenses
directly attributable to the operation of, or the assets held in,
Separate Account 55F, and (4) any expenses (including reasonable
fees and expenses for the time spent by officers or employees of the
Insurance Company) which are incurred in the course of litigation,
representation on any creditors' committees, or any other action
which the Insurance Company determines is reasonably necessary or
required to preserve or enhance the value of the assets of Separate
Account 55F. The investment management charge determined by the
Insurance Company will be charged daily based upon the value of each
Contract's share of Separate Account 55F.
The maximum aggregate annual rate of investment management
charge is one percent (1.00%).
33
(C) SEPARATE ACCOUNT 55F UNIT. Separate Account 55F is divided into
units of participation with each unit being referred to as a
Separate Account 55F Unit. When an amount is allocated or
transferred to Separate Account 55F, the number of Separate Account
55F Units is increased and when an amount is withdrawn from Separate
Account 55F, the number of Separate Account 55F Units is decreased.
Such increase or decrease in the number of Separate Account 55F Units
is determined by dividing the amount allocated to or withdrawn from
Separate Account 55F by the then current Separate Account 55F Unit
Value.
(D) SEPARATE ACCOUNT 55F UNIT VALUE. A Separate Account 55F Unit Value is
determined by the Insurance Company on each Valuation Date and
is equal to the Market Value of Separate Account 55F divided by the
total number of Separate Account 55F Units on such date. The
Separate Account 55F Unit Value on any date is equal to the amount so
determined on the Valuation Date coinciding with or last preceding
such date.
(E) MARKET VALUE OF SEPARATE ACCOUNT 55F. The Insurance Company will
determine the Market Value of Separate Account 55F for each
Valuation Date. The Market Value on any Valuation Date is based upon
the market value of the assets in Separate Account 55F at the close
of the Insurance Company's business on the current day, as determined
in accordance with generally recognized accounting procedures. The
Market Value of the investment in the Warburg Pincus International
Equity Fund will be determined by the NAV (net asset value) of the
shares plus the value of any dividends and capital gain
distributions.
R12.2 VALUATION. The value of the portion of a Participant's Account
invested in Separate Account 55F is an amount equal to the product of the
number of Accumulation 55F Units credited to such Account and the
Accumulation 55F Unit Value for the Valuation Date.
(A) ACCUMULATION 55F UNITS. When an amount is allocated to the portion
of a Contractholder's Account invested in Separate Account 55F,
the Contractholder's Account is credited with the number of
Accumulation 55F Units equal to the amount allocated divided by the
Accumulation 55F Unit Value as of the Allocation Date determined
pursuant to Contract Section 3.2(C).
When an amount is transferred, distributed or disbursed from
the portion of a Contractholder's Account invested in Separate
Account 55F, the Contractholder's Account is debited by the number of
Accumulation 55F Units equal to the amount transferred, distributed
or disbursed divided by the Accumulation 55F Unit Value as of the
later of the date the Insurance Company receives written instructions
from the Contractholder regarding the amounts to be transferred or
distributed or the effective date of such transfer or distribution;
or in the case of a disbursement, as of the Discontinuance
Disbursement Date determined pursuant to Contract Section 5.3.
34
(B) ACCUMULATION 55F UNIT VALUE. The Accumulation 55F Unit Value is the
Separate Account 55F Unit Value adjusted to reflect the
investment management charge, if applicable.
(C) VALUATION DATE. A Valuation Date will occur on each day that the
New York Stock Exchange is open for unrestricted trading and
the Insurance Company is open to transact its normal business.
R12.3 LIMITATIONS.
(A) Any transfer, distribution or disbursement from Separate
Account 55F may be delayed for a period of up to thirty (30)
days if there is a negative cash flow into Separate Account 55F
considering all contracts with funds in Separate Account 55F on the
Valuation Date for such distribution or disbursement.
(B) Transfers, distributions or disbursements from Separate Account 55F
may be deferred pursuant to Contract Section 4.5 if a determination
of the value of such distribution or disbursement is not possible
because the Securities and Exchange Commission has suspended or
otherwise restricted trading of securities or another emergency
situation outside the control of the Insurance Company exists.
R12.4 DISCONTINUANCE OF SEPARATE ACCOUNT 55F. Separate Account 55F may be
discontinued if the Warburg Pincus International Equity Fund is no
longer offered by Counsellors Securities, Inc., if Counsellors
Securities, Inc. becomes insolvent or files for voluntary or involuntary
bankruptcy, or if Connecticut General determines that Separate Account
55F is no longer commercially feasible and notifies the Contractholder in
writing that the Separate Account will be discontinued.
As of the date Separate Account 55F is discontinued:
(A) No further contributions to Separate Account 55F will be accepted by
Connecticut General and no further withdrawals or transfers
will be honored except as provided in (B) and (C) below;
(B) Connecticut General will determine an amount equal to the expenses
which are unpaid or due hereunder and withdraw such amount from
Separate Account 55F;
(C) The remaining value of this Contract's share of Separate Account
55F will be distributed in accordance with the Contractholder's
written instructions to be effective as of the date of
discontinuance.
35
SEPARATE ACCOUNT 55G RIDER
R13.1 SEPARATE ACCOUNT 55G (the Warburg Pincus Emerging Growth Fund
Separate Account) is a pooled separate account maintained by the
Insurance Company for a portion of its assets. The only amounts which
may be allocated to Separate Account 55G are amounts contributed in
accordance with the terms of pension or profit sharing plans qualified
under section 401 of the Internal Revenue Code, as amended, governmental
plans as defined in section 414(d) of the Internal Revenue Code, as
amended, or eligible deferred compensation plans as defined in section
457 of the Internal Revenue Code, as amended. The assets of Separate
Account 55G are segregated from other assets of the Insurance Company,
and are subject only to the claims of contracts participating in this
separate account.
Separate Account 55G is maintained and operated by the Insurance
Company in accordance with the following:
(A) INVESTMENTS. The assets of Separate Account 55G are invested in
shares of the Warburg Pincus Emerging Growth Fund, a mutual
fund offered by Counsellors Securities, Inc. In addition, from time
to time, the Insurance Company may invest such assets in short term
money market instruments, cash or cash equivalents. Any income,
gains or losses, realized or unrealized, from the assets in Separate
Account 55G shall be credited to or charged against said account
without regard to the other income, gains or losses of Connecticut
General.
(B) EXPENSES CHARGED TO SEPARATE ACCOUNT 55G. Separate Account 55G may
be charged with (1) an investment management charge, (2)
brokerage commissions, transfer taxes and other direct charges
arising from the purchase or sale of investments or futures
instruments thereunder, (3) other taxes, charges or expenses directly
attributable to the operation of, or the assets held in, Separate
Account 55G, and (4) any expenses (including reasonable fees and
expenses for the time spent by officers or employees of the Insurance
Company) which are incurred in the course of litigation,
representation on any creditors' committees, or any other action
which the Insurance Company determines is reasonably necessary or
required to preserve or enhance the value of the assets of Separate
Account 55G. The investment management charge determined by the
Insurance Company will be charged daily based upon the value of each
Contract's share of Separate Account 55G.
The maximum aggregate annual rate of investment management
charge is one percent (1.00%).
36
(C) SEPARATE ACCOUNT 55G UNIT. Separate Account 55G is divided into
units of participation with each unit being referred to as a
Separate Account 55G Unit. When an amount is allocated or
transferred to Separate Account 55G, the number of Separate Account
55G Units is increased and when an amount is withdrawn from Separate
Account 55G, the number of Separate Account 55G Units is decreased.
Such increase or decrease in the number of Separate Account 55G Units
is determined by dividing the amount allocated to or withdrawn from
Separate Account 55G by the then current Separate Account 55G Unit
Value.
(D) SEPARATE ACCOUNT 55G UNIT VALUE. A Separate Account 55G Unit Value
is determined by the Insurance Company on each Valuation Date
and is equal to the Market Value of Separate Account 55G divided by
the total number of Separate Account 55G Units on such date. The
Separate Account 55G Unit Value on any date is equal to the amount so
determined on the Valuation Date coinciding with or last preceding
such date.
(E) MARKET VALUE OF SEPARATE ACCOUNT 55G. The Insurance Company will
determine the Market Value of Separate Account 55G for each
Valuation Date. The Market Value on any Valuation Date is based upon
the market value of the assets in Separate Account 55G at the close
of the Insurance Company's business on the current day, as determined
in accordance with generally recognized accounting procedures. The
Market Value of the investments in the Warburg Pincus Emerging Growth
Fund will be determined by the NAV (net asset value) of the shares
plus the value of any dividends and capital gain distributions.
R13.2 VALUATION. The value of the portion of a Participant's Account
invested in Separate Account 55G is an amount equal to the product of
the number of Accumulation 55G Units credited to such Account and the
Accumulation 55G Unit Value for the Valuation Date.
(A) ACCUMULATION 55G UNITS. When an amount is allocated to the portion
of a Contractholder's Account invested in Separate Account 55G,
the Contractholder's Account is credited with the number of
Accumulation 55G Units equal to the amount allocated divided by the
Accumulation 55G Unit Value as of the Allocation Date determined
pursuant to Contract Section 3.2(C).
When an amount is transferred, distributed or disbursed from
the portion of a Contractholder's Account invested in Separate
Account 55G, the Contractholder's Account is debited by the number of
Accumulation 55G Units equal to the amount transferred, distributed
or disbursed divided by the Accumulation 55G Unit Value as of the
later of the date the Insurance Company receives written instructions
from the Contractholder regarding the amounts to be transferred or
distributed or the effective date of such transfer or distribution;
or in the case of a disbursement, as of the Discontinuance
Disbursement Date determined pursuant to Contract Section 5.3.
37
(B) ACCUMULATION 55G UNIT VALUE. The Accumulation 55G Unit Value is the
Separate Account 55G Unit Value adjusted to reflect the
investment management charge, if applicable.
(C) VALUATION DATE. A Valuation Date will occur on each day that the
New York Stock Exchange is open for unrestricted trading and
the Insurance Company is open to transact its normal business.
R13.3 LIMITATIONS.
(A) Any transfer, distribution or disbursement from Separate
Account 55G may be delayed for a period of up to thirty (30)
days if there is a negative cash flow into Separate Account 55G
considering all contracts with funds in Separate Account 55G on the
Valuation Date for such distribution or disbursement.
(B) Transfers, distributions or disbursements from Separate Account 55G
may be deferred pursuant to Contract Section 4.5 if a
determination of the value of such distribution or disbursement is
not possible because the Securities and Exchange Commission has
suspended or otherwise restricted trading of securities or another
emergency situation outside the control of the Insurance Company
exists.
R13.4 DISCONTINUANCE OF SEPARATE ACCOUNT 55G. Separate Account 55G may be
discontinued if the Warburg Pincus Emerging Growth Fund is no longer
offered by Counsellors Securities, Inc., if Counsellors Securities, Inc.
becomes insolvent or files for voluntary or involuntary bankruptcy, or if
Connecticut General determines that Separate Account 55G is no longer
commercially feasible and notifies the Contractholder in writing that the
Separate Account will be discontinued.
As of the date Separate Account 55G is discontinued:
(A) No further contributions to Separate Account 55G will be accepted by
Connecticut General and no further withdrawals or transfers
will be honored except as provided in (B) and (C) below;
(B) Connecticut General will determine an amount equal to the expenses
which are unpaid or due hereunder and withdraw such amount from
Separate Account 55G;
(C) The remaining value of this Contract's share of Separate Account 55G
will be distributed in accordance with the Contractholder's
written instructions to be effective as of the date of
discontinuance.
38
SEPARATE ACCOUNT 55J RIDER
R16.1 SEPARATE ACCOUNT 55J (the CIGNA Separate Account - INVESCO Industrial
Income) is a pooled separate account maintained by the Insurance
Company for a portion of its assets. The only amounts which may be
allocated to Separate Account 55J are amounts contributed in accordance
with the terms of pension or profit sharing plans qualified under section
401 of the Internal Revenue Code, as amended, governmental plans as
defined in section 414(d) of the Internal Revenue Code, as amended, or
eligible deferred compensation plans as defined in section 457 of the
Internal Revenue Code, as amended. The assets of Separate Account 55J
are segregated from other assets of the Insurance Company, and are
subject only to the claims of contracts participating in this separate
account.
Separate Account 55J is maintained and operated by the Insurance
Company in accordance with the following:
(A) INVESTMENTS. The assets of Separate Account 55J are invested in
shares of the INVESCO Industrial Income Fund, a mutual fund
offered by INVESCO Funds Group, Inc. In addition, from time to
time, the Insurance Company may invest such assets in short term
money market instruments, cash or cash equivalents. Any income,
gains or losses, realized or unrealized, from the assets in Separate
Account 55J shall be credited to or charged against said account
without regard to the other income, gains or losses of Connecticut
General.
(B) EXPENSES CHARGED TO SEPARATE ACCOUNT 55J. Separate Account 55J may
be charged with (1) an investment management/distribution
charge, (2) brokerage commissions, transfer taxes and other direct
charges arising from the purchase or sale of investments or futures
instruments thereunder, (3) other taxes, charges or expenses directly
attributable to the operation of, or the assets held in, Separate
Account 55J, and (4) any expenses (including reasonable fees and
expenses for the time spent by officers or employees of the Insurance
Company) which are incurred in the course of litigation,
representation on any creditors' committees, or any other action
which the Insurance Company determines is reasonably necessary or
required to preserve or enhance the value of the assets of Separate
Account 55J. The investment management/distribution charge
determined by the Insurance Company will be charged daily based upon
the value of each Contract's share of Separate Account 55J.
The maximum aggregate annual rate of investment
management/distribution charge is one percent (1.00%).
39
(C) SEPARATE ACCOUNT 55J UNIT. Separate Account 55J is divided into
units of participation with each unit being referred to as a
Separate Account 55J Unit. When an amount is allocated or
transferred to Separate Account 55J, the number of Separate Account
55J Units is increased and when an amount is withdrawn from Separate
Account 55J, the number of Separate Account 55J Units is decreased.
Such increase or decrease in the number of Separate Account 55J Units
is determined by dividing the amount allocated to or withdrawn from
Separate Account 55J by the then current Separate Account 55J Unit
Value.
(D) SEPARATE ACCOUNT 55J UNIT VALUE. A Separate Account 55J Unit Value is
determined by the Insurance Company on each Valuation Date and
is equal to the Market Value of Separate Account 55J divided by the
total number of Separate Account 55J Units on such date. The
Separate Account 55J Unit Value on any date is equal to the amount so
determined on the Valuation Date coinciding with or last preceding
such date.
(E) MARKET VALUE OF SEPARATE ACCOUNT 55J. The Insurance Company will
determine the Market Value of Separate Account 55J for each
Valuation Date. The Market Value on any Valuation Date is based upon
the market value of the assets in Separate Account 55J at the close
of the Insurance Company's business on the current day, as
determined in accordance with generally recognized accounting
procedures. The Market Value of the investments in the INVESCO
Industrial Income Fund will be determined by the NAV (net asset
value) of the shares plus the value of any dividends and capital gain
distributions.
R16.2 VALUATION. The value of the portion of a Participant's Account invested
in Separate Account 55J is an amount equal to the product of the
number of Accumulation 55J Units credited to such Account and the
Accumulation 55J Unit Value for the Valuation Date.
(A) ACCUMULATION 55J UNITS. When an amount is allocated to the portion
of a Contractholder's Account invested in Separate Account 55J,
the Contractholder's Account is credited with the number of
Accumulation 55J Units equal to the amount allocated divided by the
Accumulation 55J Unit Value as of the Allocation Date determined
pursuant to Contract Section 3.2(C).
When an amount is transferred, distributed or disbursed from
the portion of a Contractholder's Account invested in Separate
Account 55J, the Contractholder's Account is debited by the number of
Accumulation 55J Units equal to the amount transferred, distributed
or disbursed divided by the Accumulation 55J Unit Value as of the
later of the date the Insurance Company receives written instructions
from the Contractholder regarding the amounts to be transferred or
distributed or the effective date of such transfer or distribution;
or in the case of a disbursement, as of the Discontinuance
Disbursement Date determined pursuant to Contract Section 5.3.
40
(B) ACCUMULATION 55J UNIT VALUE. The Accumulation 55J Unit Value is the
Separate Account 55J Unit Value adjusted to reflect the
investment management/distribution charge, if applicable.
(C) VALUATION DATE. A Valuation Date will occur on each day that the New
York Stock Exchange is open for unrestricted trading and the
Insurance Company is open to transact its normal business.
R16.3 LIMITATIONS.
(A) Any transfer, distribution or disbursement from Separate
Account 55J may be delayed for a period of up to thirty (30) days if
there is a negative cash flow into Separate Account 55J considering
all contracts with funds in Separate Account 55J on the Valuation
Date for such distribution or disbursement.
(B) Transfers, distributions or disbursements from Separate Account 55J
may be deferred pursuant to Contract Section 4.5 if a
determination of the value of such distribution or disbursement is
not possible because the Securities and Exchange Commission has
suspended or otherwise restricted trading of securities or another
emergency situation outside the control of the Insurance Company
exists.
R16.4 DISCONTINUANCE OF SEPARATE ACCOUNT 55J. Separate Account 55J may
be discontinued if the INVESCO Industrial Income Fund is no longer offered
by INVESCO Funds Group, Inc., if INVESCO Funds Group, Inc. becomes
insolvent or files for voluntary or involuntary bankruptcy, or if
Connecticut General determines that Separate Account 55J is no longer
commercially feasible and notifies the Contractholder in writing that the
Separate Account will be discontinued.
As of the date Separate Account 55J is discontinued:
(A) No further contributions to Separate Account 55J will be accepted by
Connecticut General and no further withdrawals or transfers
will be honored except as provided in (B) and (C) below;
(B) Connecticut General will determine an amount equal to the expenses
which are unpaid or due hereunder and withdraw such amount from
Separate Account 55J;
(C) The remaining value of this Contract's share of Separate Account 55J
will be distributed in accordance with the Contractholder's
written instructions to be effective as of the date of
discontinuance.
41
Connecticut General Life Insurance Company
a CIGNA company
------------------------------------------------------------------
P.O. Box 2975
Hartford, CT 06104 [CIGNA LOGO]
JAN 13 1994
APPLICATION
Applicant's Exact Name
Trustees of the Lason Systems, Inc. 401(k) Profit Sharing Plan & Trust
------------------------------------------------------------------------------------------
Street Address
▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇
------------------------------------------------------------------------------------------
City, State & Zip Code
Livonia, MI 48150
------------------------------------------------------------------------------------------
The Applicant hereby applies for a Group Annuity Contract from Connecticut General Life
Insurance Company with the following investment options:
/X/ Guaranteed Long-Term Account / / Fidelity Special Situations Fund*
/ / Guaranteed Short-Term Account /X/ Plymouth Growth Opportunities Portfolio*
or /X/ Plymouth Income & Growth Portfolio*
/ / Guaranteed Government Securities Account* / / Counsellors Capital Appreciation Fund*
/ / Common Stock Account /X/ Counsellors International Equity Fund*
/ / Stock Market Index Account /X/ Counsellors Emerging Growth Fund*
/ / Balanced Account /X/ INVESCO Industrial Income
/ / International Equity Account* / /
*Not available on small case
ANY VARIABLE ANNUITY PAYMENTS AND OTHER BENEFITS PROVIDED HEREUNDER WHICH ARE BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE AND NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT.
The Applicant also hereby applies for the following plan services provided by the Connecticut
General Life Insurance Company under the Contract or a Service Agreement:
/ / Small Case: / / Investment Only; or / / Full Service
/X/ Regular Case with the following services: (Full Service must check all appropriate boxes)
/ / Investment Only
/X/ Plan Document Services /X/ Benefit Payments
/X/ Prototype Plan /X/ Plan Administration & Recordkeeping
or /X/ Compliance Testing
/ / Customer Plan Design & Document Preparation (RK)
/ / with Amendments / /
/X/ Employee Communications / /
Dated at Livonia, Michigan on Nov. (RK) , 1993 by Applicant
----------------- -----------------
(location) (date)
For the Employer For the Trustee
By ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇ By ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇
------------------------------- -------------------------------
Title VP/CFO Title Trustee
---------------------------- ----------------------------
By By
------------------------------- -------------------------------
Title Title
---------------------------- ----------------------------
Soliciting Agent ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇▇
-----------------------------------------------------------------
Amount of Binding Payment $5,000.00
--------------------------------------------------------
It is agreed that the binding payment represents a non-refundable deposit to be
retained by Connecticut General and applied to the Group Annuity Contract or the
Service Agreement. In the event the Contract is not executed, Connecticut General
will refund the excess, if any, of the amount of the binding payment over the amount
of expenses which Connecticut General determines it has incurred as a result of the
application. In no event, however, will the amount of expenses charged by Connecticut
General as a result of the application exceed three thousand dollars ($3,000).