See All of This Company's Exhibits
EX-99.(4)(A)
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a2058450zex-99_4a.txt
CERTIFICATE FORM
MODERN WOODMEN OF AMERICA
A FRATERNAL BENEFIT SOCIETY
FLEXIBLE PREMIUM DEFERRED
VARIABLE ANNUITY CERTIFICATE
RETIREMENT BENEFIT PAYABLE ON THE RETIREMENT DATE. DEATH BENEFIT PAYABLE AT
DEATH BEFORE THE RETIREMENT DATE. FLEXIBLE PREMIUMS PAYABLE FOR THE ANNUITANT'S
LIFE OR UNTIL THE RETIREMENT DATE. THE ACCUMULATED VALUE IN THE VARIABLE ANNUITY
ACCOUNT IS BASED ON THE INVESTMENT PERFORMANCE OF THAT ACCOUNT, AND MAY INCREASE
OR DECREASE DAILY. IT IS NOT GUARANTEED AS TO DOLLAR AMOUNT. THE VARIABLE
FEATURES OF THIS CERTIFICATE ARE DESCRIBED IN SECTIONS 6 AND 7.
Modern Woodmen of America, a fraternal benefit society, will pay the benefits of
this certificate subject to all of its terms.
RIGHT TO EXAMINE CERTIFICATE
YOU MAY CANCEL THIS CERTIFICATE BY DELIVERING OR MAILING A WRITTEN NOTICE OR
SENDING A FAX TO THE AGENT THROUGH WHOM IT WAS PURCHASED OR MODERN WOODMEN OF
AMERICA VARIABLE PRODUCT ADMINISTRATIVE CENTER, P.O. BOX 9284, DES MOINES, IOWA
50306-9284 AND BY RETURNING THE CERTIFICATE BEFORE MIDNIGHT OF THE THIRTIETH DAY
AFTER THE DATE YOU RECEIVE THE CERTIFICATE. NOTICE GIVEN BY MAIL AND RETURN OF
THE CERTIFICATE BY MAIL ARE EFFECTIVE ON BEING POSTMARKED, PROPERLY ADDRESSED
AND POSTAGE PREPAID. MODERN WOODMEN OF AMERICA WILL REFUND, WITHIN SEVEN DAYS
AFTER IT RECEIVES NOTICE OF CANCELLATION AND THE RETURNED CERTIFICATE, AN AMOUNT
EQUAL TO THE GREATER OF THE PREMIUMS PAID OR THE SUM OF:
A) THE ACCUMULATED VALUE OF THE CERTIFICATE ON THE DATE THE CERTIFICATE IS
RECEIVED AT OUR ADMINISTRATIVE CENTER;
B) ANY ADMINISTRATIVE CHARGES WHICH WERE DEDUCTED; AND
C) AMOUNTS APPROXIMATING DAILY CHARGES AGAINST THE VARIABLE ANNUITY ACCOUNT.
READ YOUR CERTIFICATE CAREFULLY. This is a certificate of membership and
insurance and is a legal contract between the person having control and Modern
Woodmen of America.
SIGNED FOR AND ON BEHALF OF MODERN WOODMEN OF AMERICA AT ROCK ISLAND, ILLINOIS,
ON THE DATE OF ISSUE.
/s/ Clyde Schoeck /s/ J.V. Standaert
President Secretary
MODERN WOODMEN OF AMERICA
HOME OFFICE VARIABLE PRODUCT ADMINISTRATIVE CENTER
1701 1ST AVENUE P.O. BOX 9284
ROCK ISLAND, IL 61201 DES MOINES, IA 50306-9284
INDEX OF MAJOR CERTIFICATE PROVISIONS
CERTIFICATE DATA Page 3
Annuitant; Issue Age; Sex; Certificate Number; Issue Date; Owner; Normal
Retirement Date; Interest Rates; Schedule of Forms and Premiums; Schedule
of Charges; Schedule of Allocation Options.
SECTION 1 - DEFINITIONS Page 5
1.1 You, Your or Owner; 1.2 Annual Administrative Charge; 1.3 Annuitant;
1.4 Age; 1.5 Beneficiary; 1.6 Business Day; 1.7 Certificate Anniversary;
1.8 Certificate Year; 1.9 Declared Interest Option; 1.10 Due Proof of
Death; 1.11 Eligibility for Waiver of Surrender Charge; 1.12 Fund; 1.13
General Account; 1.14 Home Office; 1.15 Administrative Center; 1.16 Issue
Date; 1.17 Qualified Nursing Care Center; 1.18 Qualified Physician; 1.19
Retirement Date; 1.20 SEC; 1.21 Surrender Charge; 1.22 Valuation Period;
1.23 Variable Annuity Account; 1.24 We, Our, Us or the Society.
SECTION 2 - THE CONTRACT Page 7
2.1 Retirement Date; 2.2 Contract; 2.3 Modification; 2.4 Membership; 2.5
Control and Ownership; 2.6 Assignment; 2.7 Incontestable Clause; 2.8
Misstatement of Age or Sex; 2.9 Return of Certificate and Certificate
Settlement; 2.10 Maintenance of Reserves.
SECTION 3 - BENEFICIARIES Page 8
3.1 Beneficiary; 3.2 Change of Beneficiary.
SECTION 4 - PREMIUMS Page 9
4.1 Premium Payment; 4.2 Payment Frequency; 4.3 Unscheduled Premiums; 4.4
Allocation of Premium.
SECTION 5 - ANNUITY AND DEATH BENEFITS Page 10
5.1 Annuity Benefit; 5.2 Death of Annuitant Prior to Retirement Date; 5.3
Death of Owner; 5.4 Death Benefit at Death of Annuitant Prior to Retirement
Date.
SECTION 6 - VARIABLE ANNUITY ACCOUNT Page 12
6.1 Variable Annuity Account; 6.2 Subaccounts; 6.3 Fund Investment Options;
6.4 Transfers.
SECTION 7 - ACCUMULATED VALUE BENEFITS Page 13
7.1 Accumulated Value; 7.2 Net Accumulated Value; 7.3 Variable Accumulated
Value; 7.4 Subaccount Units; 7.5 Unit Value; 7.6 Declared Interest Option
Accumulated Value; 7.7 Declared Interest Option Interest; 7.8 Surrender;
7.9 Surrender Charge; 7.10 Partial Withdrawal; 7.11 Ten Percent Withdrawal
Privilege; 7.12 Waiver of Surrender Charge; 7.13 Delay of Payment; 7.14 Tax
Charges; 7.15 Annual Report.
SECTION 8 - SETTLEMENT OPTIONS - GENERAL Page 17
8.1 Options That May Be Elected; 8.2 Choice and Availability of Options;
8.3 Payee(s) and Death of Payee(s); 8.4 Claims of Creditors; 8.5
Supplemental Contract; 8.6 Proof of Survival and Age.
SECTION 9 - FIXED SETTLEMENT OPTIONS Page 19
9.1 Fixed Options; 9.2 Withdrawal; 9.3 Basis for Settlement Option Values;
9.4 Non-Segregation of Proceeds; Fixed Settlement Option Tables.
SECTION 10 - VARIABLE SETTLEMENT OPTIONS Page 21
10.1 Variable Options; 10.2 Allocation; 10.3 Exchanges of Annuity Units;
10.4 Surrender Value; 10.5 Amount of Variable Payments; 10.6 Annuity Unit
Value; 10.7 Net Investment Factor; 10.8 Assumed Interest Rate and Factor;
Variable Settlement Option Tables.
Any additional benefits and endorsements that apply to this certificate are
listed on the certificate data page and are described in the forms that follow
Section 10 of this certificate.
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CERTIFICATE DATA
Annuitant [JOHN Q WOODMEN]
Issue Age [35]
Sex [MALE]
Certificate Number [8500000]
Issue Date [02-01-2002]
[Owner] [JOHN Q WOODMEN]
Normal Retirement Date [2-01-2032]
On Declared Interest Option:
Guaranteed Minimum Interest Rate 3.00%
Current Interest Rate [5.50%]
Current Interest Rate guaranteed to: [02-01-2003]
Membership is in Camp [26]
************************ SCHEDULE OF FORMS AND PREMIUMS ************************
FORM NO. DESCRIPTION
[VAMWA (02-02) Flexible Premium Deferred Variable Annuity]
[VAIDBR (02-02) Incremental Death Benefit Rider]
Certificate Number [01234567]
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SCHEDULE OF CHARGES
Current Annual Administrative Charge: [$30.00 per year]
Transfer Charge: $25
Mortality and Expense Risk Charge: [.0038091% of the variable cash value per day
(equivalent to 1.40% per year).]
[A surrender charge will apply during the first 8 certificate years.]
[The surrender charge will be as shown in the following table:
Surrender Charge
CERTIFICATE YEAR (AS A PERCENT OF ACCUMULATED VALUE)
---------------- -----------------------------------
1 8.0%
2 7.0%
3 6.0%
4 5.0%
5 4.0%
6 3.0%
7 2.0%
8 1.0%
Thereafter 0.0%]
However, the total surrender charge assessed will never exceed 9% of the
premiums paid.
SCHEDULE OF ALLOCATION OPTIONS
General Account: The general assets of Modern Woodmen of America
Separate Account: Modern Woodmen of America Variable Annuity Account
Subaccounts: Subaccounts are listed in the application
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SECTION 1 - DEFINITIONS
1.1 YOU, YOUR OR OWNER
means the certificate holder who is the person (or persons) having control of
this certificate. See provision 2.5.
1.2 ANNUAL ADMINISTRATIVE CHARGE
means a fee that is charged yearly. The annual administrative charge may go up
or down but is guaranteed not to exceed $45. The annual administrative charge as
of the issue date is shown on the certificate data page.
1.3 ANNUITANT
The person whose life determines the annuity and death benefits.
1.4 AGE
means age at the last birthday.
1.5 BENEFICIARY
The person (or persons) to whom the proceeds will be paid on the death of the
annuitant.
1.6 BUSINESS DAY
means each day that the New York Stock Exchange is open for trading, except:
(1) any period when the Securities and Exchange Commission determines that an
emergency exists which makes it impracticable for a fund to dispose of its
securities or to fairly determine the value of its net assets; or
(2) such other periods as the Securities and Exchange Commission may permit for
the protection of security holders of a fund.
1.7 CERTIFICATE ANNIVERSARY
means the same date in each year as the issue date.
1.8 CERTIFICATE YEAR
means the 12-month period that begins on the issue date or on a certificate
anniversary.
1.9 DECLARED INTEREST OPTION
means an option in which accumulated value accrues interest at a guaranteed
minimum rate. The declared interest option is supported by the general account.
1.10 DUE PROOF OF DEATH
means documentation provided to the Society verifying proof of death.
1.11 ELIGIBILITY FOR WAIVER OF SURRENDER CHARGE
means the annuitant:
a) is diagnosed by a qualified physician as having a terminal illness. A
terminal illness is any disease or medical condition which the qualified
physician expects will result in death within one (1) year;
b) stays in a qualified nursing care center for 90 consecutive days; or
c) is required to satisfy the minimum distribution requirement of Sec. 401(a)
9 of the Internal Revenue Code.
1.12 FUND
means an open-end, diversified management investment company or unit investment
trust registered with the SEC under the Investment Company Act of 1940 in which
the Variable Annuity Account invests.
1.13 GENERAL ACCOUNT
means all our assets other than those allocated to the variable annuity account
or any other separate account. We have
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complete ownership and control of the assets of the general account.
1.14 HOME OFFICE
means Modern Woodmen of America, 1701 1st Avenue, Rock Island, IL 61201.
1.15 ADMINISTRATIVE CENTER
means Modern Woodmen of America Variable Product Administrative Center, P.O. Box
9284, Des Moines, Iowa 50306-9284.
1.16 ISSUE DATE
means the issue date shown on the certificate data page. This date is used to
determine certificate years and certificate anniversaries.
1.17 QUALIFIED NURSING CARE CENTER
means a long-term care center that is licensed to operate according to the laws
of its location. The following are qualified nursing care centers:
a) Skilled Nursing Center - means a center:
1) that provides skilled nursing care supervised by a licensed physician;
2) that provides 24-hour nursing care by, or supervised by, a Registered
Nurse (R.N.); and
3) that keeps a daily medical record of each patient.
b) Intermediate Care Center - means a center:
1) that provides 24-hour nursing care by, or supervised by, an R.N. or a
Licensed Practical Nurse (L.P.N.); and
2) that keeps a daily medical record of each patient.
c) Hospital - means a center:
1) that operates for the care and treatment of sick or injured persons
as inpatients;
2) that provides 24-hour nursing care by, or supervised by, an R.N.;
3) that is supervised by a staff of licensed physicians; and
4) that has medical, diagnostic, and major surgery capabilities or access
to such capabilities.
Qualified Nursing Care Center does not include:
a) drug or alcohol treatment centers;
b) home for the aged or mentally ill, community living centers, or places that
primarily provide domiciliary, residency or retirement care; or
c) places owned or operated by a member of the annuitant's immediate family.
1.18 QUALIFIED PHYSICIAN
means a licensed, medical practitioner performing within the scope of his/her
license. Such person must be someone other than you, the annuitant, or a member
of the immediate family of either you or the annuitant.
1.19 RETIREMENT DATE
means the certificate anniversary nearest the retirement age chosen in the
application.
1.20 SEC
means the Securities and Exchange Commission, a U.S. government agency.
1.21 SURRENDER CHARGE
means a fee that is applied to the accumulated value at the time of any partial
withdrawal or full surrender. The surrender charges are shown on the certificate
data page.
1.22 VALUATION PERIOD
means the period between the close of business on a business day and the close
of business on the next business day.
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1.23 VARIABLE ANNUITY ACCOUNT
means the Separate Account shown on the certificate data page. It is a unit
investment trust registered with the SEC under the Investment Company Act of
1940.
1.24 WE, OUR, US OR THE SOCIETY
means Modern Woodmen of America.
SECTION 2 - THE CONTRACT
2.1 RETIREMENT DATE
You may choose a retirement date on the application. However, such retirement
date may not be after the later of the annuitant's 70th birthday or the 10th
certificate anniversary. If no date is chosen on the application, the later of
these dates will be used. You may change the retirement date at any time.
However, the retirement date may not be changed after distribution payments
begin. If the certificate is subject to Internal Revenue Service minimum
distribution requirements, we will begin distributions as required.
2.2 CONTRACT
This certificate is a legal contract. We issue this certificate in consideration
of the first premium and the statements in the application. The entire contract
consists of:
a) the basic certificate;
b) any endorsements or additional benefit riders;
c) the attached copy of your application;
d) any amendments, supplemental applications or other attached papers; and
e) the Articles of Incorporation and By-Laws of the Society which are in force
on the issue date of this certificate.
We rely on statements made in the application for the certificate. These
statements, in the absence of fraud, are deemed representations and not
warranties. No statement will void this certificate or be used in defense of a
claim unless:
a) it is contained in the application; and
b) such application is attached to this certificate.
2.3 MODIFICATION
No one can change any part of this certificate except you and one of our
officers. Both must agree to a change, and it must be in writing. No agent may
change this certificate or waive any of its provisions.
2.4 MEMBERSHIP
An annuitant of the age of 16 or more is an adult member of the Society. An
adult member has all of the privileges of membership as provided in the By-Laws.
An annuitant of the age of 15 or less is a junior member until age 16 when adult
membership begins. The rights and privileges of membership are personal to the
annuitant. They may not be transferred to any other person.
2.5 CONTROL AND OWNERSHIP
The annuitant is the owner and person having control of this certificate, unless
another owner is named. During the annuitant's lifetime, the person having
control of this certificate may exercise all of the rights and receive all of
the benefits provided by this certificate without the consent of any other
person.
If the issue age specified on the certificate data page is 15 or less, the
applicant for this certificate, or the applicant's duly appointed successor,
shall have control of this certificate but may not assign it. During the period
after the annuitant attains age 16 and before the annuitant attains age 21,
control
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will pass to the annuitant: (a) upon the death of such applicant; or (b)
upon receipt of written request by such applicant in form satisfactory to the
Society. When the annuitant attains age 21, control shall pass to the annuitant.
2.6 ASSIGNMENT
No assignment of this certificate will bind us unless it is:
a) in writing on a form acceptable to us;
b) signed by you; and
c) received by us at our administrative center.
We will not be responsible for the validity of an assignment. Any indebtedness
to the Society against this certificate will have priority over any assignment.
2.7 INCONTESTABLE CLAUSE
We will not contest this certificate from its issue date.
2.8 MISSTATEMENT OF AGE OR SEX
We have the right to correct benefits for misstated age or sex. In such an
event, benefits will be the amount the premium actually paid would have bought
at the correct age or sex.
2.9 RETURN OF CERTIFICATE AND CERTIFICATE SETTLEMENT We reserve the right to
have this certificate sent to us for any:
a) modification; b) death settlement; c) surrender; d) assignment; e) change of
beneficiary; f) election; or g) exercise of any certificate privilege.
All sums to be paid by us under this certificate are considered paid when
tendered by us at our administrative center.
2.10 MAINTENANCE OF RESERVES
This provision applies only to benefits provided through the declared interest
option which is supported by the general account. If an emergency should arise
which would impair the reserves of the Society, the Board of Directors may
determine a fair share of the deficiency which will be paid by you. If such
payment is not made, it will stand as a debt against this certificate and draw
interest at 5% per year compounded annually. In lieu of such debt or in
combination with it, you may consent to an equivalent reduction in benefits.
SECTION 3 - BENEFICIARIES
3.1 BENEFICIARY
Beneficiaries are as named in the application, unless changed by you.
Unless the beneficiary designation provides otherwise, if any beneficiary dies
before the annuitant, that beneficiary's interest will pass to any other
beneficiaries according to their respective interest.
Contingent beneficiaries will have the right to receive the proceeds only if no
principal beneficiary survives. If no designated beneficiary survives the
annuitant, the proceeds will be paid as stated in the By-Laws of the Society.
In finding and identifying beneficiaries we may rely on sworn statements, other
facts, or evidence we deem satisfactory. Any benefits we pay based on such
information will be a valid discharge of our duty up to the amount paid.
3.2 CHANGE OF BENEFICIARY
While the annuitant is alive, a change of
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beneficiary can be made at any time,
subject to the following rules:
a) the change must be in writing on a form acceptable to us;
b) it must be signed by you;
c) the change form must be sent to our administrative center and recorded by
us;
d) the change will take effect on the date signed, but it will not apply to
any payment made or action taken by us before we recorded the change form;
and
e) a change of beneficiary designation will automatically revoke any previous
designations.
SECTION 4 - PREMIUMS
4.1 PREMIUM PAYMENT
Premium payments may be made at any time. However, we reserve the right to limit
or restrict the amount of a premium payment as we deem appropriate. Premiums are
to be paid at our administrative center. The first premium must be equal to or
greater than $1,000. Thereafter, premium payments are flexible as to both timing
and amount. No payment may be less than $50 without our consent.
Any member suspended as a result of disciplinary action for conduct unbecoming a
member of the Society will have the right to make premium payments to maintain
this certificate in force.
4.2 PAYMENT FREQUENCY
The first premium is due on or prior to the issue date. We will send periodic
reminder notices to you. The minimum amount for which such notice will be sent
will be $50. A reminder notice may be sent for different periods of 12, 6, or 3
month intervals. The reminder notice period may be changed upon request.
4.3 UNSCHEDULED PREMIUMS
Unscheduled premium payments of at least $50 may be made at any time prior to
the retirement date. The Society may, in its discretion, waive the $50 minimum
requirement. We reserve the right to limit the number and amount of unscheduled
premium payments.
4.4 ALLOCATION OF PREMIUM
You will determine the percentage of premium that will be allocated to each
subaccount of the variable annuity account and to the declared interest option.
You may choose to allocate all of the premium, a percentage or nothing to a
particular subaccount or to the declared interest option. Any allocation must be
for at least 10% of the premium. A fractional percent may not be chosen.
On the issue date, when we receive your properly completed application and
initial premium at the Administrative Center, we will allocate the initial
premium and any additional premiums received within the next 10 days to the
money market subaccount. However, if your application is not properly completed,
we will retain your premium for up to five business days while we attempt to
complete the application. At the end of this five-day period, if the application
is not complete, we will inform you of the reason for the delay and we will
return the initial premium immediately unless you specifically consent to our
retaining the premium until the application is complete.
On the 11th day following the issue date, we will transfer part or all of the
accumulated value in the money market subaccount to the subaccounts or the
declared interest option
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in accordance with the premium allocation percentages shown in the application.
For any subsequent premiums received, the premium will be allocated in
accordance with the premium allocation percentages shown in the application or
in your most recent written instructions.
You may change the allocation for future premiums at any time, subject to the
following rules:
a) the certificate must be in force;
b) there must be an accumulated value;
c) the change must be in writing on a form acceptable to us;
d) the form must be signed by you;
e) the change will take effect on the business day on or next following the
date we receive the signed form at our administrative center.
A change of allocation of future premiums does not affect current accumulated
values.
SECTION 5 - ANNUITY AND DEATH BENEFITS
5.1 ANNUITY BENEFIT
If the annuitant lives to the retirement date, we will pay a monthly income
based on your life beginning on the retirement date if:
a) this certificate is in force on the retirement date;
b) you have not elected to have the accumulated value paid in a single sum;
and
c) you have not elected a different settlement option.
The amount of payments will be obtained by applying the accumulated value under
fixed settlement option 3 or variable settlement option A. We will make at least
120 monthly payments. After 120 monthly payments, you must be living for further
payments to be made. If you die before 120 monthly payments have been received,
any remaining payments will be paid to the beneficiary. If no beneficiary
survives, we will pay the commuted value, as determined by us, of any remaining
payments to the estate of the last to die.
5.2 DEATH OF ANNUITANT PRIOR TO RETIREMENT DATE
If the annuitant dies prior to the retirement date and the annuitant is not an
owner, we will pay the death benefit to the beneficiary. The beneficiary may
elect to apply this sum under one of the annuity settlement options as payee.
See Section 5.3 if the annuitant is an owner.
5.3 DEATH OF OWNER
If an owner dies prior to the retirement date and the deceased owner is the
annuitant, we will pay the death benefit to the beneficiary in one sum within
five (5) years of the deceased owner's death. The beneficiary may elect, within
60 days of the date we receive due proof of death, to apply this sum under one
of the annuity settlement options as payee, provided:
a) payments under the annuity settlement option begin not later than one (1)
year after the owner's death; and
b) payments will be payable for the life of the beneficiary, or over a period
not greater than the beneficiary's life expectancy.
If an owner dies prior to the retirement date and the deceased owner is not the
annuitant, the surviving owner will be the new owner. If there is no surviving
owner, ownership of this certificate will pass to the deceased owner's estate.
The net accumulated value of the contract must be distributed within five (5)
years of the deceased owner's death.
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If the deceased owner's spouse is the sole new owner and beneficiary, the spouse
may elect, within 60 days of the date we receive due proof of death, to the
extent permitted by law, to continue this certificate in force.
If an owner dies on or after the retirement date, but before all proceeds
payable have been distributed, we will continue payments to the beneficiary
under the payment method in effect at the time of the deceased owner's death.
For purposes of this section, if an owner of this certificate is not an
individual, the death of the annuitant shall be treated as the death of the
owner.
5.4 DEATH BENEFIT AT DEATH OF ANNUITANT PRIOR TO RETIREMENT DATE The death
benefit will be determined based on the annuitant's age on the issue date.
If the annuitant's age on the issue date is:
a) less than 76, the death benefit will be equal to the greatest of:
1) the sum of all premium payments less the sum of all partial withdrawal
reductions, as of the date due proof of death is received;
2) the accumulated value as of the date due proof of death is received;
or
3) the Performance Enhanced Death Benefit (PEDB) amount as of the date
due proof of death is received.
The PEDB amount is equal to the greater of:
i) the previous PEDB amount; or
ii) the accumulated value as of the calculation date.
The Performance Enhanced Death Benefit (PEDB) amount on the issue date
is zero. The PEDB amount is recalculated on each certificate
anniversary. In addition:
i) with each additional premium payment, the PEDB is increased by
the amount of each additional premium; and
ii) with each partial withdrawal reduction, the PEDB amount is
decreased by the amount of each partial withdrawal reduction.
We will recalculate the PEDB as described above until the certificate
anniversary immediately prior to the annuitant's age 91. After that, the
PEDB amount is recalculated only for additional premium payments or partial
withdrawal reductions as described above.
b) 76 or greater, the death benefit is equal to the greater of:
1) the sum of all premium payments less the sum of all partial withdrawal
reductions, as of the date due proof of death is received; or
2) the accumulated value as of the date due proof of death is received.
For purposes of this section, a partial withdrawal reduction is equal to a)
times b) divided by c) where:
a) is the death benefit immediately prior to withdrawal;
b) is the amount of the partial withdrawal; and
c) is the accumulated value immediately prior to withdrawal.
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SECTION 6 - VARIABLE ANNUITY ACCOUNT
6.1 VARIABLE ANNUITY ACCOUNT
We own the assets of the variable annuity account. We will value the assets of
the variable annuity account each business day. The assets of such account will
be kept separate from the assets of our general account and any other separate
accounts. Income and realized and unrealized gains or losses from assets in the
variable annuity account will be credited to or charged against such account
without regard to our other income, gains or losses.
That portion of the assets of the variable annuity account that equals the
reserves and other liabilities of the certificates that are supported by the
variable annuity account will not be charged with liabilities arising from any
other business we conduct. We have the right to transfer to our general account
any assets of the variable annuity account that are in excess of such reserves
and other certificate liabilities.
While the variable annuity account is registered with the SEC and thereby
subject to SEC rules and regulations, it is also subject to the laws of the
State of Illinois that regulate the operations of insurers incorporated in
Illinois.
We also reserve the right to transfer assets of the variable annuity account,
which we determine to be associated with the class of certificates to which this
certificate belongs, to another separate account. If this type of transfer is
made, the term "variable annuity account," as used in this certificate, shall
then mean the variable annuity account to which the assets were transferred.
When permitted by law, we also reserve the right to:
a) deregister the variable annuity account under the Investment Company Act of
1940;
b) manage the variable annuity account under the direction of a committee;
c) restrict or eliminate any voting rights you or other persons have as to the
variable annuity account; and
d) combine the variable annuity account with other separate accounts.
6.2 SUBACCOUNTS
The variable annuity account is divided into subaccounts. The subaccounts are
listed in the application. Subject to obtaining any approvals or consents
required by applicable law, we reserve the right to eliminate or combine any
subaccounts and the right to transfer the assets of one or more subaccounts to
any other subaccount.
We also reserve the right to add new subaccounts and make such subaccounts
available to any class or series of certificates as we deem appropriate. Each
new subaccount would invest in a new investment option of a fund, or in shares
of another investment company. You will determine the percentage of premium that
will be allocated to each subaccount in accordance with the allocation of
premium provision.
6.3 FUND INVESTMENT OPTIONS
The funds have one or more investment options each of which corresponds to one
of the subaccounts of the variable annuity account. The investment options are
listed in the application. Premiums allocated to a subaccount will automatically
be invested in the fund investment option associated with that subaccount. You
will share only in the income, gains or losses of the investment
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option(s) where shares are held.
We have the right, subject to compliance with any applicable laws, to make:
a) additions to;
b) deletions from; or
c) substitutions for;
the shares of a fund investment option that are held by the variable annuity
account or that the account may purchase.
We also reserve the right to dispose of the shares of a fund and to substitute
shares of another investment option of such fund or shares of another investment
company:
a) if the shares of the investment option are no longer available for
investment; or
b) if in our judgment further investment in the investment option should
become inappropriate in view of the purposes of the variable annuity
account.
In the event of any substitution or change, we may, by appropriate endorsement,
make such changes in this and other certificates as may be necessary or
appropriate to reflect the substitution or change.
6.4 TRANSFERS
You may transfer all or part of the accumulated value among the subaccounts of
the variable annuity account and between the subaccounts and the declared
interest option, subject to the following rules:
a) the transfer request may be by telephone or in writing on a form acceptable
to us;
b) the transfer will take effect as of the end of the valuation period during
which we receive the transfer request at our administrative center;
c) you may transfer amounts among the subaccounts of the variable annuity
account an unlimited number of times in a certificate year;
d) you may transfer amounts from the declared interest option to the variable
annuity account an unlimited number of times; amounts transferred from the
declared interest option are considered transferred on a last-in-first-out
basis;
e) the first 12 transfers in each certificate year will be made without a
transfer charge; thereafter, each time amounts are transferred, a transfer
charge may be imposed; this transfer charge is shown on the certificate
data page;
f) the accumulated value on the date of the transfer will not be affected by
the transfer except to the extent of the transfer charge; unless paid in
cash, the transfer charge will be deducted on a pro rata basis from the
declared interest option and/or the subaccounts to which the transfer is
made;
g) you must transfer at least:
1) a total of $100; or
2) the total accumulated value in the subaccount or the total accumulated
value in the declared interest option, if the total amount transferred
is less than $100.
h) no more than 25% of the accumulated value in the declared interest option
may be transferred unless the balance in the declared interest option after
the transfer would be less than $1,000; if the balance in the declared
interest option would fall below $1,000, the full accumulated value in the
declared interest option may be transferred.
SECTION 7 - ACCUMULATED VALUE BENEFITS
7.1 ACCUMULATED VALUE
The accumulated value of this certificate will be the sum of:
13
a) the accumulated value in the subaccounts of the variable annuity account;
PLUS
b) the accumulated value in the declared interest option.
All of the values are the same or more than the minimums set by the laws of the
state where the certificate is delivered.
7.2 NET ACCUMULATED VALUE
The net accumulated value of this certificate will be the accumulated value less
a surrender charge. All of the values are the same or more than the minimums set
by the laws of the state where the certificate is delivered.
7.3 VARIABLE ACCUMULATED VALUE
On the business day on or next following the day we receive a completed
application and the minimum initial premium, the variable accumulated value is
the total amount of premium, if any, allocated to the subaccounts of the
variable annuity account. Until 10 days after the issue date, we place this
amount in the money market subaccount. After such period, the certificate's
variable accumulated value is equal to the sum of the certificate's accumulated
value in each subaccount. The accumulated value in a subaccount is equal to a)
multiplied by b) where:
a) is the current number of subaccount units; and
b) is the current unit value.
The variable accumulated value will vary from business day to business day
reflecting changes in a) and b) above.
7.4 SUBACCOUNT UNITS
When transactions are made which affect the variable accumulated value, dollar
amounts are converted to subaccount units. The number of subaccount units for a
transaction is determined by dividing the dollar amount of the transaction by
the current unit value.
The number of units for a subaccount increases when:
a) premiums are credited to that subaccount; or
b) transfers from the declared interest option or other subaccounts are
credited to that subaccount.
The number of units for a subaccount decreases when:
a) you make a surrender or partial withdrawal from that subaccount;
b) transfers are made from that subaccount to the declared interest option or
other subaccounts; or
c) the annual administrative charge shown on the certificate data page is
deducted (the annual administrative charge will be prorated among the
subaccounts and the declared interest option).
7.5 UNIT VALUE
The unit value for a subaccount on any business day is determined by dividing
each subaccount's net asset value by the number of units outstanding at the time
of calculation. The unit value for each subaccount was set initially at $10 when
the subaccounts first purchased fund shares. The unit value for each subsequent
valuation period is calculated by dividing a) by b), where:
a) is:
1) the value of the net assets of the subaccount at the end of the
preceding valuation period;
PLUS
2) the investment income and capital gains, realized or unrealized,
14
credited to the net assets of that subaccount during the valuation
period for which the unit value is being determined;
MINUS
3) the capital losses, realized or unrealized, charged against those net
assets during the valuation period;
MINUS
4) any amount charged against the subaccount for taxes, or any amount set
aside during the valuation period by the Society as a provision for
taxes attributable to the operation or maintenance of that subaccount;
MINUS
5) the mortality and expense risk shown on the certificate data page;
this charge may go up or down but will never exceed 0.0038091% of the
net daily assets in that subaccount for each day in the valuation
period; the maximum charge corresponds to a charge of 1.4% per year of
the average daily net assets of the subaccount for mortality and
expense risks.
b) is the number of units outstanding at the end of the preceding valuation
period.
The unit value for a valuation period applies for each day in the period. We
will value the net assets in each subaccount at their fair market value in
accordance with accepted accounting practices and applicable laws and
regulations.
7.6 DECLARED INTEREST OPTION ACCUMULATED VALUE
The declared interest option accumulated value as of the 11th day following the
issue date is the amount transferred from the money market subaccount to the
declared interest option as of that date. Thereafter, the declared interest
option accumulated value changes every valuation period.
The declared interest option accumulated value increases when:
a) premiums are allocated to the declared interest option; or
b) transfers from the subaccounts are credited to the declared interest
option; or
c) any interest is credited to the declared interest option.
The declared interest option accumulated value decreases when:
a) you make a surrender or partial withdrawal from the declared interest
option; or
b) transfers are made from the declared interest option to the subaccounts; or
c) the annual administrative charge shown on the certificate data page is
deducted (the annual administrative charge will be prorated among the
subaccounts and the declared interest option).
For the purposes of the above calculation, interest does not accrue on amounts
deducted for certificate charges, amounts transferred from or on amounts
surrendered or withdrawn from the declared interest option. Interest is accrued
on the accumulated value of the declared interest option on a daily basis and is
credited no less frequently than once a certificate year.
7.7 DECLARED INTEREST OPTION INTEREST
The guaranteed minimum interest rate applied to the declared interest option
accumulated value is an effective rate of 3% per year. Interest in excess of the
minimum rate may be applied. The amount of the excess interest credited for any
certificate year will be set by us at the start of that
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certificate year and will be guaranteed for such year.
7.8 SURRENDER
Before the retirement date, you may surrender the certificate, subject to the
following rules:
a) you must send a written request to us along with such information or
evidence as may be required by law or as may be needed to process the
request;
b) the amount of any such surrender may be paid in cash or we will apply part
or all of it under a settlement option;
c) a surrender charge may apply; if the surrender charge is not paid in cash,
such charge will be deducted from the amount surrendered;
d) upon surrender, the certificate will terminate unless the proceeds are
applied under a variable settlement option.
7.9 SURRENDER CHARGE
The surrender charge is shown on the certificate data page. The total surrender
charges assessed will never exceed 9% of premiums paid.
If all of the accumulated value is applied under settlement option 2, 3, 4, 5, A
or B, the surrender charge will be reduced as follows:
a) if option 3, 5, A or B is used, the surrender charge will be zero; or
b) if option 2 or 4 is used, the surrender charge will be applied; however,
the fixed number of years for which payment will be made is added to the
number of years the certificate has been in force to determine what the
charge will be.
All of the values are the same or more than the minimums set by the laws of the
state where the certificate is delivered.
7.10 PARTIAL WITHDRAWAL
Before the retirement date, you may obtain a partial withdrawal of the
accumulated value, subject to the following rules:
a) the amount of any partial withdrawal must be at least $500;
b) if the accumulated value after a partial withdrawal is less than $2,000, we
have the right to pay the remaining accumulated value to you as a full
surrender;
c) the accumulated value will be reduced by the amount of any partial
withdrawal and any surrender charge applying to such withdrawal; you may
tell us how to allocate a partial withdrawal among the subaccounts and the
declared interest option; if you do not so instruct, we will prorate the
partial withdrawal among the subaccounts and the declared interest option;
the allocation will be in the same proportion that the accumulated value in
each of the subaccounts and the accumulated value in the declared interest
option bears to the total accumulated value on the date we receive the
request; and
d) amounts withdrawn from the declared interest option are considered
withdrawn on the last-in-first-out basis.
7.11 TEN PERCENT WITHDRAWAL PRIVILEGE
After the first certificate year, amounts up to the "withdrawal privilege
amount" may be withdrawn from the certificate during each certificate year
without being subject to the surrender charge. The withdrawal privilege amount
will be equal to 10% of the accumulated value on the most recent certificate
anniversary.
7.12 WAIVER OF SURRENDER CHARGE
You may surrender this certificate without
16
incurring a surrender charge if the annuitant becomes eligible for waiver of the
surrender charge.
The waiver of the surrender charge is subject to the following rules:
a) we must receive a written request signed by you;
b) the certificate must be in force or not providing benefits under any
payment option;
c) proof must be provided that the conditions of eligibility requirements for
waiver of the surrender charge as described in Section 1.11 have been met,
including an attending physician's statement and any other proof we may
require; we reserve the right to seek a second medical opinion or have an
examination performed at our expense by a physician we choose; and
d) the annuitant must become eligible for waiver of surrender charge after the
first certificate year ends.
7.13 DELAY OF PAYMENT
Proceeds from full surrenders and partial withdrawals will usually be mailed to
you within 7 days after your signed request is received in our administrative
center. We will usually mail any death claim proceeds within 7 days after we
receive due proof of death. We have the right to delay such payment whenever:
a) the New York Stock Exchange is closed other than on customary weekends and
any holiday closing;
b) trading on the New York Stock Exchange is restricted as determined by the
SEC;
c) the SEC, by order, permits postponement for the protection of certificate
holders; or
d) as a result of an emergency, as determined by the SEC, it is not reasonably
possible to dispose of securities or to determine the value of the net
assets of the variable annuity account.
We have the right to defer payment which is derived from any amount paid to us
by check or draft until we are satisfied the check or draft has been paid by the
bank on which it is drawn.
We also have the right to delay making a full surrender or partial withdrawal,
from the declared interest option for up to 6 months from the date we receive
your request.
7.14 TAX CHARGES
The Society may make a charge against the accumulated value of this certificate
for any tax or economic burden on the Society resulting from the application of
federal, state or local tax laws that the Society determines to be properly
attributable to the separate account or the certificate.
7.15 ANNUAL REPORT
At least once each year we will send a report, without charge, to you that
shows:
a) all premiums paid and charges made since the last report;
b) the current accumulated value including the value in each subaccount and
the declared interest option; and
c) any partial withdrawals since the last report.
At other times, an illustrative report will be sent to you upon request. A fee
may be charged for this report.
SECTION 8 - SETTLEMENT OPTIONS - GENERAL
8.1 OPTIONS THAT MAY BE ELECTED
Settlement proceeds include amounts
17
payable resulting from the death of the annuitant, partial withdrawals applied
to a settlement option, or surrender of this certificate. All or part of the
settlement proceeds may be left with the Society under the Fixed Settlement
Options described in Section 9 or the Variable Settlement Options described in
Section 10 or a combination of both. Additional options may also be available.
8.2 CHOICE AND AVAILABILITY OF OPTIONS
An option may be elected in the application for this certificate. An option may
be elected, revoked or changed by you during the lifetime of the annuitant upon
written request recorded at our administrative center. If an election is not in
effect at the death of the annuitant, the beneficiary may elect an option,
unless the manner of settlement has been restricted.
If no option is chosen, we will pay the proceeds of this certificate in one sum.
We may also fulfill our obligation under this certificate by paying the proceeds
in one sum if:
a) the proceeds are less than $5,000;
b) the payments are less than $50 each; or
c) the payee is an assignee, estate, trustee, partnership, corporation or
association.
8.3 PAYEE(S) AND DEATH OF PAYEE(S)
A person for whose benefit an option is elected shall be a payee under the
option. A person to be a payee must be a natural person taking in his or her own
right. When an option is elected, a secondary payee may be designated to receive
any final amount that would be payable.
Unless otherwise provided, at the death of a payee under any optional method of
settlement, any unpaid proceeds due such payee and remaining with the Society
under Fixed Settlement Option 1 or 4, or the commuted value, as determined by
us, of any remaining guaranteed payments due such payee under Fixed Settlement
Option 2 or 3 or Variable Settlement Option A, will be paid in a lump sum
settlement in equal shares to the then surviving principal beneficiaries as
secondary payees. If no principal beneficiary is then living, any such unpaid
amounts will be paid to the then surviving contingent beneficiaries as secondary
payees. If no principal or contingent beneficiary survives the payee, any such
unpaid amounts will be paid in one sum to the estate of the payee. Commutation
will be based on interest at 3% per year.
8.4 CLAIMS OF CREDITORS
Payments under any settlement option will be exempt from the claims of creditors
to the maximum extent allowed by law.
8.5 SUPPLEMENTAL CONTRACT
A supplemental contract will be issued on the date of settlement. It will show
the rights and benefits of the payee(s) under the settlement option elected. The
first payment will be payable, or in the case of Option 1 interest will commence
to accrue, as of the date of the supplemental contract. Payment intervals may be
annual, semiannual, quarterly or monthly.
8.6 PROOF OF SURVIVAL AND AGE
If payment under an option depends on the survival of any person, the Society
may require satisfactory evidence that such person is living when the payment
becomes due. The Society may also require satisfactory evidence of the age of
any person on whose life the payments are based.
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SECTION 9 - FIXED SETTLEMENT OPTIONS
9.1 FIXED OPTIONS
The fixed settlement options, which are supported by the Society's general
account, are:
OPTION 1. DEPOSIT AT INTEREST. Interest income will be paid on proceeds
left with the Society. The rate of interest will be not less than 3% per year.
OPTION 2. INCOME FOR A FIXED PERIOD. Equal monthly income payments will be
made for a period specified by you for between one and 30 years. Amounts are
shown in the Settlement Option Table for Option 2.
OPTION 3. LIFE INCOME WITH GUARANTEED PERIOD. Equal monthly income payments
will be made for a guaranteed period, and will continue thereafter during the
lifetime of the payee. Amounts are shown in the Settlement Option Table for
Option 3. The guaranteed period may be 10 or 20 years or the period required for
the total payments to equal the proceeds applied (installment refund).
OPTION 4. INCOME OF A FIXED AMOUNT. Equal monthly, quarterly, semiannual or
annual income payments of a specified amount will be made. Payments each year
must total not less than 5% of the original proceeds left with the Society. The
payments will continue until the proceeds, together with interest at the rate of
3% per year, are fully paid.
OPTION 5. JOINT AND SURVIVOR LIFE INCOME. Equal monthly income payments may
be made jointly to two payees. Two-thirds of the original income payment will be
paid to the survivor during the survivor's remaining lifetime. The amount of
each payment will depend on the age and sex of the payees. Amounts are shown in
the Settlement Option Table for Option 5. This option has no guaranteed period.
9.2 WITHDRAWAL
Except as otherwise provided in the election of a settlement option, a payee may
elect to withdraw any unpaid balance of proceeds under Option 1 or 4, or may
elect to receive the commuted value of any remaining payments under Option 2.
Options 3 and 5 have no withdrawal rights.
9.3 BASIS FOR SETTLEMENT OPTION VALUES
Reserves and net single premiums for fixed settlement options involving life
contingencies are based on the Annuity 2000 individual annuity mortality table
with interest at 3% per year.
9.4 NON-SEGREGATION OF PROCEEDS
Any proceeds held by us under a fixed settlement option may be mingled with the
general assets of the Society. We will not be under any duty or requirement to
segregate or separately invest the proceeds of the fixed account.
19
FIXED SETTLEMENT OPTION TABLES
Monthly Income Payments for
Each $1,000 of Proceeds
OPTION 2 - INCOME FOR A FIXED PERIOD
PERIOD PERIOD PERIOD
OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENT YEARS PAYMENT YEARS PAYMENT
----------- ----------- -------- ----------- --------- ------------
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
Annual, Semiannual, or Quarterly payments are respectively, 11.839, 5.963, and
2.993 times the monthly payments.
GUARANTEED SETTLEMENT OPTION 3
MONTHLY LIFE INCOME WITH GUARANTEED PERIOD
MALE FEMALE UNISEX
------- --------------------------- ------------------------------ --------------------------
AGE OF 10 20 INSTALLMENT 10 20 INSTALLMENT 10 20 INSTALLMENT
PAYEE YEARS YEARS REFUND YEARS YEARS REFUND YEARS YEARS REFUND
------- ------ ----- ----------- ----- ----- ----------- ----- ----- -----------
35 $3.34 $3.33 $3.31 $3.22 $3.21 $3.20 $3.24 $3.23 $3.22
40 3.53 3.50 3.47 3.37 3.35 3.34 3.40 3.38 3.37
45 3.76 3.70 3.68 3.57 3.54 3.52 3.61 3.57 3.55
50 4.05 3.95 3.93 3.81 3.76 3.74 3.86 3.80 3.78
55 4.41 4.24 4.25 4.13 4.03 4.02 4.18 4.07 4.07
60 4.88 4.56 4.64 4.54 4.35 4.38 4.61 4.40 4.43
65 5.48 4.88 5.15 5.07 4.71 4.84 5.16 4.75 4.90
70 6.23 5.16 5.80 5.78 5.05 5.45 5.87 5.08 5.52
75 7.08 5.36 6.63 6.67 5.31 6.26 6.75 5.32 6.33
80 7.95 5.46 7.70 7.66 5.45 7.34 7.72 5.45 7.41
85 8.69 5.50 9.07 8.55 5.50 8.75 8.58 5.50 8.82
GUARANTEED SETTLEMENT OPTION 5
JOINT AND 2/3 TO SURVIVOR LIFE INCOME
Male Female Payee Age
Payee
Age 50 55 60 65 70 75
------------ ------- -------- -------- -------- ------- --------
50 $3.80 $3.95 $4.12 $4.30 $4.50 $4.73
55 3.93 4.11 4.31 4.53 4.77 5.04
60 4.09 4.29 4.53 4.79 5.09 5.42
65 4.25 4.49 4.77 5.09 5.46 5.88
70 4.43 4.70 5.02 5.42 5.88 6.41
Unisex Unisex Payee Age
Payee
Age 50 55 60 65 70 75
------------ ------- -------- -------- -------- ------- --------
50 $3.74 $3.88 $4.03 $4.20 $4.38 $4.58
55 3.88 4.04 4.22 4.42 4.64 4.87
60 4.03 4.22 4.44 4.68 4.95 5.23
65 4.20 4.42 4.68 4.98 5.31 5.67
70 4.38 4.64 4.95 5.31 5.73 6.20
20
SECTION 10 - VARIABLE SETTLEMENT OPTIONS
10.1 VARIABLE OPTIONS
The variable settlement options are:
OPTION A. LIFE INCOME WITH GUARANTEED PERIOD. Monthly income payments will
be made for a guaranteed period, and will continue thereafter during the
lifetime of the payee. Initial amounts are shown in the Variable Settlement
Option Table for Option A. The guaranteed period may be 10 or 20 years.
OPTION B. JOINT AND SURVIVOR LIFE INCOME. Monthly income payments may be
made jointly to two payees. The payment will be paid to the survivor during the
survivor's remaining lifetime. The amount of each payment may depend on the age
and sex of the payees. Initial amounts are shown in the Variable Settlement
Option Table for Option B. This option has no guaranteed period.
10.2 ALLOCATION
On the date the proceeds are applied to a variable settlement option, the
payee(s) will determine the percentage of proceeds that will be allocated to the
subaccounts. Any allocation must be for at least 10% of the proceeds. A
fractional percent may not be chosen.
10.3 EXCHANGES OF ANNUITY UNITS
An annuity unit is a unit of measure used to calculate the amount of payments.
The payee(s) may exchange annuity units of one subaccount for those of another
on a dollar equivalent basis.
The following rules apply to exchanges:
a) the exchange request may be by telephone or in writing on a form acceptable
to us;
b) the exchange will take effect as of the end of the valuation period during
which we receive the request at our administrative center; and
c) the payee(s) may exchange annuity units among the subaccounts an unlimited
number of times in a contract year.
10.4 SURRENDER VALUE
The value payable at full surrender will be equal to:
a) the commuted value of remaining term certain payments;
MINUS
b) a commutation fee varying by contract year since the effective date of the
supplemental contract:
CONTRACT YEAR COMMUTATION FEE
OF SETTLEMENT (AS A PERCENT OF
OPTION ORIGINAL PROCEEDS)
------------- ------------------
1 6%
2 5
3 4
4 3
5 2
6 1
Thereafter 0
The interest rate used to compute the commuted value of any unpaid payments
certain will be the assumed interest rate. Each payment under a variable
settlement option will be assumed to be equal to the number of annuity units
times the applicable annuity unit value.
10.5 AMOUNT OF VARIABLE PAYMENTS
The amount of the first payment under a variable settlement option is equal to:
a) the number of thousands of dollars of proceeds applied to the option;
TIMES
b) the factor per $1,000 for the option, from
21
the Variable Settlement Option Tables.
The amount of each later payment is equal to the sum for each subaccount of the
number of annuity units times the applicable annuity unit value as of the end of
the valuation period on the payment date selected.
10.6 ANNUITY UNIT VALUE
The number of annuity units credited under a variable settlement option for each
subaccount is equal to:
a) the amount of the first payment;
TIMES
b) the initial subaccount percentage allocation;
DIVIDED BY
c) the applicable annuity unit value as of the option's effective date.
The number of annuity units remains constant. However, if the payee(s) exchange
annuity units among the subaccounts, the units are exchanged on a dollar
equivalent basis.
The annuity unit values depend on the assumed interest rate and on the net
investment factor. An annuity unit value is determined for each subaccount for
each valuation period. The annuity unit value of each subaccount for its first
valuation period was set at $1.00. Each annuity unit value for each later
valuation period is equal to:
a) the annuity unit value for the immediately preceding valuation period;
TIMES
b) the net investment factor for that valuation period;
TIMES
c) the daily assumed interest factor for each day in that valuation period.
10.7 NET INVESTMENT FACTOR
The net investment factor for each subaccount for each valuation period is
determined by dividing a) by b) and subtracting c) from the result, where:
a) is equal to the net asset value of the subaccount as of the end of the
valuation period;
PLUS
the amount of all investment income and capital gains, realized or
unrealized, credited to the net assets of the subaccount during the
valuation period; MINUS the amount of capital losses, realized or
unrealized, charged against the net assets during the valuation period;
b) is equal to the net asset value of the subaccount for the immediately
preceding valuation period;
c) is a charge no greater than 0.0038091% of the net assets in the subaccount
for each day in the valuation period.
10.8 ASSUMED INTEREST RATE AND FACTOR
The assumed interest rate in the Variable Settlement Option Tables is 5% per
year. The daily assumed interest factor derived from an assumed interest rate of
5% is 0.9998663. We may also offer other assumed interest rates and other
variable settlement options from time to time, which may be available at the
time a settlement option is elected.
22
VARIABLE SETTLEMENT OPTION TABLES
VARIABLE SETTLEMENT OPTION A INITIAL FACTORS
MONTHLY LIFE INCOME WITH GUARANTEED PERIOD
ORIGINAL INSTALLMENT PER $1,000 PROCEEDS
Male Female Unisex
-------------- -------------- --------------
Age of 10 20 10 20 10 20
Payee Years Years Years Years Years Years
------ ----- ----- ----- ----- ----- -----
35 $4.38 $4.35 $4.26 $4.25 $4.32 $4.30
40 4.55 4.50 4.39 4.37 4.47 4.43
45 4.76 4.67 4.56 4.52 4.66 4.60
50 5.02 4.89 4.79 4.71 4.90 4.80
55 5.37 5.13 5.08 4.95 5.22 5.04
60 5.82 5.40 5.47 5.22 5.64 5.31
65 6.40 5.67 5.98 5.53 6.19 5.60
70 7.11 5.89 6.66 5.80 6.88 5.84
75 7.89 6.02 7.50 5.99 7.69 6.01
80 8.65 6.09 8.40 6.08 8.51 6.08
85 9.24 6.11 9.14 6.11 9.18 6.11
VARIABLE SETTLEMENT OPTION B
JOINT AND 100% TO SURVIVOR MONTHLY
LIFE INCOME
ORIGINAL MONTHLY INSTALLMENT PER
$1,000 PROCEEDS
Male Female Payee Age
Payee
Age 55 60 65 70 75
------------ ------- -------- -------- -------- -------
55 $4.73 $4.88 $5.02 $5.15 $5.25
60 4.83 5.03 5.24 5.44 5.62
65 4.92 5.18 5.47 5.77 6.05
70 4.98 5.29 5.66 6.08 6.52
75 5.03 5.38 5.82 6.36 6.98
Unisex Unisex Payee Age
Payee
Age 55 60 65 70 75
------------ ------- -------- -------- -------- -------
55 $4.73 $4.86 $4.98 $5.07 $5.15
60 4.86 5.04 5.22 5.38 5.50
65 4.98 5.22 5.48 5.72 5.94
70 5.07 5.38 5.72 6.09 6.44
75 5.15 5.50 5.94 6.44 6.98
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FLEXIBLE PREMIUM DEFERRED
VARIABLE ANNUITY CERTIFICATE
If you have any questions concerning this certificate or if anyone suggests that
you change or replace this certificate, please contact your Modern Woodmen
representative or our administrative center.
MODERN WOODMEN OF AMERICA
HOME OFFICE VARIABLE PRODUCT ADMINISTRATIVE CENTER
1701 1ST AVENUE P.O. BOX 9284
ROCK ISLAND, IL 61201 DES MOINES, IOWA 50306-9284
TOLL-FREE: (800) 447-9811 TOLL-FREE: (877) 249-3692