Exhibit 4(e)



 EXHIBIT 4(e) 
 FORM OF POLICY RIDER 
 (ADDITIONAL DEATH DISTRIBUTION+) 








			
	 




 A Stock Company (Hereafter called the Company, we, our or us)
	  	 Home Office:

 4333 Edgewood Road N.E.

 Cedar Rapids, Iowa
52499
(319)355-8511


 ADDITIONAL DEATH BENEFIT RIDER 

We issued this rider as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider
apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

This rider will pay an Additional Death Benefit amount as described below. This Additional Death Benefit, if any, will be paid whenever
death proceeds are payable on the base policy to which this rider is attached. 
 This rider can only be terminated when the
policy to which this rider is attached terminates, including when the Policy Value becomes zero, is annuitized, or an Additional Death Benefit is paid or added to the policy under spousal continuation under the terms of this rider. You may also
cancel this benefit at any time by notifying us at our service center. However, if the rider is terminated it can not be re-elected within a year after it was last terminated. Once re-elected, a new rider will be issued and the Additional Death
Benefit amount will be re-determined. 
 Rider Data Specifications 

 

							
		 	 Policy Number:
	  	12345	 	
		 	 Rider Date:
	  	05/01/2013	 	
		 	 Rider Benefit Percentage:
	  	30%	 	
		 	 Rider Fee Percentage:*
	  	0.55%	 	

 *The Rider Fee applies for the life of the rider. 
 DEFINITIONS 
 Rider Anniversary 

The anniversary of the Rider Date for each year the rider remains in force. 
 Rider Benefit Base 
 This amount is equal to the Policy Value minus premiums paid after the
Rider Date. 
 Rider Date 
 The
date that this rider is added to the policy. 
 Rider Fee 
 The Rider Fee amount is equal to the Rider Fee Percentage above multiplied by the Policy Value on the date the fee is deducted. A Rider Fee is deducted annually on each Rider Anniversary prior to
annuitization. We will also deduct this fee upon full Surrender of the policy or termination of the rider. However, once terminated the Rider Fee will also terminate. The Rider Fee is deducted pro rata from each Investment Option. The Rider Fee is
deducted even during periods when the Additional Death Benefit rider would not pay any benefit. 
 ADDITIONAL DEATH BENEFIT AMOUNT

 If death proceeds are payable under the terms of the base policy to which this rider is attached, this rider will
pay an Additional Death Benefit. If death occurs prior to the fifth Rider Anniversary, the rider will pay an Additional Death Benefit equal to the sum of all Rider Fees paid since the Rider Date. If death occurs on or after the fifth Rider
Anniversary, the rider will pay an Additional Death Benefit equal to the Rider Benefit Percentage multiplied by the Rider Benefit Base on the date used to calculate the death proceeds. This amount cannot be withdrawn as a lump sum.


  

					
	 ICC12 RTP170513
	  	Page 1	  	









 SPOUSAL CONTINUATION 
 If a death occurs and the base policy gives the surviving spouse the right to continue the policy, the surviving spouse has two options: 

 

	 	1.)	 Receive the death benefit attributable to this rider as well as the death benefit attributable to the base policy, at which time both rider and base
policy would terminate, or 


  

	 	2.)	 Continue the policy and receive a one-time Policy Value increase equal to the amount of the Additional Death Benefit paid by this rider. At this
time the rider would terminate. 


 If the policy is continued, the spouse would have the option of immediately
re-electing the rider if they meet issue requirements at the time the rider is re-elected. 
 REPORTS TO OWNER 

The amount of the Additional Death Benefit will be included in a report sent to You at least once each year until the Annuity Commencement
Date as described in Section 3, Reports to Owner provision, in the policy. 
 Additional Death Benefit Example: 

The Additional Death Benefit rider is added to a new policy opened with $100,000 initial premium. The Rider Benefit Percentage is 30% and
the Rider Fee Percentage is 0.55%. On the first and second Rider Anniversaries, the Policy Value is $110,000 and $95,000 respectively when the Rider Fees are deducted. The client adds $25,000 premium in the third Rider Year. After five years, the
Policy Value has grown to $130,000 and death proceeds have grown to $150,000. 
  

				                  	
	
Additional Death Benefit Example Calculations:
	  	 	 	 
	 Death proceeds on Rider Date (= initial Policy Value)
	  	$	100,000	  
	 Additional Death Benefit during 1st rider year
	  	$	0	  
	 Rider Fee on first Rider Anniversary (= Rider Fee Percentage * Policy
Value = 0.55% * $110,000)
	  	$	605	  
	 Additional Death Benefit during 2nd rider year (= sum of total Rider Fees
paid)
	  	$	605	  
	 Rider Fee on second Rider Anniversary (= Rider Fee Percentage * Policy
Value = 0.55% * $95,000)
	  	$	522.50	  
	 Additional Death Benefit during 3rd
rider year (= sum of total Rider Fees paid = $605 + $522.40)
	  	$	1,127.50	  
	 Rider Fees will continue to be
deducted each Rider Anniversary.
	  	 	 	 
	 Rider Benefit Base after 5th rider year (= Policy Value - premiums =
$130,000 - $25,000)
	  	$	105,000	  
	 Additional Death Benefit after 5th rider year = Rider Benefit Percentage
*
Rider Benefit Base = 30% * $105,000
	  	$	31,500	  
	 Total death proceeds (= base policy
death proceeds + Additional Death Benefit amount =
$150,000 + $31,500)
	  	$	181,500	  

 Signed for us at our Home Office. 

 

							
		 	 




 SECRETARY
	  	 




 PRESIDENT
	  	


  

					
	 ICC12 RTP170513
	  	Page 2