Document:

EXHIBIT 10.1

                                   MERRILL LYNCH COMMERCIAL FINANCE CORP.
                                   222 North LaSalle Street
                                   17th Floor
                                   Chicago, Illinois 60601
[GRAPHIC OMITTED]
MERRILL LYNCH
                                   Anne Easter, Vice President
                                   TEL: (312) 499-3044

                                   November 19,2009

Orbit  International  Corp
80  Cabot  Court
Hauppauge, NY  11788

 Re:  Amendedment to Loan Documents

Dear Gentlemen:

This Amendment ("Amendment") is by and between MERRILL LYNCH COMMERCIAL FINANCE
CORP. ("MLCFC") and Orbit International Corp. ("Customer") and will serve to
confirm certain agreements with respect to the following documents:

     (i) WCMA LOAN AND SECURITY AGREEMENT NO. 885-07587 dated January 28,
2003 by and between MLCFC and Customer, as thereafter supplemented, modified,
renewed, extended or amended (the " WCMA  Loan Agreement");

     (ii) TERM LOAN AND SECURITY AGREEMENT dated April 4, 2005 by and
between MLCFC and Customer, as thereafter supplemented, modified, renewed,
extended or amended (the " Term Loan Agreement A");

    (iii)  COLLATERAL INSTALLMENT NOTE dated April 4, 2005 by and between MLCFC
and Customer, as thereafter supplemented, modified, renewed, extended or amended
(the " Note A");

     (iv) TERM LOAN AND SECURITY AGREEMENT June 5, 2007 by and between MLCFC and
Customer, as thereafter supplemented, modified, renewed, extended or amended
(the " Term Loan Agreement B");

     (v) COLLATERAL INSTALLMENT NOTE dated April 4, 2005 by and between MLCFC
and Customer, as thereafter supplemented, modified, renewed, extended or amended
(the " Note B");

     (vi)     TERM LOAN AND SECURITY AGREEMENT December 19, 2007 by and between
MLCFC and Customer, as thereafter supplemented, modified, renewed, extended or
amended (the " Term Loan Agreement C");

(vii)     COLLATERAL INSTALLMENT NOTE dated April 4, 2005 by and between MLCFC
and Customer, as thereafter supplemented, modified, renewed, extended or amended
(the " Note B");

(viii)     UNCONDITIONAL GUARANTIES (i) dated December 31, 2007 given to MLCFC
by Integrated Consulting Services, Inc. and  (ii) dated April 4, 2005 and June
5, 2007, given to MLCFC  jointly by TDL Manufacturing, Inc., Tulip Development
Laboratory, Inc., Orbit Instrument of California, and Behlman Electronics,
Inc.(collectively, the "Business Guarantors" )

(ix)     all other agreements between MLCFC and Customer, or any other party who
at any time has guaranteed or provided collateral, or will hereinafter guarantee
or  provide  collateral,  for  Customer's  obligations  to  MLCFC  in connection
therewith  (the  "Additional  Agreements")

For  purposes  of  this  Amendment,  (i)  Customer  and  Business Guarantors are
collectively  referred  to  as the "Obligors", and (ii) the WCMA Loan Agreement,
Term  Loan  Agreement  A,  Note  A,  Term  Loan  Agreement  B, Note B, Term Loan
Agreement  C,  Note  C,  the  Guaranties,  and  the  Additional  Agreements  are
collectively  referred  to  as  the  "Loan  Documents".

Capitalized terms used herein and not defined herein shall have the same meaning
as  set  forth  in  the  Loan  Documents.

I.  LIMITED  WAIVER  OF  FINANCIAL  COVENANTS
---------------------------------------------

Obligors  acknowledge  that for the period ended September 30, 2009, they are in
violation  of  the following covenants under the Loan Documents (the "Identified
Defaults"):

       FIXED  CHARGE  COVERAGE  RATIO  COVENANT

       FUNDED  DEBT  TO  EBITDA  COVENANT

Obligors  have requested, and, subject to the terms and conditions hereof, MLCFC
has  agreed  to  waive  the  default  for  the  period ended September 30, 2009.

Nothing  in  this  letter  shall  be  construed as a waiver of any other term or
condition  of  the  Loan  Documents,  nor  shall  this  letter be construed as a
commitment  on  the part of MLCFC to waive any other term or condition set forth
in  the  Loan  Documents.  This  waiver  is  expressly  limited  to the covenant
referenced  above,  for  the period referenced above.  In all other respects and
except  as  expressly  amended  hereby,  the  terms  and  conditions of the Loan
Documents  remain  in  full  force  and  effect.

II.     AMENDMENT  TO  LOAN  DOCUMENTS.
        -------------------------------
A.  WCMA  LOAN  AGREEMENT. The WCMA Loan Agreement is hereby amended as follows:

1.  Definitions.  The  following  terms  set  forth  in  Subsection 1.1 entitled
"Specific  Terms"  shall  be  amended  and  restated  as  follows:

"APPLICABLE  MARGIN"  shall  be  amended  by deleting the percentage "3.50%" and
inserting  the  percentage  "4.00%"  in  lieu  thereof.

"MAXIMUM  WCMA  LINE  OF  CREDIT" shall mean (X) prior to December 31, 2009, the
lesser  of:  (A)  $2,000,000.00  or  (B)  the sum of (i) 85% of the aggregate of
Customer  and Business Guarantors Eligible A/R , plus (ii) the lesser of (a) 50%
of  the aggregate of Customer and Business Guarantors raw materials Inventory as
shown  on  its  regular books and records or b) 500,000.00; and (Y) on and after
December  31,  2009 the lesser of: A) $1,500,000.00 or (B) the sum of (i) 85% of
the  aggregate of Customers and Business Guarantors Eligible A/R , plus (ii) the
lesser  of  (a)  50%  of  the aggregate of Customers and Business Guarantors raw
materials Inventory as shown on its regular books and records or (b) 500,000.00.

For  purposes  hereof  the term "Eligible A/R" shall mean the aggregate Accounts
and  Chattel  Paper  of  Customer  as  shown  on  its regular books and records,
excluding (i) Accounts over 90 days old from date of invoice, Chattel Paper with
installments  or  other  sums  more  than 60 days past due (90 days from invoice
date),  (ii)  all amounts from any account debtor not having its principal place
of  business  in  the United States or not domiciled in the United States, (iii)
Accounts and Chattel Paper and any other amounts directly or indirectly from any
account  debtor  who  is an affiliated entity of either Customer or any Business
Guarantor,  (iv)  Accounts  deemed  as  ineligible  by  MLCFC,  (v)  any  bonded
receivables,  retainage,  and  (vi)  and  Accounts where the account debtor with
respect  to  which  is not any foreign government, the United States of America,
any State, political subdivision, department, agency or instrumentality thereof,
unless,  if  such  account  debtor  is  the  United  States  of  America, or any
department,  agency or instrumentality thereof, the Federal Assignment of Claims
Act  of  1940,  as  amended,  has been complied with in a manner satisfactory to
MLCFC.
"MATURITY  DATE"  shall  mean  June  30,  2010.

1.     2. FIXED CHARGE COVERAGE RATIO. Subsection 3.3(i) entitled "Fixed Charge
Coverage Ratio" shall be deleted in its entirety.

2.     3. OTHER COVENANTS. Subsection 3.3(h) entitled "Total Funded Debt to
EBITDA"  shall be amended and restated as follows and a new Subsection 3.3(i)
entitled "Debt Service Coverage Ratio" shall be added as follows:

3.3(h)  Total Funded Debt to EBITDA. Commencing December 31, 2009 and continuing
quarterly  on  a  trailing  12-month basis thereafter, the Consolidated Entities
"Total  Funded  Debt  to  EBITDA"  ratio  shall  not  exceed  3.00  to  1.00.

For  purposes  hereof  "Total Funded Debt to EBITDA" shall mean the ratio of (a)
all  debt  for  borrowed  money  including  all  outstandings  (excluding unused
availability)  under any revolving credit facility, and including debt to MLCFC,
to (b) income before interest (including payments in the natureof interest under
capital  leases)  taxes,  depreciation, amortization, and other similar non-cash
charges;  all  as  determined  on  a  trailing 12month basis as set forth in the
Consolidated  Entities  regular  quarterly  financial  statements  prepared  in
accordance  with  GAAP.

"3.3(i)  Debt  Service  Coverage  Ratio.  Commencing the quarterly period ending
December 31, 2009, the Consolidated Entities "Debt Service Coverage Ratio" shall
exceed  1.50  to  1.00;  and

On  March  31,  2010  and  continuing quarterly on a trailing 12-month basis the
Consolidated  Entities  "Debt  Service Coverage Ratio" shall at all times exceed
1.00  to  1.00."

For  purposes  hereof, "Debt Service Coverage Ratio" shall mean the ratio of (a)
income  before  interest  (including  payments  in  the nature of interest under
capital  leases),  taxes, depreciation, amortization, and other similar non-cash
charges,  to  (b)  the  sum of (i) any dividends and other distributions paid or
payable to shareholders, any taxes paid in cash, and interest expense, plus (ii)
any principal paid during the prior 12-month period and any rental under capital
leases  scheduled  to  be  paid or accrued over the next 12-month period; all as
determined  on  a  trailing  12-month  basis  as  set  forth in the Consolidated
Entities  quarterly  financial  statements  prepared  in  accordance  with GAAP.

B.  Term  Loan  Agreement A. Term Loan Agreement A is hereby amended as follows:

1.     1. FIXED CHARGE COVERAGE RATIO. Subsection 3.3(m) entitled "Fixed Charge
Coverage Ratio" shall be deleted in its entirety.

2.     2. OTHER COVENANTS. Subsection 3.3(l) entitled "Total Funded Debt to
EBITDA"  shall be amended and restated as follows and a new Subsection 3.3(m)
entitled "Debt Service Coverage Ratio" shall be added as follows:

3.3(l)  Total Funded Debt to EBITDA. Commencing December 31, 2009 and continuing
quarterly  on  a  trailing12-month  basis  thereafter, the Consolidated Entities
"Total  Funded  Debt  to  EBITDA"  ratio  shall  not  exceed  3.00  to  1.00.

For  purposes  hereof  "Total Funded Debt to EBITDA" shall mean the ratio of (a)
all  debt  for  borrowed  money  including  all  outstandings  (excluding unused
availability)  under any revolving credit facility, and including debt to MLCFC,
to (b) income before interest (including payments in the natureof interest under
capital  leases)  taxes,  depreciation, amortization, and other similar non-cash
charges;  all  as  determined  on  a  trailing 12month basis as set forth in the
Consolidated  Entities  regular  quarterly  financial  statements  prepared  in
accordance  with  GAAP.

"3.3(m)  Debt  Service  Coverage  Ratio.  Commencing the quarterly period ending
December 31, 2009, the Consolidated Entities "Debt Service Coverage Ratio" shall
exceed  1.50  to  1.00;  and

On  March  31,  2010  and  continuing quarterly on a trailing 12-month basis the
Consolidated  Entities  "Debt  Service Coverage Ratio" shall at all times exceed
1.00  to  1.00."

For  purposes  hereof, "Debt Service Coverage Ratio" shall mean the ratio of (a)
income  before  interest  (including  payments  in  the nature of interest under
capital  leases),  taxes, depreciation, amortization, and other similar non-cash
charges,  to  (b)  the  sum of (i) any dividends and other distributions paid or
payable to shareholders, any taxes paid in cash, and interest expense, plus (ii)
any principal paid during the prior 12-month period and any rental under capital
leases  scheduled  to  be  paid or accrued over the next 12-month period; all as
determined  on  a  trailing  12-month  basis  as  set  forth in the Consolidated
Entities  quarterly  financial  statements  prepared  in  accordance  with GAAP.

C.  Note  A.  Note  A  is  hereby  amended  as  follows:

1.  DEFINITIONS.  The  defined  term  set forth as Subsection 1(a)(iii) entitled
"Interest  Rate"  shall  be  amended  as  follows:
1(a)

(iii)  "Applicable  Margin"  shall be amended by deleting the percentage "3.50%"
and  inserting  the  percentage  "4.00%"  in  lieu  thereof.

D.  Term  Loan  Agreement B. Term Loan Agreement B is hereby amended as follows:

1.     1. FIXED CHARGE COVERAGE RATIO. Subsection 3.3(m) entitled "Fixed Charge
Coverage Ratio" shall be deleted in its entirety.

2.     2. OTHER COVENANTS. Subsection 3.3(l) entitled "Total Funded Debt to
EBITDA"  shall be amended and restated as follows and a new Subsection 3.3(m)
entitled "Debt Service Coverage Ratio" shall be added as follows:

3.3(l)  Total Funded Debt to EBITDA. Commencing December 31, 2009 and continuing
quarterly  on  a  trailing12-month  basis  thereafter, the Consolidated Entities
"Total  Funded  Debt  to  EBITDA"  ratio  shall  not  exceed  3.00  to  1.00.

For  purposes  hereof  "Total Funded Debt to EBITDA" shall mean the ratio of (a)
all  debt  for  borrowed  money  including  all  outstandings  (excluding unused
availability)  under any revolving credit facility, and including debt to MLCFC,
to (b) income before interest (including payments in the natureof interest under
capital  leases)  taxes,  depreciation, amortization, and other similar non-cash
charges;  all  as  determined  on  a  trailing 12month basis as set forth in the
Consolidated  Entities  regular  quarterly  financial  statements  prepared  in
accordance  with  GAAP.

"3.3(m)  Debt  Service  Coverage  Ratio.  Commencing the quarterly period ending
December 31, 2009, the Consolidated Entities "Debt Service Coverage Ratio" shall
exceed  1.50  to  1.00;  and

On  March  31,  2010  and  continuing quarterly on a trailing 12-month basis the
Consolidated  Entities  "Debt  Service Coverage Ratio" shall at all times exceed
1.00  to  1.00."

For  purposes  hereof, "Debt Service Coverage Ratio" shall mean the ratio of (a)
income  before  interest  (including  payments  in  the nature of interest under
capital  leases),  taxes, depreciation, amortization, and other similar non-cash
charges,  to  (b)  the  sum of (i) any dividends and other distributions paid or
payable to shareholders, any taxes paid in cash, and interest expense, plus (ii)
any principal paid during the prior 12-month period and any rental under capital
leases  scheduled  to  be  paid or accrued over the next 12-month period; all as
determined  on  a  trailing  12-month  basis  as  set  forth in the Consolidated
Entities  quarterly  financial  statements  prepared  in  accordance  with GAAP.

E.  Note  B.  Note  B  is  hereby  amended  as  follows:
    -------

1.  DEFINITIONS.  The  defined  term  set forth as Subsection 1(a)(iii) entitled
"Interest  Rate"  shall  be  amended  as  follows:
1(a)

(iii)  "Applicable  Margin"  shall be amended by deleting the percentage "3.50%"
and  inserting  the  percentage  "4.00%"  in  lieu  thereof.

F.  Term  Loan  Agreement C. Term Loan Agreement C is hereby amended as follows:
1.     1. FIXED CHARGE COVERAGE RATIO. Subsection 3.3(n) entitled "Fixed Charge
Coverage Ratio" shall be deleted in its entirety.

2.     2. OTHER COVENANTS. Subsection 3.3(m) entitled "Total Funded Debt to
EBITDA"  shall be amended and restated as follows and a new Subsection 3.3(n)
entitled "Debt Service Coverage Ratio" shall be added as follows:

3.3(m)  Total Funded Debt to EBITDA. Commencing December 31, 2009 and continuing
quarterly  on  a  trailing12-month  basis  thereafter, the Consolidated Entities
"Total  Funded  Debt  to  EBITDA"  ratio  shall  not  exceed  3.00  to  1.00.

For  purposes  hereof  "Total Funded Debt to EBITDA" shall mean the ratio of (a)
all  debt  for  borrowed  money  including  all  outstandings  (excluding unused
availability)  under any revolving credit facility, and including debt to MLCFC,
to (b) income before interest (including payments in the natureof interest under
capital  leases)  taxes,  depreciation, amortization, and other similar non-cash
charges;  all  as  determined  on  a  trailing 12month basis as set forth in the
Consolidated  Entities  regular  quarterly  financial  statements  prepared  in
accordance  with  GAAP.

"3.3(n)  Debt  Service  Coverage  Ratio.  Commencing the quarterly period ending
December 31, 2009, the Consolidated Entities "Debt Service Coverage Ratio" shall
exceed  1.50  to  1.00;  and

On  March  31,  2010  and  continuing quarterly on a trailing 12-month basis the
Consolidated  Entities  "Debt  Service Coverage Ratio" shall at all times exceed
1.00  to
1.00.

For  purposes  hereof, "Debt Service Coverage Ratio" shall mean the ratio of (a)
income  before  interest  (including  payments  in  the nature of interest under
capital  leases),  taxes, depreciation, amortization, and other similar non-cash
charges,  to  (b)  the  sum of (i) any dividends and other distributions paid or
payable to shareholders, any taxes paid in cash, and interest expense, plus (ii)
any principal paid during the prior 12-month period and any rental under capital
leases  scheduled  to  be  paid or accrued over the next 12-month period; all as
determined  on  a  trailing  12-month  basis  as  set  forth in the Consolidated
Entities  quarterly  financial  statements  prepared  in  accordance  with GAAP.

G.  Note  C.  Note  C  is  hereby  amended  as  follows:

1.  DEFINITIONS.  The  defined  term  set forth as Subsection 1(a)(iii) entitled
"Interest  Rate"  shall  be  amended  as  follows:
1(a)

(iii)  "Applicable  Margin"  shall be amended by deleting the percentage "3.50%"
and  inserting  the  percentage  "4.00%"  in  lieu  thereof.

III.  Other  Agreements.

Audit/Appraisal.  If  the  Obligations  owed  under  the  Loan Documents are not
refinanced by another lender on or before March 31, 2010, Customer shall, at its
own  expense,  permit  a  field examination of Customers and Business Guarantors
books,  records  and/or  property  and  an  appraisal  of Customers and Business
Guarantors  machinery  and  equipment  to commence no later than April 19, 2010.
The  results  of  such  examination  shall  be  acceptable  to MLCFC in its sole
discretion,

Covenant  Waiver  Fees.
----------------------

..     (i) To induce MLCFC to grant a waiver of the Identified Defaults and enter
into this Amendment, Customer shall, contemporaneously with the execution of
this Amendment, pay MLCFC a covenant waiver fee in the amount of Fifteen
Thousand Dollars 00/100 ($15,000.00), ("Covenant Waiver Fee"). The Covenant
Waiver Fee shall be drawn on a non-Merrill Lynch bank account and shall be
deemed fully earned by MLCFC upon receipt.

..     (ii) To induce MLCFC to grant a waiver of the Identified Defaults and
enter into this Amendment, Customer agrees to provide MLCFC with a commitment
letter from another lender on or before February 28, 2010 to finance the
outstanding indebtedness under the Loan Documents (the "Take-Out Commitment").
Such commitment letter shall be sent to the attention of Anne Easter via fax no.
(312) 499-3252 or e-mail at anne.m.easter@baml.com.

In  the  event Customer fails to provide a Take-Out Commitment on or before such
date  there  shall  be  due  an additional fee of $35,000.00.  Such fee shall be
drawn  on  a  non-Merrill Lynch bank account and shall be deemed fully earned at
5:00  PM  central  time  on  February  28,  2010.

Customer  and  Guarantor  hereby  confirm  that  (a)  each  of the warranties of
Customer  in  the  Loan Documents are true and correct as of the date hereof and
shall  be  deemed  remade  as  of the date hereof and on the effective date; (b)
neither Customer nor Guarantor have any claim against MLCFC arising out of or in
connection  with  the Loan Documents or any other matter whatsoever; and do each
hereby release and forever discharge  MLCFC and their parents, and affiliates of
and  from any and all causes of action, claims, or demands whatsoever, in law or
in  equity  arising  from  the  conduct  of  MLCFC.

By  their  execution  of  this  Amendment,  the below-named Guarantors do hereby
consent  to  the  foregoing  amendment to the Loan Documents, and agree that the
obligations  under  the  Guaranty shall extend to and include the Obligations of
Customer  under  the  Loan  Documents,  as  amended  hereby.

Although each of the undersigned Guarantors has been informed of the matters set
forth herein and has acknowledged and agreed to same, such Guarantor understands
that  MLCFC  has  no  obligation  to inform any Guarantor of such matters in the
future  or  to  seek  any  Guarantor's  acknowledgment  or  agreement  to future
consents,  waivers  or  amendments, and nothing herein shall create such a duty.

This Amendment shall become effective upon execution and delivery by Obligors of
the  executed  document  together  with  the following, provided however, if the
Effective  Date of this Amendment has not occurred within five (5) Business Days
from  the date hereof, then this Amendment will, at the sole option of MLCFC, be
void  and  no  effect.

                            SIGNATURE PAGES FOLLOW:
Very  truly  yours,

MERRILL  LYNCH  COMMERCIAL  FINANCE  CORP.

By:  /s/  Anne  Easter
    -------------------
    Anne  Easter
    Vice  President

Accepted:

ORBIT  INTERNATIONAL  CORP.

By:  /s/  Dennis  Sunshine
     ---------------------

Name:  Dennis  Sunshine

Title: President, CEO

Approved:

INTEGRATED  CONSULTING  SERVICES,  INC.

By: /s/  Kenneth J. Ice
    -------------------------
    Kenneth J. Ice, President

By: /s/  Julie A. McDearman
    -------------------------
    Julie A. McDearman, Secretary

TDL  MANUFACTURING,  INC.

By: /s/  Mitchell  Binder
    -----------------------
    Mitchell  Binder, Vice President

By: /s/  David Goldman
    -----------------------
    David Goldman, Controller

TULIP  DEVELOPMENT  LABORATORY,  INC.

By: /s/  Mitchell  Binder
    ----------------------
    Mitchell Binder, Vice President

By: /s/  David Goldman
    ----------------------
    David Goldman, Controller

ORBIT  INSTRUMENT  OF  CALIFORNIA,  INC.

By: /s/  Mitchell  Binder
    ----------------------
    Mitchell Binder, Vice President

By: /s/  Dennis Sunshine
    ----------------------
    Dennis Sunshine, President

BEHLMAN  ELECTRONICS,  INC,

By: /s/  Mark  Tublisky
    -------------------
    Mark  Tublisky, President

By: /s/  Mitchell Binder
    -------------------
    Mitchell Binder, Vice Presidentexhibit41.htm

 

 

 

	
 Great-West Life & Annuity Insurance Company

A Stock Company

[8515 East Orchard Road                Greenwood Village, CO  80111]

 

 

 

	 Group Fixed Deferred Annuity Certificate (the “Certificate”)

 

PLEASE READ THE CERTIFICATE CAREFULLY.

Great-West Life & Annuity Insurance Company (“Great-West”) has issued the Certificate in connection with your Individual Retirement Account.  Great-West agrees, subject to the terms and conditions of the Certificate, to provide benefits set forth in the Certificate while the Certificate is in force.  The
Certificate Owner owns the Account.

The Certificate is issued to the Certificate Owner shown on the Certificate Data Page.  It takes effect on the Effective Date shown on the Certificate Data Page.

 

The Certificate has no cash value or surrender value.

 

 

The Certificate does not pay dividends or death benefits.

 

 

Non-Participating.

 

 

Non-Assignable.

 

Signed for Great-West Life & Annuity Insurance Company on the issuance of the Certificate.

	
[]
	  	
[]

	
[Richard Schultz,]
	  	
[Mitchell T.G. Graye,]

	
[Secretary]
	  	
[President and Chief Executive Officer]

  

  

 

  

CERTIFICATE DATA

	
Certificate Election Date:
	 	
[January 1, 2010]

	
Certificate Owner:
	 	
[John B. Doe]

	  	 	 
	
Group Contractholder:
	 	
[Orchard Trust Company f/b/o IRA Contractholders]

	  	 	 
	
Initial Benefit Base:
	 	
[Covered Fund Value on Certificate Election Date]

	
Maximum Benefit Base:
	 	$[5,000,000]
	
Benefit Base Ratchet Date Accumulation Phase:
	 	
[Certificate Anniversary Date]

	
Benefit Base Ratchet Date Withdrawal Phase:
	 	
[Initial Installment Anniversary Date]

	
Guaranteed Withdrawal Percentage:
	  	  	  
	 	 	 	 
	
Age at First Withdrawal
	
%
	
Age of Younger Person at First Withdrawal
	
%

	
(Single Covered Person)
	  	
(Joint Covered Persons)*
	  
	  	  	  	  
	
[55- 64]
	
[4%]
	
[55-64]
	
[3.25%]

	
[65-69]
	
[5%]
	
[65-69]
	
[4.25%]

	
[70-79]
	
[6%]
	
[70-79]
	
[5.25%]

	
[80+]
	
[7%]
	
[80+]
	
[6.25%]

 

* If there are Joint Covered Persons, age at first withdrawal is based on age of younger Covered Person and the Guaranteed Withdrawal Percentage is reduced by 0.75%.

 

	 Annual Charges:	 	 
	 	 	 
	 Certificate Current Guarantee Benefit Fee: 	 	[.90% of Covered Fund Value]
	 Certificate Minimum Guarantee Benefit Fee: 	 	.70% of Covered Fund Value
	 Certificate Maximum Guarantee Benefit Fee:	 	1.5% of Covered Fund Value

 

 

                                                                                                      

 

  

  

 

  

 

	 TABLE OF CONTENTS

 

	
Section 1
	
DEFINITIONS

 
	
3

	
Section 2
	
OWNERSHIP PROVISIONS

 
	
5

	
Section 3
	
GLWB ELECTION

 
	
5

	
Section 4
	
THE ACCUMULATION PHASE AND THE CALCULATION OF THE BENEFIT BASE

 
	
6

	
Section 5
	
WITHDRAWAL PHASE

 
	
8

	
Section 6
	
SETTLEMENT PHASE

 
	
11

	
Section 7
	
BENEFIT BASE CAP

 
	
12

	
Section 8
	
REQUIRED MINIMUM DISTRIBUTION

 
	
12

	
Section 9
	
GUARANTEE BENEFIT FEE

 
	
12

	
Section 10
	
GROUP CONTRACT TERMINATION

 
	
12

	
Section 11
	
CERTIFICATE TERMINATION

 
	
13

	
Section 12
	
GENERAL PROVISIONS

 
	
13

	
Section 13
	
ANNUITY PAYMENT OPTIONS

 
	
15

	
Section 14
	
MISSTATEMENT OF AGE OR DEATH

 
	
16

  

  

 

  

SECTION 1: DEFINITIONS

Account - A separate record in the name of each Certificate Owner which reflects his or her interests in the assets in both Covered Fund(s) and other investment options in the IRA.

Accumulation Phase – The period of time between the Certificate Election Date and the Initial Installment Date.

 

Administrative Offices – [8515 East Orchard Road, Greenwood Village, CO  80111.]

 

Alternate Payee – Any spouse, former spouse, child or other dependent of a Certificate Owner, or other person allowed by law, who is recognized by a Qualified Domestic Relations Order as having a right to receive all or a portion of the benefit payable under the IRA with respect
to such Certificate Owner.

Annuitant – The person upon whose life the payment of an annuity is based.

Annuity Commencement Date – The date that annuity payments begin to an Annuitant.

Applicable Tax – The amount of tax, if any, charged by a state or other governmental authority.

Attained Age – The GLWB Elector’s age on the Ratchet Date.

Beneficiary – A person or entity named by the Certificate Owner or the terms of the IRA to receive all or a portion of the Account at his or her death.

 

Benefit Base – The amount that is multiplied by the Guaranteed Annual Withdrawal Percentage to calculate the Guaranteed Annual Withdrawal.  The Benefit Base increases dollar-for-dollar upon any Certificate Contribution and is reduced proportionately for an Excess Withdrawal.  The
Benefit Base can also increase with positive market performance on the Ratchet Date.  Each Covered Fund will have its own Benefit Base.  A Covered Fund Benefit Base cannot be transferred to another Covered Fund.

Business Day – Any day, and during the hours, on which the New York Stock Exchange is open for trading.  In the event that a date falls on a non-Business Day, the date of the preceding Business Day will be used.

 

Certificate - This document issued to the Certificate Owner which specifies the benefits, rights, privileges, and obligations of the Certificate Owner and Great-West under the Group Contract.

Certificate Anniversary Date – The anniversary of the Certificate Election Date, or the preceding Business Day to the extent that the Certificate Election Date is not a Business Day.

Certificate Contributions – Certificate Owner directed amounts received and allocated to the Certificate Owner’s Covered Fund(s) including rollovers as defined under Section 402 of the Code and Transfers. Reinvested dividends, capital gains, and settlements arising from the
Covered Fund(s) will not be considered Certificate Contributions for the purpose of calculating the Benefit Base but will affect the Covered Fund Value.

Certificate Election Date –The date on which the GLWB Elector, Alternate Payee or Beneficiary elects the GLWB option in the Certificate and pursuant to the terms of the Covered Fund(s) prospectus or disclosure document.  The Certificate Election Date shall be the date
upon which the initial Benefit Base is calculated.

Certificate Owner – The person named on the Certificate Data Page.  The Certificate Owner is entitled to exercise all of the benefits, rights and privileges under the Certificate while the Covered Person(s) is still living.  The Certificate Owner must be a Covered
Person.

Code – The Internal Revenue Code of 1986, as amended, and all related laws and regulations which are in effect during the term of the Certificate.

Covered Fund– Interests in the mutual fund(s) held in the Account designed for the GLWB, as follows:

	
§  
	
[Maxim SecureFoundationSM Balanced Portfolio]

	
§  
	
[Maxim SecureFoundation Lifetime Portfolios]

	
§  
	
Any other fund as approved by Great-West for the GLWB

 

Covered Fund Value – The aggregate value of each Covered Fund held in the Account.

Covered Person(s) – For purposes of the Certificate, the person(s) whose age determines the Guaranteed Annual Withdrawal Percentage and on whose life the Guaranteed Annual Withdrawal Amount will be based.  If there are two Covered Persons, the Guaranteed Annual Withdrawal
Percentage will be based on the age of the younger life and the Installments can continue until the death of the second life.  A joint Covered Person must be the GLWB Elector’s spouse and the 100% primary beneficiary under the IRA.

Distributions – Amounts paid to a GLWB Elector from a Covered Fund pursuant to the terms of the IRA.

 

Excess Withdrawal – An amount either distributed or transferred from the Covered Fund(s) during the Accumulation Phase or any amount combined with all other amounts that exceeds the annual GAW during the Withdrawal Phase.  The Excess Withdrawal reduces the Benefit Base,
pursuant to Section 4.04 and Section 5.06.  Neither the Guarantee Benefit Fee nor any other fees or charges assessed against the Covered Fund Value as directed by the IRA Custodian and as agreed to by Great-West shall be treated as a Distribution or Excess Withdrawal for this purpose.    

GLWB Elector – A Certificate Owner, Alternate Payee or Beneficiary who is:  (i) eligible to elect the GLWB; (ii) invested in a Covered Fund(s) pursuant to the Covered Fund prospectus or disclosure document; and (iii) a Covered Person..

 

Great-West – Great-West Life & Annuity Insurance Company, located at the Administrative Offices.

Group Contract – The written agreement between the Group Contractholder and Great-West.

Group Contractholder – The entity with ownership rights under the Group Contract.

Guaranteed Annual Withdrawal (GAW) – The annualized withdrawal amount that is guaranteed for the lifetime of the Covered Person(s), subject to the terms of this Certificate.

Guaranteed Annual Withdrawal Percentage (GAW%) –The percentage of the Benefit Base that determines the amount of the GAW.  This percentage is based on the age of the Covered Person(s) at the time of the first Installment.  If there are two Covered Persons the
percentage is based on the age of the younger Covered Person, pursuant to Section 5.01.

Guarantee Benefit Fee – The fee described in Section 9 of the Certificate.

Guaranteed Lifetime Withdrawal Benefit (GLWB) – A payment option offered by the IRA that pays Installments during the life of the Covered Person(s).  The Covered Person(s) will receive periodic payments in either monthly, quarterly, semiannual, or annual Installments that
in total over a twelve month period equal the GAW.

Initial Installment Date –The date of the first Installment under the GLWB, which must be a Business Day.

Installments – Periodic payments of the GAW made pursuant to Section 5.02.

Installment Frequency Options – The options listed in Section 5.02.

IRA – The traditional Roth or other Individual Retirement Account established for the Certificate Owner and the Certificate Owner’s beneficiaries, for which a Certificate is issued.

Qualified Domestic Relations Order (QDRO) – A domestic relations order that creates or recognizes the existence of an Alternate Payee’s right to, or assigns to an Alternate Payee the right to receive all or a portion of the benefits payable with respect to a GLWB Elector and
that complies with the requirements of the Code and ERISA, if applicable, that is accepted and approved by the Group Contractholder for the IRA, except as otherwise agreed.

Ratchet – An increase in the Benefit Base if the Covered Fund Value exceeds the current Benefit Base on the Ratchet Date, pursuant to Section 4.03 and Section 5.04.

Ratchet Date – During the Accumulation Phase, the Ratchet Date is the anniversary of the GLWB Elector’s Certificate Election Date and each anniversary thereafter.  During the Withdrawal Phase, the Ratchet Date is the Initial Installment Date and each anniversary
thereafter.  If any anniversary in the Accumulation and Withdrawal Phase is a non-Business Day, the Ratchet Date shall be the preceding Business Day for that year.

Request – An inquiry or instruction in a form satisfactory to Great-West.  A valid Request must be: (i) received by Great-West at the Administrative Office in good order; and (ii) submitted in accordance with the provisions of the Certificate, or as required by Great-West.  The
Request is subject to any action taken by Great-West before the Request was processed.

 

Reset – An optional GLWB Elector election during the Withdrawal Phase in which the current GAW Percentage and Benefit Base may be changed to the GLWB Elector’s Attained Age GAW Percentage and Covered Fund Value on the Ratchet Date.

RMD – Required Minimum Distribution, as described in Section 8.

Settlement Phase –The period when the Covered Fund Value has reduced to zero, but the Benefit Base is still positive. Installments continue under the terms of the Certificate.

Transfer – The reinvestment or exchange of all or a portion of the Covered Fund Value to or from a Covered Fund to: (i) another Covered Fund; or (ii) another investment option offered under the IRA.

Withdrawal Phase – The period of time between the Initial Installment Date and the first day of the Settlement Phase.

 

SECTION 2: OWNERSHIP PROVISIONS

2.01 OWNERSHIP OF THE CERTIFICATE; RIGHTS OF THE CERTIFICATE OWNER

 

The Certificate Owner is identified on the Certificate Data Page.  The Certificate Owner owns the Certificate and has certain rights and privileges as set forth in this Certificate.

 

 

2.02 TRANSFER AND ASSIGNMENT

 

The interests of the Certificate Owner in the Certificate may not be transferred, sold, assigned, pledged, charged, encumbered, or in any way alienated.

 

SECTION 3: GLWB ELECTION

	
3.01  
	
GLWB ELECTION

 

An individual eligible to become a GLWB Elector makes a GLWB election by investing in a Covered Fund through a Great-West approved method and pursuant to the terms of the Covered Fund prospectus or disclosure document.  Such individual may elect the GLWB on any Business Day on or after the Contract Date as long as he or she
is younger than age 85 on the Certificate Election Date.  Great-West will record a Certificate Election Date for each GLWB Elector.

 

	
3.02  
	
GLWB INVESTMENT RESTRICTIONS

 

The GLWB applies only to the Covered Fund Value subject to Section 7 of the Certificate.

 

3.03    GLWB TERMINATION DUE TO THE BENEFIT BASE REDUCING TO ZERO

 

The GLWB is cancelled when the GLWB Elector causes the Covered Fund Value or Benefit Base to be reduced to zero prior to the Settlement Phase due to one or more Excess Withdrawals.  If the GLWB is cancelled, the Benefit Base, GAW and any other benefit accrued or received under the GLWB shall terminate.  The GLWB Elector
shall not make a subsequent Transfer into the same Covered Fund until at least ninety (90) calendar days after the termination, but other Certificate Contributions will be allowed, at which point a new Election Date would be recorded. In this situation, the Benefit Base will be based on the current Covered Fund Value on the date the new GLWB is established

 

SECTION 4: THE ACCUMULATION PHASE AND CALCULATION OF THE BENEFIT BASE

4.01 INITIAL BENEFIT BASE

 

The Initial Benefit Base is the sum of all Certificate Contributions initially allocated to the Covered Fund(s) on the Certificate Election Date.

 

4.02 RESTORATION OF THE BENEFIT BASE

 

If the Certificate Owner funds the IRA with proceeds rolled over or directly transferred from a tax-deferred retirement plan established under Section 401(a), 403(a), 403(b) or 457(b) of the Code (“tax-deferred retirement plan”) to which a Great-West guaranteed lifetime withdrawal product was issued, the Certificate Owner’s
Benefit Base determined under the tax-deferred retirement plan immediately prior to distribution shall be restored within the Certificate only to the extent that the Certificate Owner:  (a) invests the rollover or transfer proceeds covered by the Great-West guaranteed lifetime withdrawal benefit product immediately prior to distribution from the tax-deferred retirement plan in the Covered Fund(s); (b) invests in the same Covered Fund, except if the Certificate Owner is in Settlement Phase; and (c) Requests
restoration of the Benefit Base.  For purposes of subsection (c), a Request is deemed to be made when, in Great-West’s reasonable judgment, there is a de minimis rollover from the tax-deferred retirement plan to the IRA with a GLWB.  The Certificate Owner must begin in the same phase that he or she was in at the time of the rollover or transfer after the transaction is complete.

 

4.03 ADDITIONAL CERTIFICATE CONTRIBUTIONS

 

Additional Certificate Contributions may be allocated to the Covered Fund(s) only during the Accumulation Phase.  Additional Certificate Contributions made any time after the Certificate Election Date will increase the Benefit Base dollar-for-dollar.  Great-West reserves the right to refuse additional Certificate Contributions
at any time and for any reason.  If Great-West refuses additional Certificate Contributions, the GLWB Elector shall retain all other rights under the Certificate.

 

4.04 ANNUAL ADJUSTMENTS TO BENEFIT BASE

 

On each Ratchet Date during the Accumulation Phase, the Benefit Base automatically adjusts to the greater of:

(a) the current Benefit Base; or

(b) the current Covered Fund Value.

 

4.05 EFFECT OF DISTRIBUTIONS AND TRANSFERS DURING THE ACCUMULATION PHASE

 

Any Transfer out of a Covered Fund by the GLWB Elector during the Accumulation Phase will be an Excess Withdrawal.  If the GLWB Elector Transfers any asset out of a Covered Fund, he or she shall be prohibited from making any Transfer into the same Covered Fund for at least ninety (90) calendar days.

At the time of any partial or periodic Distribution, if the Covered Person is [55] years of age or older, the GLWB Elector may elect to begin receiving Installments and establish his or her GAW% at that time. If the GLWB Elector chooses not to establish the GAW%, the Distribution will be treated as an Excess Withdrawal.  If the Covered
Person is not yet [55] years old, then any partial or periodic Distribution will be treated as an Excess Withdrawal.  The Benefit Base will be reduced by the ratio of the Covered Fund Value after the Excess Withdrawal to the previous Covered Fund Value.

Any Distribution from the Covered Fund(s) required to satisfy any contribution limitation imposed by the Code or ERISA, if applicable, on the IRA, or the GLWB Elector as a Certificate Owner, will be an Excess Withdrawal at all times.

A GLWB Elector should consult a qualified tax advisor regarding withdrawals to satisfy his or her RMD amount and other tax implications.

Numerical Example

Excess Withdrawals during the Accumulation Phase are illustrated as follows:

 

Covered Fund Value before the Excess Withdrawal adjustment = $50,000

 

Benefit Base = $100,000

 

Excess Withdrawal amount: $10,000

 

Covered Fund Value after adjustment= $50,000 - $10,000 = $40,000

 

Covered Fund Value adjustment = $40,000/$50,000 = 0.80

 

Adjusted Benefit Base = $100,000 x 0.80 = $80,000

 

4.06 QDROs DURING ACCUMULATION PHASE

 

Great-West will make payment to the Alternate Payee and/or establish an Account on behalf of the Alternate Payee named in a QDRO approved during the Accumulation Phase.  The Alternate Payee shall be responsible for submitting a Request to begin Distributions in accordance with the Code.

If the Alternate Payee is the GLWB Elector’s spouse during the Accumulation Phase, he or she may elect to become a GLWB Elector, either by maintaining the current Benefit Base of the previous GLWB Elector, divided pursuant to the terms of the QDRO, or establishing a new Benefit Base based on the current Covered Fund Value on the date
his or her Account is established and he or she will continue as a GLWB Elector.  If the Alternate Payee elects to maintain the current Benefit Base, the Benefit Base will be divided between the GLWB Elector and the Alternate Payee in the same proportion as their respective Covered Fund Values pursuant to the terms of the QDRO.  In either situation, the Alternate Payee’s Certificate Election Date shall be the date the Account is established.

A non-spouse Alternate Payee cannot elect to maintain the current Benefit Base, or proportionate share, but may elect to establish a new GLWB.  The Benefit Base and Certificate Election Date will be based on the current Covered Fund Value on the date his or her Account is established.

To the extent that the Alternate Payee becomes a GLWB Elector, he or she will be subject to all terms and conditions of the Certificate, the IRA Contract and the Code.

Any election made by the Alternate Payee pursuant to this section is irrevocable.

 

4.07 DEATH DURING ACCUMULATION PHASE

 

If a GLWB Elector dies before the Initial Installment Date, the GLWB will terminate and the Covered Fund Value shall be paid to the Beneficiary in accordance with the terms of the IRA (unless an election is made by a spouse Beneficiary as provided in this section).  A spouse Beneficiary may elect to become a new GLWB Elector and
maintain the deceased GLWB Elector’s current Benefit Base (or proportionate share if multiple Beneficiaries) as of the date of death.  A spouse Beneficiary also has the option to establish a new Account with a new Benefit Base based on the current Covered Fund Value on the date the Account is established.  In either situation, the spouse Beneficiary shall become a GLWB Elector and the Ratchet Date will be the date when his or her Account is established.

A non-spouse Beneficiary cannot elect to maintain the current Benefit Base but may elect to establish a new GLWB.  The Benefit Base and Certificate Election Date will be based on the current Covered Fund Value on the date his or her Account is established.

To the extent that the Beneficiary becomes a GLWB Elector, he or she will be subject to all terms and conditions of the Certificate, the IRA Contract and the Code.

Any election made by Beneficiary pursuant to this section is irrevocable.

 

SECTION 5: WITHDRAWAL PHASE

5.01 CALCULATION OF GUARANTEED ANNUAL WITHDRAWAL

 

The GAW is calculated by multiplying the Benefit Base by the GAW%, based on the age of the Covered Person(s) on the Initial Installment Date.  If a Request is made to begin Installments, Great-West shall compare the current Benefit Base to the current Covered Fund Value on the Initial Installment Date.  If the Covered Fund
Value exceeds the Benefit Base, the Covered Fund Value shall become the Benefit Base and the GAW shall be based on that amount.

The GLWB Elector must provide information sufficient for Great-West to determine the age of each Covered Person.  Installments shall not begin and an Initial Installment Date shall not be recorded until Great-West receives appropriate information about the Covered Person(s) in good order and in manner reasonably satisfactory to Great-West.

Single Covered Person: GAWs shall not begin until a single Covered Person attains age [55] and has a distributable event under the IRA and the Code.

Joint Covered Person: If there are two Covered Persons, Installments may not begin until both Covered Persons reach age [55] and there is a distributable event under the IRA and the Code.  If the GLWB Elector elects to declare his or her spouse as a joint Covered Person, the
election is irrevocable and the GAW % will be determined by the age of the younger life on the Initial Installment Date, and the spouse must be the GLWB Elector’s sole Beneficiary.

Any Distribution taken before the youngest Covered Person attains age [55] shall be considered an Excess Withdrawal, pursuant to Section 4.04.  No Certificate Contributions shall be made to the Covered Fund(s) on and after the Initial Installment Date.

A GLWB Elector should consult a qualified tax advisor regarding withdrawals to satisfy his or her Required Minimum Distribution (“RMD”) amount and other tax implications.

The GAW is based on a percentage of the Benefit Base pursuant to the following schedule:

	
Single Covered Person
	  	
Joint Covered Person

	
[4.0%] for life at ages [55-64]
	  	
[3.25%] for youngest joint life at [55-64]

	
[5.0%] for life at ages [65-69]
	  	
[4.25%] for youngest joint life at [65-69]

	
[6.0%] for life at ages [70-79]
	  	
[5.25%] for youngest joint life at [70-79]

	
[7.0%] for life at ages [80+]
	  	
[6.25%] for youngest joint life at [80+]

	
[X%] for life at ages [X]
	  	
[X%] for youngest joint life at [X]

The Installment equals the GAW divided by the number of payments per year under the elected Installment Frequency Option, as defined in Section 5.02.

 

5.02 INSTALLMENT FREQUENCY OPTIONS

 

Installment Frequency Options are as follows:

 

(a) Annual – the GAW will be paid on the Initial Installment Date and each anniversary annually thereafter.

(b) Semi-Annual – half of the GAW will be paid on the Initial Installment Date and in Installments every 6 month anniversary thereafter.

(c) Quarterly – one quarter of the GAW will be paid on the Initial Installment Date and in Installments

every 3 month anniversary thereafter.

(d) Monthly – one-twelfth of the GAW will be paid on the Initial Installment Date and in Installments every monthly anniversary thereafter.

If an Installment is scheduled to be made on a non-Business Day, the Installment shall be paid on the immediately preceding Business Day.

 

5.03 EFFECT OF INSTALLMENTS ON COVERED FUND VALUE

 

Installments will reduce the Covered Fund Value on a dollar-for-dollar basis.

 

5.04 RATCHET TO BENEFIT BASE DURING THE WITHDRAWAL PHASE

 

On each Ratchet Date, the Benefit Base automatically adjusts to the greater of:

(a) the current Benefit Base; or

(b) the current Covered Fund Value.

GAWs will adjust annually on the Ratchet Date based on the new Benefit Base.

 

5.05 OPTIONAL RESETS OF THE GUARANTEED ANNUAL WITHDRAWALS DURING THE WITHDRAWAL PHASE

 

Annually, a GLWB Elector may Request a Reset of the GAW during the Withdrawal Phase at least thirty (30) calendar days prior to the Ratchet Date.  If requested, Great-West shall multiply the Covered Fund Value as of the Ratchet Date by the GAW% (based on GLWB Elector’s Attained Age) and determine if it is higher than the current Benefit
Base multiplied by the current applicable GAW%.  If so, the current GAW% will change to the Attained Age GAW% and the Benefit Base will change to the current Covered Fund Value as of the Ratchet Date.    If it does not, the Reset shall be void but a Ratchet may still occur.  If the Reset takes effect, it will be effective on the Ratchet Date as the Ratchet Date does not change due to Reset.

	
Example:
	
If
	
(Attained Age GAW%) x (Covered Fund Value as of Ratchet Date) >

(Current GAW%) x (Current Benefit Base)

           

	
  
	
Then
	
(Attained Age GAW%) x (Covered Fund Value as of Ratchet Date) becomes new GAW

and

(Covered Fund Value) = (New Benefit Base)

 

Numerical Example When Reset is Beneficial:

Age at Initial Installment Date: 60

Attained Age: 70

Covered Fund Value = $120,000

Current Benefit Base = $125,000

Current GAW% before Ratchet Date:  4%

Attained Age GAW% after Ratchet Date: 6%

(Current GAW%) x (Current Benefit Base) = 4% x $125,000 = $5,000

(Attained Age GAW%) x (Covered Fund Value) = 6% x $120,000 = $7,200

So           New GAW Amount is $7,200

New Benefit Base is $120,000

New GAW% is 6%

Numerical Example When Reset is NOT Beneficial:

Age at Initial Installment Date: 60

Attained Age: 70

Covered Fund Value = $75,000

Current Benefit Base = $125,000

Current GAW% before Ratchet:  4%

Attained Age GAW% after Ratchet Date: 6%

(Current GAW %) x (Current Benefit Base) = 4% x $125,000 = $5,000

(Attained age withdrawal %) x (Covered Fund Value) = 6% x $75,000 = $4,500

So           Because $4,500 is less than current GAW of $5,000, no Reset

5.06 EFFECT OF EXCESS WITHDRAWALS DURING THE WITHDRAWAL PHASE

 

After the Initial Installment Date, a Distribution or Transfer combined with all other amounts in excess of the GAW will be considered an Excess Withdrawal.   The Benefit Base will be reduced by the ratio of the new Covered Fund Value (after the Excess Withdrawal) to the previous
Covered Fund Value (after the GAW).

If an Excess Withdrawal occurs, the GAW and current Benefit Base shall be adjusted on the next Ratchet Date.

Numerical Example:

Covered Fund Value before GAW = $55,000

Benefit Base = $100,000

GAW %:5%

GAW Amount = $100,000 x 5% = $5,000

Total annual withdrawal: $10,000

Excess Withdrawal = $10,000 – $5,000 = $5,000

Covered Fund Value after GAW = $55,000 – $5,000 = $50,000

Covered Fund Value after Excess Withdrawal = $50,000 – $5,000 = $45,000

Covered Fund Value Adjustment due to Excess Withdrawal = $45,000/$50,000 = 0.90

Adjusted Benefit Base = $100,000 x 0.90 = $90,000

Adjusted GAW Amount (assuming no Benefit Base increase on succeeding Ratchet Date) = $90,000 x 5% = $4,500

 

 5.07 CHANGE OF INSTALLMENT FREQUENCY DURING WITHDRAWAL PHASE

 

The GLWB Elector may Request to change the Installment Frequency Option starting on each Ratchet Date during the Withdrawal Phase.

At any time during the Withdrawal Phase, the GLWB Elector receiving Installments more frequently than annually may elect to take a lump sum Distribution up to the remaining scheduled amount of the GAW for that year. It is the GLWB Elector’s responsibility to Request the suspension of the remaining Installments that are scheduled to be
paid during the year until the next Ratchet Date and to re-establish Installments that will commence upon the next Ratchet Date, if applicable.  If the GLWB Elector chooses not to suspend remaining Installments for the year, an Excess Withdrawal may occur.  If the GLWB Elector does not elect to recommence Installments 30 calendar days prior to Ratchet Date, no additional Installments shall be made until GLWB Elector notifies Great-West 30 calendar days prior to the next Ratchet Date.  The
GLWB Elector’s Withdrawal Phase Ratchet Date shall remain in effect while Installments are suspended.

 

5.08 QDROs DURING WITHDRAWAL PHASE

 

Great-West will make payment to the Alternate Payee and/or establish an Account on behalf of the Alternate Payee named in a QDRO approved during the Withdrawal Phase.  The Alternate Payee shall be responsible for submitting a Request to begin Distributions in accordance with the Code.

Pursuant to the instructions in the QDRO, if there is a single Covered Person, the Benefit Base and GAW will be divided in the same proportion as their respective Covered Fund Values as of the effective date of the QDRO.  The GLWB Elector may continue to receive the proportional GAWs after the accounts are split.  If the
Alternate Payee is the GLWB Elector’s spouse, he or she may elect to receive his or her portion of the Covered Fund Value as a lump sum Distribution or can separately elect to become a GLWB Elector pursuant to the provisions of Section 4.06.

Pursuant to the instructions in the QDRO, if there are two Covered Persons, the Benefit Base and GAW will be divided in the same proportion as their respective Covered Fund Values as of the effective date of the QDRO.  The GLWB Elector may continue to receive the proportional GAWs after the accounts are split, based on the amounts
calculated pursuant to the joint Covered Person GAW%.  If the Alternate Payee is the GLWB Elector’s spouse, he or she may elect to receive his or her portion of the Covered Fund Value as a lump sum Distribution or can separately elect to continue proportionate GAWs in the Withdrawal Phase based on the amounts calculated pursuant to the joint Covered Persons GAW% in Section 5.01 after the accounts are split.   A new Ratchet Date will be established for the Alternate Payee on the
date the Accounts are split.  Within thirty (30) days of each person’s Ratchet Date, the GLWB Elector and Alternate Payee can each elect a Reset based on the person’s own Attained Age GAW% for joint Covered Persons.

In the alternative, the Alternate Payee may establish a new GLWB in the Accumulation Phase with the Benefit Base based on the current Covered Fund Value on the date his or her Account is established.

A non-spouse Alternate Payee cannot elect to maintain the current Benefit Base or GAW but may elect to establish a new GLWB.  The Benefit Base and Certificate Election Date will be based on the current Covered Fund Value on the date his or her Account is established.

To the extent that the Alternate Payee becomes a GLWB Elector, he or she will be subject to all terms and conditions of the Certificate, the IRA Contract and the Code.

Any election made by the Alternate Payee pursuant to this section is irrevocable.

 

5.09 PAYMENTS ON DEATH DURING WITHDRAWAL PHASE

 

If a GLWB Elector Dies After the Initial Installment Date as a Single Covered Person

If the GLWB Elector dies after the Initial Installment date without a second Covered Person, the GLWB will terminate and no further Installments will be paid.  The remaining Covered Fund Value shall be distributed to the Beneficiary in accordance with the IRA.  If permitted by the IRA and the Code, the GLWB Elector’s
Beneficiary may elect to become a GLWB Elector in which event an initial Benefit Base shall be established and he or she  will be subject to all terms and conditions of the Certificate, the IRA Contract and the Code. Any election made by the Beneficiary is irrevocable.

If a GLWB Elector Dies After the Initial Installment Date while Second Covered Person is Living

Upon the death of an GLWB Elector after the Initial Installment Date, and while the second Covered Person is still living, the second Covered Person/Beneficiary may elect to become a GLWB Elector (if permitted by the IRA and the Code) and he or she will acquire all rights under the Certificate and continue to receive GAWs based on the original
GLWB Elector’s election.   Installments may continue to be paid to the surviving Covered Person based on the GAW% for joint Covered Persons in Section 5.01.  Installments will continue to be paid to the surviving Covered Person until his or her death and, upon death, the surviving Covered Person’s beneficiary will receive any remaining Covered Fund Value.  Alternatively, he or she may elect to receive his or her portion of the Covered Fund Value as a lump sum Distribution
or can separately elect to become a GLWB Elector pursuant to the provisions of Section 4.07.  In either situation the Ratchet Date will be the date when the Account is established.

To the extent to that the Beneficiary becomes a GLWB Elector, he or she will be subject to all terms and conditions of the Certificate, the IRA Contract and the Code.

	
Any election made by the Beneficiary pursuant to this section is irrevocable.

 

SECTION 6: SETTLEMENT PHASE

6.01 CERTIFICATE RIGHTS AND BENEFITS

 

During the Settlement Phase, rights to receive Installments will continue but all other rights and benefits under the Certificate will terminate.

 

6.02 FEES

 

The Guarantee Benefit Fee described in Section 9 will not be deducted during the Settlement Phase.

 

6.03 INSTALLMENTS

 

Installments will continue in the same frequency as previously elected, and cannot be changed during the Settlement Phase.

 

6.04 QDROs DURING THE SETTLEMENT PHASE

 

If a Request in connection with a QDRO is approved during the Settlement Phase, Great-West will divide the Installment pursuant to the terms of the QDRO. Installments will continue pursuant to the lives of each payee.

 

6.05 DEATH DURING THE SETTLEMENT PHASE

 

When the last Covered Person dies during the Settlement Phase, the GLWB will terminate and no additional Installments will be paid to the Beneficiary.

 

SECTION 7: BENEFIT BASE CAP

The Benefit Base may not exceed [$5 million].   Any value over [$5 million] will be considered excess Covered Fund Value and will not be used to calculate GAWs or the Guarantee Benefit Fee described in Section 9. A GLWB Elector may Transfer or Distribute any excess Covered Fund Value on a dollar for dollar basis without reducing
the Benefit Base.  However, if the Covered Fund Value falls below [$5 million] based on Excess Withdrawals, the Benefit Base will adjust pursuant to the terms of the Certificate.

 

SECTION 8: REQUIRED MINIMUM DISTRIBUTION

RMDs made under the Certificate will only be made in a manner consistent with the required minimum distribution or other provisions of the Code.   It is the responsibility of the GLWB Elector, Alternate Payee, or Beneficiary, as applicable, to Request payments in accordance
with the distribution requirements of the Code.  Great-West is not responsible for any penalties resulting from a failure to Request timely payments in the proper amount.

Any RMD during the Accumulation Phase shall be considered an Excess Withdrawal.

During the Withdrawal Phase, RMDs are not Excess Withdrawals if the Distribution made under the IRA causes the total Distributions to exceed GAW amount.   The Benefit Base will not be reduced for a RMD Installment to the extent that the RMD Amount is attributable to the Covered
Fund. 

A GLWB Elector should consult a qualified tax advisor regarding withdrawals to satisfy his or her RMD amount.

 

SECTION 9: GUARANTEE BENEFIT FEE

The amount of the annual Guarantee Benefit Fee is set forth on the Certificate Data page.  The Guarantee Benefit Fee will be deducted from the GLWB Elector’s Covered Fund Value up to $5 million.  Any Covered Fund Value exceeding $5 million will not factor into the Guarantee Benefit Fee calculation.  [One-
twelfth] of the Guarantee Benefit Fee is deducted on a [monthly] basis in arrears.  Great-West reserves the right to change the frequency of the deduction, but will notify the GLWB Elector and the Group Contractholder in writing at least thirty (30) calendar days prior to the change.

Great-West shall inform the Certificate Owner of the current percentage amount of the Guarantee Benefit Fee.  The Guarantee Benefit Fee will be divided by [twelve] on the date Great-West charges the fee.  The Guarantee Benefit Fee is withdrawn from the Covered Fund, and
Great-West is authorized to cause the custodian to remit the Guarantee Benefit Fee when due, if applicable.

The Guarantee Benefit Fee begins at the end of the month of the Certificate Election Date. Great-West reserves the right to change the Guarantee Benefit Fee at any time and for any reason upon thirty (30) days written notice to the GLWB Elector and Certificate Owner.  Any change to the fee will affect all assets in the Covered Fund(s).

If Great-West does not receive the Guarantee Benefit Fee for the GLWB attributed to the GLWB Elector, the GLWB attributed to such GLWB Elector will terminate as of the date such Guarantee Benefit Fee is due.

The Guarantee Benefit Fee is not deducted during the GLWB Elector’s Settlement Phase.

 

SECTION 10: GROUP CONTRACT TERMINATION

Unless otherwise provided in this Certificate, either Great-West or the Group Contractholder may terminate the Group Contract with advance written notice to the other party. The Group Contract termination date shall be the [seventy-fifth (75th)] day after the date
written notice is received in the Administrative Offices in good order.  If the [seventy-fifth (75th)] day is not a Business Day, the Group Contract termination date shall be the Business Day immediately following the [seventy-fifth (75th)] day.  Prior to the Group Contract termination date, Great-West and Group Contractholder may agree
to an alternate Group Contract termination date.

In addition, a GLWB Elector’s rights under the Group Contract and the Certificate terminate if the IRA is terminated.

If the Group Contractholder Terminates the Contract

If the Group Contractholder terminates the Group Contract, all benefits, rights, and privileges provided by the Group Contract, including without limitation, the GLWB shall terminate.  GLWB Electors who are not eligible to receive Distributions under the IRA or are eligible to receive their Distributions but do not take a Distribution
prior to the Group Contract termination date shall have the Benefit Base and Covered Fund Value reduced to zero and any and all other benefits provided under the Group Contract shall terminate on the Group Contract termination date.

Any GLWB Elector who is eligible to receive Distributions under the IRA  prior to the Group Contract termination date may elect a direct rollover of their Covered Fund assets to a Individual Retirement Account that offers a Great-West approved GLWB feature, if available. GLWB Electors who make this election will retain their Benefit
Base from the Group Contract and their GAW, if applicable, as of the date of Distribution from the Covered Fund(s).  If the GLWB Electors choose to transfer their Covered Fund assets to any investment vehicle not offering a GLWB portability option, the GLWB Elector’s Benefit Base and GAW, if applicable, will be reduced to zero as of the date of the Distribution from the Covered Fund(s).

If Great-West Terminates the Contract

If Great-West terminates the Group Contract, such termination will not adversely affect the Certificate Owner’s rights under the Group Contract, except that additional Certificate Contributions may not be invested in the
Covered Fund(s) other than reinvested dividends and capital gains.

Other Termination

This Contract and the GLWB shall automatically terminate if: (i) an IRA trustee, custodian or service provider discontinues the use of a Great-West approved Covered Fund, (ii) Great-West is unable to collect the Guarantee Benefit Fee; or (iii) Great-West cannot effectively administer the GLWB.  Should the Contract terminate under
this subsection, the IRA trustee, custodian or service provider, rather than Great-West, shall be treated as having terminated the Contract.

In the event of a complete IRA termination, the effected GLWB Elector (“Terminated GLWB Elector”) may elect a direct rollover of his or her Covered Fund assets to an Individual Retirement Account that offers a Great-West approved GLWB feature, if available.  Terminated GLWB Electors who make this election will retain their
Benefit Base from the Group Contract and their GAW, if applicable, as of the date of Distribution from the Covered Fund(s).  If the Terminated GLWB Electors choose to transfer their Covered Fund assets to any investment vehicle not offering a GLWB portability option, the Terminated GLWB Elector’s Benefit Base and GAW, if applicable, will be reduced to zero as of the date of the Distribution from the Covered Fund(s).

 

SECTION 11: CERTIFICATE TERMINATION

The Certificate will terminate upon the earlier of:

 

(a)  the date of death of the Certificate Owner if there is no surviving Covered Person; or

 

 

(b) the date there is no longer a Covered Person under the Certificate;

 

 

(c) the date the Certificate is canceled as set forth in Section 3.03;

 

 

(d)  the date the Group Contract terminates subject to Section 10; or

 

 

(e)  the date that the Guarantee Benefit Fee is not received by the Company, subject to the provisions of Section 9.

 

SECTION 12: GENERAL PROVISIONS

12.01 CERTIFICATE

 

Great-West has issued the Certificate to the Certificate Owner setting forth in substance the benefits, rights, and privileges to which the Certificate Owner is entitled under the Group Contract.

 

12.02 ENTIRE CERTIFICATE

 

The Certificate, including the Certificate Owner’s application, amendments, endorsements, specification page, if any, and or other riders, if any, constitutes the entire Certificate.

 

All statements in the Certificate Owner’s application, in the absence of fraud, have been accepted as representations and not warranties.  Only the President, Vice-President, or the Secretary of Great-West, or their authorized designees, can agree on behalf of Great-West to modify any provisions of the Certificate.

 

One or more provisions of the Certificate may be clarified by amendment, or other writing executed by both Great-West and the Certificate Owner.

 

12.03 GROUP CONTRACT MODIFICATION

 

Great-West may modify the Group Contract from time to time to conform it to changes in tax or other law, including applicable regulations and rulings, without consent of the Certificate Owner or any other person.  Great-West will provide notice and a copy of any such modification to the Certificate Owner as soon as reasonably practicable.  

 

The Group Contractholder and Great-West may, by written agreement, make other modifications to the Group Contract, subject to the approval of the appropriate state department of insurance, if applicable.  No such modification will, without the written consent of the Group Contractholder, affect the terms, provisions, or conditions
of the Certificate, which are or may be applicable to Certificate Contributions made prior to the date of such modification. 

 

12.04 MODIFICATION OF COVERED FUNDS

 

Great-West may, without the consent of the Certificate Owner or the Group Contractholder, offer new a Covered Fund(s) or cease offering a Covered Fund(s).  Great-West will notify the Group Contractholder whenever the Covered Fund(s) are changed.  Great-West shall complete the allocations between the Covered Fund(s) as disclosed
in the notice as of the effective date of the change.  Such allocation will remain in effect until the date Great-West receives a Request for a different allocation.

 

12.05 IRA PROVISIONS

 

In all cases, the trust or custodial account agreement for the IRA shall determine (subject to the Code) the specific features of the IRA, which may include the availability of certain types of investment options, distributions, and other features allowed but not mandated by the Code. Any provision of the Certificate or the Group Contract
which relates to a feature that conflicts with the IRA shall not apply.

 

12.06 NON-PARTICIPATING

 

The Certificate is Non-Participating.  The Certificate Owner is not eligible to share in Great-West’s divisible surplus.

 

12.07 CURRENCY AND CERTIFICATE CONTRIBUTIONS

 

All amounts to be paid to or by Great-West must be in currency of the United States of America.  All Certificate Contributions must be made payable to Great-West or to a designee acceptable to Great-West.

 

12.08 NOTICES OR OTHER COMMUNICATIONS

 

Any notice or demand by Great-West to or upon the Group Contractholder, any GLWB Elector, Covered Person(s) or any other person, if applicable, may be given by mailing it to that person’s last known address as stated in Great-West’s file through the United States Postal Service or last known email address or facsimile number on
file.

 

An application, report, Request, election, direction, notice or demand by the Group Contractholder, any GLWB Elector, or other Covered Person(s), if applicable, will be made in a form satisfactory to Great-West.  When Great-West requires it, the Certificate Owner will obtain the signature of the Covered Person(s) on forms provided
by Great-West.  Great-West must first approve any written materials developed by any other person describing the Group Contract or the Certificate.

 

12.09 DISCLAIMER

 

Nothing contained in the Certificate shall be construed to be tax or legal advice, and Great-West assumes no responsibility or liability for any costs, including but not limited to taxes, penalties or interest incurred by the IRA, the Group Contractholder, any GLWB Elector, Covered Person(s) or any other person, if applicable,  arising
out of a determination of liability.  Great-West shall not be held liable for the negligence, willful misconduct, or failure to perform of any third party.

 

12.10 REPRESENTATIONS

 

Great-West shall be entitled to rely and act solely on the reports, directions, proofs, notices, elections, and other information furnished to it by the Group Contractholder or its agent, GLWB Electors, Covered Persons, Alternate Payees, Beneficiaries or their respective agents, and such acts shall be conclusive and binding as to all GLWB
Electors and other persons or corporations claiming an interest hereunder.

 

12.13 NON-WAIVER

 

Great-West may, in its sole discretion, elect not to exercise a right, privilege, or option under the Group Contract or the Certificate.  Such election shall not constitute a waiver of the right to exercise such right, privilege, or option at any subsequent time, nor shall it constitute a waiver of any provision of the Group Contract
or the Certificate.

 

12.14 APPLICABLE TAX

 

An Applicable Tax may be assessed on the Covered Fund Value or any Distribution, based on applicable state law during the term of the Group Contract or the Certificate. 

 

12.15 INFORMATION

 

The Certificate Owner shall furnish all information that Great-West may reasonably require for the administration of the Group Contract or the Certificate.  Great-West shall not be responsible for any obligation under the Group Contract or the Certificate until it receives all requested information in a form acceptable to Great-West.

 

SECTION 13: ANNUITY PAYMENT OPTIONS

13.01 EFFECT OF ANNUITIZATION

 

If the GLWB Elector elects to annuitize, if permitted by the IRA, prior to the Initial Installment Date, the GLWB will terminate for those Covered Fund assets and all previously incurred fees will not be refunded.

 

13.02 ANNUITY PAYMENT OPTIONS

 

If, based upon information provided by the Certificate Owner, the GLWB Elector is entitled to a Distribution under the applicable terms and provisions of the IRA and the Code sections governing the IRA, all or a portion of an Account may be applied to an annuity payment option selected by the GLWB Elector, so long as the requirements of
the Code are met.  Thereafter, the Certificate shall no longer be applicable with respect to amounts in the annuity payment option.

 

The amount to be applied to an annuity payment option is: (i) the portion of the Account value elected by GLWB Elector, less (ii) Applicable Tax, if any, less (iii) any fees and charges described in the Certificate.

The minimum amount that may be applied under the elected annuity option is $[5,000].  If any payments to be made under the elected annuity payment option will be less than $[50], Great-West may make the payments in the most frequent interval that produces a payment of at least $[50].

Great-West will issue a certificate or other statement setting forth in substance the benefits, rights, and privileges to which such person is entitled under the Group Contract, to each Annuitant describing the benefits payable under the elected annuity payment option.

 

13.03 ELECTION OF ANNUITY OPTIONS

 

An Annuitant is required to elect an annuity payment option.  The Annuitant must Request an annuity payment option or change an annuity payment option no later than 30 days prior to the Annuity Commencement Date elected by the GLWB Elector.

 

To the extent available under the IRA, the annuity payment options are:

 

Income for Single Life Only

 

Income for Single Life with Guaranteed Period

 

Income for Joint Life Only

 

Income for Joint Life with Guaranteed Period

 

Income for a Specific Period

 

Any other form of annuity payment permitted under the IRA, if acceptable to Great-West.

 

The annuity option that will always be available is the Income for Single Life Only Annuity.  If this annuity option is elected, Great-West will make payments to the Annuitant at a frequency specified in the annuity certificate or other statement for the duration of the Annuitant’s lifetime.  Payments will cease pursuant
to the terms of the certificate or other statement.

 

Annuity purchase rates will be the same rates that are available for a Single Premium Immediate Annuity currently offered by Great-West at the time of annuitization.

 

SECTION 14: MISSTATEMENT OF AGE OR DEATH

Great-West may require adequate proof of the age and death of the Annuitant, GLWB Elector or Covered Person(s) before processing a Request for GAWs and annuity payments. If the age of the Annuitant, GLWB Elector or Covered Person(s) has been misstated, the Installment or annuity
payment established for him or her will be made on the basis or his or her correct age.

If Installments or annuity payments made were too large because of a misstatement of age, Great-West may deduct the difference from the next payment or payments with interest.  If payments were too small, Great-West may add the difference to the next payment with interest.  Any interest payable will be made at the rate
required by law.

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