Document:

Exh 4.4 EscrowAgreement

EXHIBIT 4.4

FORM OF ESCROW AGREEMENT

[NAME AND ADDRESS OF BANK]
__________________
__________________

Re:    Griffin-American Healthcare REIT III, Inc.  

Ladies and Gentlemen:

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC., a Maryland corporation (the “Company”), will issue in a public offering (the “Offering”) shares of its common stock (the “Stock”) pursuant to a registration statement on Form S-11 filed by the Company with the Securities and Exchange Commission.  GRIFFIN CAPITAL SECURITIES, INC., a California corporation (the “Dealer Manager”), will act as dealer manager for the offering of the Stock.  The Company is entering into this Escrow Agreement (the “Agreement”) to set forth the terms on which [NAME OF BANK] (the “Escrow Agent”) will, except as otherwise provided herein, hold and disburse the proceeds from subscriptions for the purchase of the Stock in the Offering until such time as (i) in the case of subscriptions received from all nonaffiliates of the Company, other than from residents of Washington, Ohio and Pennsylvania, the Company has received subscriptions for Stock resulting in a total of $2,000,000 in shares of common stock sold in the Offering (the “Required Capital”); (ii) in the case of subscriptions received from residents of Washington (“Washington Subscribers”), the Company has received subscriptions for Stock from nonaffiliates of the Company resulting in a total of $20,000,000 in shares of Stock sold in the Offering (the “Washington Required Capital”); (iii) in the case of subscriptions received from residents of Ohio (“Ohio Subscribers”), the Company has received subscriptions for Stock from nonaffiliates of the Company resulting in a total of $_______ in shares of Stock sold in the Offering (the “Ohio Required Capital”); and (iv) in the case of subscriptions received from residents of Pennsylvania (“Pennsylvania Subscribers”), the Company has received subscriptions for Stock from nonaffiliates of the Company resulting in a total of $60,000,000 in shares of Stock sold in the Offering (the “Pennsylvania Required Capital”).

The Company hereby appoints [NAME OF BANK] as Escrow Agent for purposes of holding the proceeds from the subscriptions for the Stock, on the terms and conditions hereinafter set forth: 

1.    Until such time as the Company has received subscriptions for Stock resulting in total minimum capital raised equal to the Required Capital and such funds are disbursed from the Escrow Account (as defined below) in accordance with paragraph 3(a) hereof, persons subscribing to purchase the Stock (the “Subscribers”) will be instructed by the Dealer Manager or any soliciting dealers to remit the purchase price in the form of checks, drafts, wires, Automated Clearing House (ACH) or money orders (hereinafter, the “instrument of payment”), payable to the order of “[NAME OF BANK], Agent for Griffin-American Healthcare REIT III, Inc.”  After subscriptions are received resulting in total minimum capital raised equal to the Required Capital and such funds are disbursed from the Escrow Account in accordance with paragraph 3(a) hereof, subscriptions shall continue to be so submitted and paid for by delivering a check for the full purchase price made payable to “Griffin-American Healthcare REIT III, Inc.”; provided, however, that Washington Subscribers, Ohio Subscribers and Pennsylvania Subscribers shall continue to make checks payable to the order of “[NAME OF BANK], Agent for Griffin-American Healthcare REIT III, Inc.” until 

1

subscriptions are received resulting in total minimum capital raised equal to the Washington Required Capital, the Ohio Required Capital or the Pennsylvania Required Capital, as applicable, and such funds are disbursed from the Washington Escrow Account (as defined below), the Ohio Escrow Account (as defined below) or the Pennsylvania Escrow Account (as defined below), as applicable, in accordance with paragraph 3(a) hereof.  Within one (1) business day after receipt of an instrument of payment from the Offering, (a) the Dealer Manager, the Company or their respective agents will send to the Escrow Agent a copy of the relevant part of each Subscriber’s subscription agreement showing the Subscriber’s name, address, tax identification number (Substitute IRS Form W-9), number of shares purchased, and purchase price remitted, and (b) the Escrow Agent will deposit the instrument of payment from such Subscribers using the Escrow Agent’s electronic facilities, into an interest-bearing deposit account entitled “Escrow Account for the Benefit of Subscribers for Common Stock of Griffin-American Healthcare REIT III, Inc.” (the “Escrow Account”), until such Escrow Account has closed pursuant to paragraph 3(a) hereof; provided, however, that instruments of payment received from Washington Subscribers (as identified as such by the Company) shall be accounted for separately in a subaccount entitled “Escrow Account for the Benefit of Washington Subscribers for Common Stock of Griffin-American Healthcare REIT III, Inc.” (the “Washington Escrow Account”), until such Washington Escrow Account has closed pursuant to paragraph 3(a) hereof; provided, further, that instruments of payment received from Ohio Subscribers (as identified as such by the Company) shall be accounted for separately in a subaccount entitled “Escrow Account for the Benefit of Ohio Subscribers for Common Stock of Griffin-American Healthcare REIT III, Inc.” (the “Ohio Escrow Account”), until such Ohio Escrow Account has closed pursuant to paragraph 3(a) hereof; and provided, further, that instruments of payment received from Pennsylvania Subscribers (as identified as such by the Company) shall be accounted for separately in a subaccount entitled “Escrow Account for the Benefit of Pennsylvania Subscribers for Common Stock of Griffin-American Healthcare REIT III, Inc.” (the “Pennsylvania Escrow Account”), until such Pennsylvania Escrow Account has closed pursuant to paragraph 3(a) hereof.  Each of the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account will be established and maintained in such a way as to permit the interest income calculations described in paragraph 7.  The Company shall, and shall cause its agents to, cooperate with the Escrow Agent in separately accounting for Washington, Ohio and Pennsylvania subscription proceeds in the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account, as applicable, and the Escrow Agent shall be entitled to rely upon information provided by the Company or its agents in this regard.

2.    The Escrow Agent agrees to promptly process for collection the instrument of payment upon deposit into the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, as applicable.  Deposits shall be held in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account, as applicable, until such funds are disbursed in accordance with paragraph 3 hereof.  Prior to disbursement of the funds deposited in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, such funds shall not be subject to claims by creditors of the Escrow Agent, the Company, the Dealer Manager, any soliciting dealer or any of their respective affiliates.  If the instrument of payment is returned to the Escrow Agent for nonpayment prior to receipt of the Required Capital or, in connection with subscriptions from Washington Subscribers, the Washington Required Capital, or, in connection with subscriptions from Ohio Subscribers, the Ohio Required Capital, or, in connection with subscriptions from Pennsylvania Subscribers, the Pennsylvania Required Capital, the Escrow Agent shall promptly notify the Dealer Manager and the Company in writing via mail, email or facsimile of such nonpayment, and is authorized to debit the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, as applicable, in the amount of such returned payment as well as any interest earned on the amount of such payment. 

3.    (a)    Subject to the provisions of subparagraphs 3(b)-3(f) below,

(i)    Once the collected funds in the Escrow Account are an amount equal to or greater than the Required Capital, the Escrow Agent shall, upon receiving written instruction from the Dealer Manager or the Company, (A) disburse to the Company, by check, ACH or wire transfer, the funds in the Escrow Account representing the gross purchase price for the Stock, and (B) within five business days after the first business day of the succeeding month, disburse to the Subscribers or the Company, as applicable, any interest thereon pursuant to the provisions of subparagraph 3(f).  After such time the Escrow Account shall remain open and the Dealer Manager or Company shall continue to cause subscriptions for the Stock that are not to be deposited in the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account to be deposited therein until the Company informs the Escrow Agent in writing to close the Escrow Account.  For purposes of this Agreement, the term “collected funds” shall mean all funds received by the Escrow Agent that have cleared normal banking channels and are in the form of cash or cash equivalent.  After the satisfaction of the aforementioned provisions of this paragraph 3(a)(i), in the event the Company receives subscriptions made payable to the Escrow Agent (other than subscriptions that are to be deposited in the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account), subscription proceeds may continue to be received in this account generally, but to the extent such proceeds shall not be subject to escrow due to the satisfaction of the aforementioned provisions of this paragraph 3(a)(i), such proceeds are not subject to this Agreement and at the instruction of the Dealer Manager or the Company to the Escrow Agent shall be transferred from the Escrow Account to the Company.

(ii)    Regardless of any release of funds from, or the closing of, the Escrow Account, the Company, the Dealer Manager and soliciting dealers shall continue to forward instruments of payment received from Washington Subscribers for deposit into the Washington Escrow Account to the Escrow Agent until such time as the Dealer Manager or the Company notifies the Escrow Agent in writing that total subscription proceeds (including the amount then in the Washington Escrow Account) equal or exceed the Washington Required Capital.  Upon the receipt by the Escrow Agent of such notice, the Escrow Agent shall (A) disburse to the Company, by check, ACH or wire transfer, the funds in the Washington Escrow Account representing the gross purchase price for the Stock, and (B) within five business days after the first business day of the succeeding month, disburse to the Washington Subscribers or the Company, as applicable, any interest thereon pursuant to the provisions of subparagraph 3(f).  Following such disbursements, the Escrow Agent shall close the Washington Escrow Account, and thereafter any instruments of payment received by the Escrow Agent from Washington Subscribers shall not be subject to this Third Amended and Restated Escrow Agreement and shall be deposited directly into the Escrow Account (or to the Company, if it has closed the Escrow Account, as instructed in writing by the Company pursuant to subparagraph 3(a)(i) above).

(iii)    Regardless of any release of funds from, or the closing of, the Escrow Account or the Washington Escrow Account, the Company, the Dealer Manager and soliciting dealers shall continue to forward instruments of payment received from Ohio Subscribers for deposit into the Ohio Escrow Account to the Escrow Agent until such time as the Dealer Manager or the Company notifies the Escrow Agent in writing that total subscription proceeds (including the amount then in the Ohio Escrow Account) equal or exceed the Ohio Required Capital.  Upon the receipt by the Escrow Agent of such notice, the Escrow Agent shall (A) disburse to the Company, by check, ACH or wire transfer, the funds in the Ohio Escrow Account representing the gross purchase price for the Stock, and (B) within five business days after the first business day of the succeeding month, disburse to the Ohio Subscribers or the Company, as applicable, any interest thereon pursuant to the provisions of subparagraph 3(f).  Following such disbursements, the Escrow Agent shall close the Ohio Escrow Account, and thereafter any instruments of payment received by the Escrow Agent from Ohio Subscribers shall not be subject to this Third Amended and Restated Escrow Agreement and shall be deposited directly into the Escrow Account (or to the Company, if it has closed the Escrow Account, as instructed in writing by the Company pursuant to subparagraph 3(a)(i) above).

(iv)    Regardless of any release of funds from, or the closing of, the Escrow Account, the Washington Escrow Account or the Ohio Escrow Account, the Company, the Dealer Manager and soliciting dealers shall continue to forward instruments of payment received from Pennsylvania Subscribers for deposit into the Pennsylvania Escrow Account to the Escrow Agent until such time as the Dealer Manager or the Company notifies the Escrow Agent in writing that total subscription proceeds (including the amount then in the Pennsylvania Escrow Account) equal or exceed the Pennsylvania Required Capital.  Upon the receipt by the Escrow Agent of such notice, the Escrow Agent shall (A) disburse to the Company, by check, ACH or wire transfer, the funds in the Pennsylvania Escrow Account representing the gross purchase price for the Stock, and (B) within five business days after the first business day of the succeeding month, disburse to the Pennsylvania Subscribers or the Company, as applicable, any interest thereon pursuant to the provisions of subparagraph 3(f).  Following such disbursements, the Escrow Agent shall close the Pennsylvania Escrow Account, and thereafter any instruments of payment received by the Escrow Agent from Pennsylvania Subscribers shall not be subject to this Third Amended and Restated Escrow Agreement and shall be deposited directly into the Escrow Account (or to the Company, if it has closed the Escrow Account, as instructed in writing by the Company pursuant to subparagraph 3(a)(i) above).

(b)    Within four business days of the close of business on the date that is one year following commencement of the Offering (the Company will notify the Escrow Agent of the commencement of the Offering) (the “Expiration Date”), the Escrow Agent shall promptly notify the Company if it is not in receipt of evidence of deposits for the purchase of Stock providing for aggregate offering proceeds that equal or exceed the Required Capital (from all sources but exclusive of any funds received from subscriptions for Stock from entities which the Company has notified the Escrow Agent are affiliated with the Company).  Within ten days following the date of such notice, the Escrow Agent shall promptly return directly to each Subscriber the collected funds deposited in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account on behalf of such Subscriber, or shall return the instrument of payment delivered, but not yet processed for collection prior to such time, in either case, together with interest income (which interest shall be paid within five business days after the first business day of the succeeding month) in the amounts calculated pursuant to paragraph 7 for each Subscriber at the address provided by the Dealer Manager or the Company to the Escrow Agent, which the Escrow Agent shall be entitled to rely upon.  However, the Escrow Agent shall not be required to remit any payments until the Escrow Agent has collected funds represented by such payments. 

(c)    Notwithstanding subparagraphs 3(a) and 3(b) above, if on or before the close of business on such date that is 120 days after a Pennsylvania Subscriber’s subscription for Stock received by the Company (with respect to each Pennsylvania Subscriber, the “Initial Escrow Period”) (such subscription date shall be promptly provided to the Escrow Agent by the Company after each subscription for Stock received by the Company from a Pennsylvania Subscriber), the Escrow Agent is not in receipt of instruments of payment dated not later than that date from nonaffiliated sources in an amount that, when added to the total subscription proceeds (excluding the amount in the Pennsylvania Escrow Account) as of such date, equals or exceeds the Pennsylvania Required Capital, the Company or the Dealer Manager shall send to the applicable Pennsylvania Subscriber within ten (10) calendar days after the end of such Pennsylvania Subscriber’s Initial Escrow Period a notification in the form of Exhibit C.  If, pursuant to such notification, the applicable Pennsylvania Subscriber requests the return of his or her subscription funds within ten (10) calendar days after receipt of the notification (the “Request Period”), the Company or the Dealer Manager shall notify the Escrow Agent of such request by the close of business on the next business day after receipt of the request from such Pennsylvania Subscriber.  Within fifteen (15) calendar days after receipt of notice of such request from the Company or the Dealer Manager, the Escrow Agent shall deliver directly to the applicable Pennsylvania Subscriber the collected funds from instruments of payment deposited in the Pennsylvania Escrow Account 

on behalf of such Pennsylvania Subscriber, together with interest income in the amount calculated pursuant to paragraph 7.  However, the Escrow Agent shall not be required to remit such payments until the Escrow Agent has collected funds represented by such payments.

(d)    The subscription funds of each Pennsylvania Subscriber who does not request the return of their subscription funds within the Request Period shall remain in the Pennsylvania Escrow Account for successive 120-day escrow periods (with respect to each Pennsylvania Subscriber, a “Successive Escrow Period”), each commencing automatically upon the termination of the respective Pennsylvania Subscriber’s Initial Escrow Period or prior Successive Escrow Period, as applicable, and the Company and the Escrow Agent shall follow the notification and payment procedure set forth in paragraph 3(c) above with respect to the Initial Escrow Period for each Pennsylvania Subscriber’s Successive Escrow Period until the occurrence of the earliest of (i) such time as the Dealer Manager or the Company notifies the Escrow Agent in writing pursuant to paragraph 3(a)(iv) that total subscription proceeds (including the amount then in the Pennsylvania Escrow Account) equal or exceed the Pennsylvania Required Capital and the disbursement of the Pennsylvania Escrow Account on the terms specified herein, or (ii) all funds held in the Pennsylvania Escrow Account having been returned to the Pennsylvania Subscribers in accordance with the provisions hereof.

(e)     If the Company rejects any subscription for which the Escrow Agent has collected funds, the Escrow Agent shall, upon the written request of the Dealer Manager or the Company, promptly issue a refund to the rejected Subscriber at the address provided by the Dealer Manager or the Company, which the Escrow Agent shall be entitled to rely upon.  If the Company rejects any subscription for which the Escrow Agent has not yet collected funds but has submitted the Subscriber’s check for collection, the Escrow Agent shall promptly return the funds in the amount of the Subscriber’s check to the rejected Subscriber, at the address provided by the Dealer Manager or the Company or their respective agents, which the Escrow Agent shall be entitled to rely upon, after such funds have been collected.   

(f)    At any time after funds are disbursed upon the Company’s acceptance of subscriptions pursuant to subparagraph 3(a) above on the fifth business day following the first business day of the next succeeding month following the date of such acceptance, the Escrow Agent shall promptly provide directly to each Subscriber the amount of the interest payable to the Subscribers.  However, the Escrow Agent shall not be required to remit any payments until the Escrow Agent has collected funds represented by such payments.  The forgoing notwithstanding, interest, if any, earned on accepted subscription proceeds will be payable to a Subscriber only if the Subscriber’s funds have been held in escrow by the Escrow Agent for at least 35 days; interest, if any, earned on accepted subscription proceeds of Subscribers’ funds held less than 35 days will be payable to the Company.

In the event that the instrument of payment is returned for nonpayment, the Escrow Agent is authorized to debit the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, as applicable, in accordance with paragraph 2 hereof.

4.    The Escrow Agent shall provide the Dealer Manager and the Company with electronic access to view the account balance and account activity in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account and shall provide the Company printed monthly statements (or more frequently as reasonably requested by the Company) on the account balance in each of the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account, and the activity in such accounts since the last report.  

5.    Prior to the disbursement of funds deposited in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account in accordance with the provisions of paragraph 

3 hereof, the Escrow Agent shall invest all of the funds deposited as well as earnings and interest derived therefrom in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, as applicable, in the “Short-Term Investments” specified below at the written direction of the Company, unless the costs to the Company for the making of such investment are reasonably expected to exceed the anticipated interest earnings from such investment in which case the funds and interest thereon shall remain in the respective escrow account until the balance in the respective escrow account reaches the minimum amount necessary for the anticipated interest earnings from such investment to exceed the costs to the Company for the making of such investment, as determined by the Company based upon applicable interest rates.  

“Short-Term Investments” include obligations of, or obligations guaranteed by, the United States government or bank money-market accounts or certificates of deposit of national or state banks that have deposits insured by the Federal Deposit Insurance Corporation (including certificates of deposit of any bank acting as a depository or custodian for any such funds) which mature on or before the Expiration Date, unless such instrument cannot be readily sold or otherwise disposed of for cash by the Expiration Date without any dissipation of the offering proceeds invested.  Without limiting the generality of the foregoing, Exhibit A hereto sets forth specific Short-Term Investments that shall be deemed permissible investments hereunder.

The following securities are not permissible investments: 

(a)    money market funds; 
(b)    corporate equity or debt securities; 
(c)    repurchase agreements; 
(d)    bankers’ acceptances; 
(e)    commercial paper; and 
(f)    municipal securities. 

It is hereby expressly agreed and stipulated by the parties hereto that the Escrow Agent shall not be required to exercise any discretion hereunder and shall have no investment or management responsibility and, accordingly, shall have no duty to, or liability for its failure to, provide investment recommendations or investment advice to the parties hereto.  It is the intention of the parties hereto that the Escrow Agent shall never be required to use, advance or risk its own funds or otherwise incur financial liability in the performance of any of its duties or the exercise of any of its rights and powers hereunder.

6.    The Escrow Agent is entitled to rely upon written instructions received from the Company or the Dealer Manager or their respective agents, unless the Escrow Agent has actual knowledge that such instructions are not valid or genuine; provided that, if in the Escrow Agent’s opinion, any instructions from the Company or the Dealer Manager or their respective agents are unclear, the Escrow Agent may request clarification from the Company or the Dealer Manager or their respective agents, as applicable, prior to taking any action, and if such instructions continue to be unclear, the Escrow Agent may rely upon written instructions from the Company’s legal counsel in distributing or continuing to hold any funds.  However, the Escrow Agent shall not be required to disburse any funds attributable to the instrument of payment that have not been processed for collection, until such funds are collected and then shall disburse such funds in compliance with the disbursement instructions from the Company or the Dealer Manager or their respective agents.

7.    If the Offering terminates prior to receipt of the Required Capital or, with respect to Washington Subscribers, Ohio Subscribers and Pennsylvania Subscribers, the Washington Required Capital, the Ohio Required Capital or the Pennsylvania Required Capital, as applicable, interest income earned on subscription 

proceeds deposited in the Escrow Account (the “Escrow Income”), the Washington Escrow Account (the “Washington Escrow Income”), the Ohio Escrow Account (the “Ohio Escrow Income”) or the Pennsylvania Escrow Account (the “Pennsylvania Escrow Income”), shall be remitted to Subscribers to the address provided by the Dealer Manager or the Company to the Escrow Agent, which the Escrow Agent shall be entitled to rely upon, or to the Company if the applicable Subscriber’s funds have been held in escrow by the Escrow Agent for less than 35 days, in accordance with paragraph 3 and without any deductions for escrow expenses.  The Company shall reimburse the Escrow Agent for all escrow expenses.  If the Escrow Agent remits interest income pursuant to this Agreement, the Escrow Agent shall be responsible for any necessary federal tax reporting associated with such income; provided, however, that the Escrow Agent shall not be responsible for any other tax reporting associated with this Agreement.  The Escrow Agent shall remit all such Escrow Income, Washington Escrow Income, Ohio Escrow Income and Pennsylvania Escrow Income in accordance with paragraph 3.  If the Company chooses to leave the Escrow Account open after receiving the Required Capital then it shall make regular acceptances of subscriptions therein, but no less frequently than monthly, and the Escrow Income from the last such acceptance shall be calculated and remitted to the Subscribers or the Company, as applicable, pursuant to the provisions of paragraph 3(f).

8.    The Escrow Agent shall receive compensation from the Company as set forth in Exhibit B attached hereto, which such Exhibit B is hereby incorporated by reference. 

9.    In performing any of its duties hereunder, the Escrow Agent shall not incur any liability to anyone for any damages, losses, or expenses, except for willful misconduct, breach of trust, or gross negligence.  Accordingly, the Escrow Agent shall not incur any such liability with respect to any action taken or omitted (a) in good faith upon advice of the Escrow Agent’s counsel given with respect to any questions relating to the Escrow Agent duties and responsibilities under this Agreement, or (b) in reliance upon any instrument, including any written instrument or instruction provided for in this Agreement, not only as to its due execution and validity and effectiveness of its provisions but also as to the truth and accuracy of information contained therein, which the Escrow Agent shall in good faith believe to be genuine, to have been signed or presented by a proper person or persons and to conform to the provisions of this Agreement. 

10.    The Company and the Dealer Manager hereby agree to indemnify and hold the Escrow Agent harmless against any and all losses, claims, damages, liabilities, and expenses, including reasonable attorneys’ fees and disbursements, that may be imposed on or incurred by the Escrow Agent in connection with acceptance of appointment as the Escrow Agent hereunder, or the performance of the duties hereunder, including any litigation arising from this Agreement or involving the subject matter hereof, except where such losses, claims, damages, liabilities, and expenses result from willful misconduct, breach of trust, or gross negligence on the part of the Escrow Agent.  Venue for any action or litigation arising between or among the Company and/or Dealer Manager on one hand and the Escrow Agent on the other hand involving the subject matter hereof shall lie exclusively in Orange County, California.

11.    In the event of a dispute between the parties hereto sufficient in the Escrow Agent’s discretion to justify doing so, the Escrow Agent shall be entitled to tender into the registry or custody of any court of competent jurisdiction all money or property in its hands under this Agreement, together with such legal pleadings as deemed appropriate, and thereupon be discharged from all further duties and liabilities under this Agreement. In the event of any uncertainty as to the duties hereunder, the Escrow Agent may refuse to act under the provisions of this Agreement pending order of a court of competent jurisdiction and shall have no liability to the Company or to any other person as a result of such action.  Any such legal action may be brought in such court, as the Escrow Agent shall determine to have jurisdiction thereof.  The filing of any such legal proceedings shall not deprive the Escrow Agent of its compensation earned prior to such filing. 

12.    All communications and notices required or permitted by this Agreement shall be in writing and shall be deemed to have been given when delivered personally or by messenger or by overnight delivery service or when received via telecopy or other electronic transmission, in all cases addressed to the person for whom it is intended at such person’s address set forth below or to such other address as a party shall have designated by notice in writing to the other party in the manner provided by this paragraph: 

(a)    if to the Company: 

4000 MacArthur Boulevard
West Tower, Suite 200
Newport Beach, California 92660
Attention:  Jeffrey T. Hanson

(b)    if to the Dealer Manager: 

Griffin Capital Securities, Inc.
4000 MacArthur Boulevard
West Tower, Suite 220
Newport Beach, California 92660
Facsimile No.: ___________ 
Attention: _____________

(c)    if to the Escrow Agent: 
        
[NAME AND ADDRESS OF BANK]
__________________
__________________
Attention: _____________

Each party hereto may, from time to time, change the address to which notices to it are to be delivered or mailed hereunder by notice in accordance herewith to the other parties. 

13.    This Agreement shall be governed by the laws of the State of California as to both interpretation and performance without regard to the conflict of laws rules thereof. 

14.    The provisions of this Agreement shall be binding upon the legal representatives, successors, and assigns of the parties hereto. 

15.    The Company and the Dealer Manager hereby acknowledge that [NAME OF BANK] is serving as Escrow Agent only for the limited purposes herein set forth, and hereby agree that they will not represent or imply that, by serving as Escrow Agent hereunder or otherwise, the Escrow Agent has investigated the desirability or advisability of investment in the Company or has approved, endorsed, or passed upon the merits of the Stock or the Company, nor shall they use the name of the Escrow Agent in any manner whatsoever in connection with the offer or sale of the Stock other than by acknowledgment that it has agreed to serve as Escrow Agent for the limited purposes herein set forth. 

16.    This Agreement and any amendment hereto may be executed by the parties hereto in one or more counterparts, each of which shall be deemed to be an original. 

17.    In the event that the Dealer Manager receives the instrument of payment after the Required Capital, the Washington Required Capital, the Ohio Required Capital or the Pennsylvania Required Capital, as applicable, has been received and the proceeds of the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account, as applicable, have been distributed to the Company, the Escrow Agent is hereby authorized to deposit such instrument of payment within one (1) business day to any deposit account as directed by the Company.  The application of said funds into a deposit account or to forward such funds directly to the Company, in either case directed by the Company, shall be a full acquittance to the Escrow Agent, who shall not be responsible for the application of said funds thereafter. 

18.    The Escrow Agent shall be bound only by the terms of this Agreement and shall not be bound by or incur any liability with respect to any other agreements or understanding between any other parties, whether or not the Escrow Agent has knowledge of any such agreements or understandings. 

19.    Indemnification provisions set forth herein shall survive the termination of this Agreement. 

20.In the event that any part of this Agreement is declared by any court or other judicial or administrative body to be null, void, or unenforceable, said provision shall survive to the extent it is not so declared, and all of the other provisions of this Agreement shall remain in full force and effect.

21.    Unless otherwise provided in this Agreement, final termination of this Agreement shall occur on the date that all funds held in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account and the Pennsylvania Escrow Account are distributed either (a) to the Company or to Subscribers and the Company has informed the Escrow Agent in writing to close the Escrow Account pursuant to paragraph 3 hereof or (b) to a successor escrow agent upon written instructions from the Company. 

22.    Neither the Escrow Agent, nor its agents, shall have responsibility for accepting, rejecting, or approving subscriptions.  The Escrow Agent, or its agent, shall complete an OFAC search, in compliance with its policy and procedures, of each subscription check and shall inform the Company if a subscription check fails the OFAC search.  The Dealer Manager shall provide a copy of each subscription check in order that the Escrow Agent, or its agent, may perform such OFAC search.

23.    This Agreement shall not be modified, revoked, released, or terminated unless reduced to writing and signed by all parties hereto, subject to the following paragraph. 

If, at any time, any attempt is made to modify this Agreement in a manner that would increase the duties and responsibilities of the Escrow Agent or to modify this Agreement in any manner which the Escrow Agent shall deem undesirable, or at any other time, the Escrow Agent may resign by providing written notice to the Company and until (a) the acceptance by a successor escrow agent as shall be appointed by the Company; or (b) thirty (30) days after such written notice has been given, whichever occurs sooner, the Escrow Agent’s only remaining obligation shall be to perform its duties hereunder in accordance with the terms of the Agreement. 

24.    The Escrow Agent may resign at any time from its obligations under this Agreement by providing written notice to the Company.  Such resignation shall be effective on the date specified in such notice, which shall be not less than thirty (30) days after such written notice has been given.  The Escrow Agent shall have no responsibility for the appointment of a successor escrow agent. 

25.    The Escrow Agent may be removed for cause by the Company by written notice to the Escrow Agent effective on the date specified in such written notice.  The removal of the Escrow Agent shall not deprive the Escrow Agent of its compensation earned prior to such removal. 

26.    The Company shall provide to Escrow Agent any documentation and information reasonably requested by the Escrow Agent for it to comply with the USA PATRIOT Act of 2001, as amended from time to time.

27.    If any state securities administrator requires the Company to cause the Escrow Agent to notify such administrator when the Escrow Agent releases the funds in the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account to the Company, the Company shall notify the Escrow Agent of such requirement, and provide the Escrow Agent with the contact information for such administrator.  The Escrow Agent agrees to notify such administrator in writing when the Escrow Agent releases such funds to the Company.  The Escrow Agent agrees to permit state securities administrators to inspect the Escrow Agent’s records related to the Escrow Account, the Washington Escrow Account, the Ohio Escrow Account or the Pennsylvania Escrow Account at any reasonable time at the location where the records are located, and to copy any records that are inspected.

[Signature page follows]

Agreed to as of the ____ day of ______, 2013.

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC., 
a Maryland corporation

By:                          
Name:                          
Title:                          

GRIFFIN CAPITAL SECURITIES, INC.,
a California corporation 

By:                          
Name:                          
Title:                          

The terms and conditions contained above are hereby accepted and agreed to by: 

[NAME OF BANK], as Escrow Agent

By:            
Name:            
Title:            

EXHIBIT A

PERMISSIBLE ESCROW INVESTMENTS

		
	(i)
	Bank accounts;

		
	(ii)
	Bank money-market accounts;

		
	(iii)
	Short time certificates of deposit issued by a bank; and

		
	(iv)
	Short-term securities issued or guaranteed by the U.S. government

EXHIBIT B

ESCROW FEES AND EXPENSES

[TO BE PROVIDED.]

EXHIBIT C

FORM OF NOTICE TO PENNSYLVANIA SUBSCRIBERS  

Name:                            
Address:                             

Dear             :
You submitted a subscription to purchase shares of Griffin-American Healthcare REIT III, Inc. (the “Company”).  Your subscription is currently being held in escrow because the guidelines of the Pennsylvania Securities Commission do not permit the Company to accept subscriptions from Pennsylvania residents until an aggregate of $60,000,000 of gross offering proceeds have been received by the Company.  Until this minimum amount of offering proceeds is received by the Company, we are required to offer to return your money every 120 days.  
If you wish to continue your subscription in escrow until the Pennsylvania minimum subscription amount is received, no further action is required.  Thank you for your continued confidence. 
If you wish to terminate your subscription for the Company’s common stock and have your subscription returned, please so indicate below, sign, date, and return to Griffin-American Healthcare REIT II, Inc., c/o DST Systems, Inc., 430 W. 7th Street, Kansas City, MO 64105] or by fax to (___) ________. 

*     *    *

I am a resident of Pennsylvania and I hereby terminate my prior subscription to purchase shares of common stock of Griffin-American Healthcare REIT III, Inc. and request the return of my subscription funds.  

Signature:                            

Name:                              
        (please print)

Date:                              

C-1ex4e-gmwbpib3rider

GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER 
  
This rider is part of Your contract. All definitions, provisions, and exceptions of the contract apply to this 
rider unless specifically changed by this rider. This rider is available only if the Owner(s) and Covered 
Lives meet Our rider eligibility guidelines. 
  
The rider effective date is shown on the Data Page. In the event of a conflict between any provision in 
this rider and the contract, the provisions of this rider will control. The initial charge for this rider is shown 
on the Data Page. You may terminate this rider any time after it has been in force for five full Contract 
Years. 
  
RIDER BENEFITS 
  
This rider guarantees that You may take certain Withdrawals in each Contract Year for life, regardless of 
Your contract's accumulated value, subject to the terms and conditions of this rider. The purpose of the 
guaranteed minimum withdrawal benefit provided under this rider is to provide security through available 
Withdrawals. The guaranteed minimum withdrawal benefit will terminate upon assignment or a change in 
ownership of the contract unless the new assignee or Owner meets the qualifications specified in the 
COVERED LIFE CHANGE provision of this rider. 
  
DEFINITIONS 
  
COVERED LIFE or COVERED LIVES are the natural person(s) upon whose lives the Withdrawal 
Benefit Payments of this rider are based. There can be no more than two Covered Lives. 
  
EXCESS WITHDRAWAL is the portion of a Withdrawal that exceeds the Withdrawal Benefit 
Payment. 
  
OWNER is the person, including any Joint Owner, who owns all rights and privileges of this rider. If 
the Owner is not a natural person, for purposes of this rider, the term "Owner" shall mean the 
Annuitant(s). 
  
SPOUSE is the person recognized as the Owner's Spouse and eligible to make a spousal election 
under federal tax laws. 
  
WITHDRAWAL is any partial surrender of the contract accumulated value (including Surrender 
Charges, if the partial surrender exceeds the Free Surrender Amount) and/or any partial annuitization 
of the contract. 
  
WITHDRAWAL BENEFIT BASE (also referred to as For Life Withdrawal Benefit Base) is the amount 
on which a Withdrawal Benefit Payment is based. 
  
WITHDRAWAL BENEFIT PAYMENT (also referred to as For Life Withdrawal Benefit Payment) is 
any amount guaranteed to be available for Withdrawal each Contract Year. 
  
GUARANTEED MINIMUM WITHDRAWAL BENEFIT (GMWB) 
  
This rider provides for guaranteed minimum Withdrawal Benefit Payments, up to an annual percentage of 
the For Life Withdrawal Benefit Base, on and after the Contract Anniversary following the date the oldest 
Owner attains age 59 1⁄2. The annual percentage is based on “Single Life” unless You have elected "Joint 
Life" Withdrawal Benefit Payments as described in "SINGLE LIFE" AND "JOINT LIFE" WITHDRAWAL 
BENEFIT PAYMENTS. When calculating the For Life Withdrawal Benefit Base, all Withdrawals taken 

prior to the Contract Anniversary following the date the oldest Owner attains age 59 1⁄2 are treated as  Excess Withdrawals. 

You are not required to take Withdrawals, except as described in EFFECT ON RIDER BENEFITS IF 
CONTRACT ACCUMULATED VALUE IS ZERO. You may take Withdrawals when, and in any amount, 
You desire subject to the Minimum Unscheduled Partial Surrender amount shown on the Data Page. 
Anytime You take a Withdrawal, We adjust the For Life Withdrawal Benefit Payment and the For Life 
Withdrawal Benefit Base, as described in WITHDRAWAL BENEFIT PAYMENT CALCULATION and 
WITHDRAWAL BENEFIT BASE CALCULATION. Withdrawals are deducted from the Investment Options 
in the same proportion as Your current premium payment allocations unless You direct otherwise. 
  
Note: Although this rider does not restrict Your Withdrawal rights under the contract, You need to know 
that the amount of Withdrawals that exceed the Withdrawal Benefit Payment have a negative effect 
on this rider's value as described in EFFECT OF EXCESS WITHDRAWALS ON RIDER 
BENEFITS. 
  
"SINGLE LIFE" AND "JOINT LIFE" WITHDRAWAL BENEFIT PAYMENTS 
  
"Single Life" For Life Withdrawal Benefit Payments 
  
The Withdrawal Benefit Payments under this rider are automatically calculated as "Single Life", meaning 
based on one Covered Life. To be eligible for "Single Life" Withdrawal Benefit Payments, the Covered 
Life:       
  
1 . must be either: 
    a. the Owner if there is only one Owner; or 
    b. the youngest Joint Owner if there are Joint Owners; and 
  
2 . must meet Our rider eligibility guidelines on the date named as a Covered Life. 
  
"Single Life" Withdrawal Benefit Payments continue until the earlier of: 
  
1 . the death of the first Owner to die; or 
  
2 . the Withdrawal Benefit Base is zero. 
  
The "Single Life" Withdrawal Benefit Payment percentage is locked in as of the date of Your first 
Withdrawal and is set out in the table on the Data Page. 
  
"Joint Life" For Life Withdrawal Benefit Payments 
  
Anytime on or before Your first Withdrawal, You may elect to take Withdrawal Benefit Payments on a 
"Joint Life" basis, meaning based on two Covered Lives. You may only elect "Joint Life" Withdrawal 
Benefit Payments if there are two eligible Covered Lives. The "Joint Life" election is not available if the 
Owner is not a natural person. 
  
In order to be eligible for "Joint Life" Withdrawal Benefit Payments, the Covered Lives: 
  
1 . must be either: 
    a. if there is only one Owner, the Owner and the Owner's Spouse, provided the Spouse is 
              named as a primary beneficiary; or 
    b. the Joint Owners, provided the Joint Owners are each other's Spouse; and 
  

2 . must meet Our rider eligibility guidelines on the date named as Covered Lives. 
  
"Joint Life" Withdrawal Benefit Payments continue until the earlier of: 
  
1 . the death of the last Covered Life to die, or 
  
2 . the Withdrawal Benefit Base is zero. 

The "Joint Life" Withdrawal Benefit Payment percentage is locked in as of the date of Your first 
Withdrawal and is set out in the table on the Data Page. 
  
Note: The Withdrawal Benefit Payment will always be based on "Single Life" unless You notify us that 
 You are electing "Joint Life" Withdrawal Benefit Payments and You are eligible to make a "Joint 
  Life" election. At the time You take Your first Withdrawal, Your Withdrawal Benefit Payment is 
  locked in as either "Single Life" or "Joint Life", whichever is applicable. You may not change Your 
  Withdrawal Benefit Payment election after You have taken a Withdrawal. 
  
EFFECT ON RIDER BENEFITS IF CONTRACT ACCUMULATED VALUE IS ZERO 
  
If Your contract accumulated value is zero and rider benefits are available: 
  
1 . You will receive "Single Life" or "Joint Life" For Life Withdrawal Benefit Payments as described in 
 "SINGLE LIFE" AND "JOINT LIFE" WITHDRAWAL BENEFIT PAYMENTS. You may elect the 
  frequency of Your Withdrawal Benefit Payment on a schedule that is acceptable to Us. 
  
2 . You will continue to receive the Withdrawal Benefit Payment under this rider according to the 
 rider terms, but all other rights and benefits under this rider and the contract, including death 
 benefits and the ability to make additional premium payments, will cease. 
  
WITHDRAWAL BENEFIT PAYMENT CALCULATION 
  
We calculate the Withdrawal Benefit Payment on the rider effective date and on each Contract 
Anniversary thereafter. 
  
The Withdrawal Benefit Payment is calculated as a fixed percentage of the Withdrawal Benefit Base. The 
Withdrawal Benefit Payment percentage is locked in as of the date of Your first Withdrawal as set out in 
the tables on the Data Page, and is automatically based on "Single Life" unless You are eligible and elect 
"Joint Life".   
  
You are not required to take a Withdrawal of any or all of a Withdrawal Benefit Payment in a Contract 
Year. If You do not take an available Withdrawal Benefit Payment in a Contract Year, that remaining 
Withdrawal Benefit Payment does not carry over to the next Contract Year. 
  
WITHDRAWAL BENEFIT BASE CALCULATION 
  
We calculate the Withdrawal Benefit Base on the rider effective date and on each Contract Anniversary 
this rider is in force. If the Contract Date and the rider effective date are the same, the Withdrawal Benefit 
Base equals premium payments made on that date. If the Contract Date and the rider effective date are 
different, the Withdrawal Benefit Base equals the contract accumulated value on the rider effective date. 
Additional premium payments made during any Contract Year plus any applicable GMWB Bonus will 
increase the Withdrawal Benefit Base on the next Contract Anniversary. 
  
Withdrawals during a Contract Year that are less than or equal to a Withdrawal Benefit Payment will not 

decrease the Withdrawal Benefit Base. Excess Withdrawals will reduce the Withdrawal Benefit Base in 
an amount equal to the greater of: 
  
1. the Excess Withdrawals; and 
  
2. the result of (a. divided by b.), multiplied by c., where: 
            a. is the amount withdrawn in excess of the Withdrawal Benefit Payment remaining prior to the 
Withdrawal; 
            b. is the contract accumulated value after the Withdrawal Benefit Payment is deducted, but prior 
to the Excess Withdrawal; and 
            c. is the Withdrawal Benefit Base prior to the adjustment for the Excess Withdrawal. 
  
Note: The Withdrawal Benefit Base cannot be withdrawn in a lump sum and is not payable as a death 
 benefit. 

GMWB BONUS 
  
We may credit a GMWB Bonus to the Withdrawal Benefit Base, provided that You have not taken a 
Withdrawal in any preceding Contract Year during the life of this rider. The GMWB Bonus, if any, is 
shown on the Data Page. 
  
Note: The GMWB Bonus is used only for purposes of calculating the Withdrawal Benefit Base. It is not 
 included in Your contract accumulated value. 
  
ANNUAL GMWB STEP-UP 
  
On each Contract Anniversary following the rider effective date, We will compare the contract 
accumulated value on the Contract Anniversary to the Withdrawal Benefit Base. If the contract 
accumulated value is greater than the Withdrawal Benefit Base, We will automatically increase ("Step- 
Up") the Withdrawal Benefit Base to the contract accumulated value if You are eligible for that Step-Up. 
  
You are eligible for a Step-Up to the Withdrawal Benefit Base if the following requirements are satisfied: 
  
1. the Contract Anniversary occurs before the later of: 
a. the Contract Anniversary following the date the oldest Owner attains age 80; or 
b. ten years after the rider effective date; 
  
2. You have not declined any increases in the rider charge; and 
  
3. You have not fully annuitized Your contract. 
  
So long as You remain eligible for the Step-Up feature of this rider, You will be charged the then current 
rider charge as described in RIDER CHARGE. You may avoid an increase in Your rider charge by 
declining the rider charge increase before the rider charge increase becomes effective. If You decline 
the increased charge, You are no longer eligible for the Step-Up feature. The feature may not be added 
later and You will not receive future Step-Ups. 
  
EFFECT OF EXCESS WITHDRAWALS ON RIDER BENEFITS 
  
Any Withdrawal, or portion thereof, when aggregated with all prior Withdrawals during that Contract Year, 
that exceeds the Withdrawal Benefit Payment is an Excess Withdrawal. As stated previously in 
GUARANTEED MINIMUM WITHDRAWAL BENEFIT (GMWB), all Withdrawals taken prior to the Contract 
Anniversary following the date the oldest Owner attains age 59 1⁄2 are treated as Excess Withdrawals. 

  
Excess Withdrawals will reduce the Withdrawal Benefit Base. This reduction may be greater than 
the dollar amount of the Excess Withdrawal when the contract accumulated value is less than the 
Withdrawal Benefit Base. For a description of how Excess Withdrawals impact the Withdrawal Benefit 
Base, see WITHDRAWAL BENEFIT BASE CALCULATION. For a description of how Excess 
Withdrawals impact the GMWB Death Benefit, see RIDER BENEFITS AT DEATH. 
  
REQUIRED MINIMUM DISTRIBUTIONS (RMD) 
  
Tax-qualified contracts are subject to certain federal tax rules requiring that RMD be taken on a calendar 
year basis (as opposed to a contract year basis), usually beginning after age 701⁄2. 
  
If You are eligible for and enroll in our RMD Program for GMWB, as discussed below, a Withdrawal taken 
to satisfy RMD for the contract (an "RMD amount") that exceeds a Withdrawal Benefit Payment for that 
Contract Year will not be deemed an Excess Withdrawal. 
  
RMD Program: Eligibility in the RMD Program for GMWB is determined by satisfaction of the following 
requirements: 
  
1. the amount required to be distributed each calendar year for purposes of satisfying the RMD rules 
of the Internal Revenue Code is based only on this contract (the "RMD amount"); and 
 
2. You have elected scheduled Withdrawal Payments. 
  
Note: Although enrollment in the RMD Program for GMWB does not prevent You from taking an 
 unscheduled Withdrawal, an unscheduled Withdrawal will cause You to lose the RMD Program 
 protections for the remainder of the Contract Year. This means that any Withdrawals (scheduled 
 or unscheduled) during the remainder of the Contract Year that exceed the Withdrawal Benefit 
 Payment will be treated as Excess Withdrawals, even if the purpose is to take the RMD amount. 
 You will automatically be re-enrolled in the RMD Program for GMWB on Your next Contract 
 Anniversary. 
  
We reserve the right to modify or eliminate the RMD Program for GMWB; for example, if there is a 
change to the Internal Revenue Code or Internal Revenue Service rules or interpretations relating to 
RMD, including the issuance of relevant IRS guidance. We will send You at least 30 days advance Notice 
of any change in or elimination of the RMD Program for GMWB. Any modifications or elimination of the 
RMD Program for GMWB will take effect after Notice. If We exercise our right to modify or eliminate the 
RMD Program for GMWB, then any scheduled or unscheduled Withdrawal in excess of a Withdrawal 
Benefit Payment after the effective date of the program's modification or elimination will be deemed an 
Excess Withdrawal. 
  
RIDER CHARGE 
  
There is an additional charge for this rider. The rider charge is computed quarterly based on the 
Withdrawal Benefit Base and is deducted from Your contract accumulated value at the end of each 
calendar quarter. The rider charge is deducted through the redemption of units from Your Separate 
Account Division(s) accumulated value and/or withdrawal from Your Fixed Account(s) Value in the same 
proportion as the surrender allocation percentages. If the surrender allocation percentages include the 
Fixed Account(s), We will not deduct charges from the Fixed Account(s) that reduce the credited interest 
amount below the guaranteed minimum interest amount. Any rider charges We cannot deduct from the 
Fixed Account(s) are pro-rated among Your remaining Separate Account Division(s) included in the 
surrender allocation percentages. If this rider is issued after the beginning of a calendar quarter, We will 
pro-rate the rider charge to reflect the number of days the rider is in effect during the calendar quarter. 

  
The initial rider charge is shown on the Data Page. We may increase the rider charge, but We guarantee 
that the increased charge will not exceed the maximum rider charge shown on the Data Page. Rider 
charge increases, if any, will automatically apply unless We receive Notice from You declining the 
increase prior to the effective date of the rider charge increase. 
  
Note: If You decline an increase in the rider charge, You will no longer be eligible for future Step-Ups and 
Your current rider charge will remain in effect for the remaining life of this rider. 
  
If this rider is terminated, We will pro-rate the rider charge to reflect the number of days that this rider was 
in effect during the calendar quarter. There will be no further deductions for the rider charge. 
  
INVESTMENT OPTION RESTRICTIONS 
  
While this rider is in effect, the Investment Options You may select are limited to the allocation models 
and/or Divisions that We designate ("GMWB Investment Options"). We may modify the GMWB 
Investment Options available with this rider from time to time. 
  
You may select only one GMWB Investment Option at a time and additional premiums will be applied in 
the same proportion as Your current premium payment allocations. You may transfer from one GMWB 
Investment Option to another by providing Us Notice. 

If You select a GMWB Investment Option which is an allocation model: 
  
1 . Your allocation percentages must match the percentages of the model You have selected; and 
  
2 . You direct us to automatically rebalance Your contract accumulated value on each calendar 
 quarter to match Your selected model. 
  
The Owner will be notified in writing at least 30 days (or longer if required by state and/or federal 
regulatory authorities) prior to any change in Investment Option restrictions. 
  
MAXIMUM TOTAL PREMIUM CONTRIBUTIONS 
  
The Maximum Total Premium Contributions You may make during the lifetime of the contract are shown 
on the Data Page. We reserve the right to treat all deferred variable annuity contracts issued by Us to 
You and/or Your Spouse with a guaranteed minimum withdrawal benefit rider attached as one contract for 
purposes of determining the Maximum Total Premium Contributions. We reserve the right to limit 
additional premium payments while this rider is in force. 
  
ADDITIONAL PREMIUM PAYMENTS 
  
Before Your contract accumulated value is reduced to zero, You may make additional premium 
payments, subject to the limitations described below. We will not accept additional premium payments 
once the contract accumulated value becomes zero. 
  
While this rider is in effect, We may limit or not accept additional premium payments if We determine that, 
as a result of the timing and amounts of Your additional premium payments and Withdrawals, a limitation 
is necessary for Us to manage the financial risks in providing the GMWB. We also reserve the right to 
limit or not accept additional premium payments if We are not then offering this benefit for new contracts, 
or if We are offering a modified version of this benefit for new contracts. We will exercise such 
reservation of right for all annuity Owners in the same class, in a non-discriminatory manner. 
  

EFFECT OF REACHING THE MAXIMUM ANNUITIZATION DATE 
  
On or before the maximum Annuitization Date, You must elect one of the contract or GMWB rider 
payment options described below. 
  
1 . Contract payment options: 
 a. payments resulting from applying the contract accumulated value to an annuity benefit 
   payment option, or 
b. payment of the contract accumulated value as a single payment. 
  
2 . GMWB rider payment option: 
 a. fixed scheduled payments each year in the amount of the For Life Withdrawal Benefit 
Payment, until the date of death of the last Covered Life. 
  
We will send You written Notice at least 30 days prior to the maximum Annuitization Date and ask You to 
select one of the available payment options listed above. If We have not received Your election as of the 
maximum Annuitization Date, We will automatically apply Your contract accumulated value to an annuity 
benefit payment option as described in the contract. 

RIDER BENEFITS AT DEATH 
  
While this rider is active, the GMWB Death Benefit replaces any other death benefit under the 
contract. The GMWB Death Benefit terminates when this rider terminates. 
  
If You die when the contract accumulated value is greater than zero: 
  
1 . If You are the only Owner, upon Your death, Your primary beneficiary may elect one of the 
following: 
a. receive the GMWB Death Benefit as set forth below; or 
b. if the primary beneficiary is Your Spouse, Your Spouse may continue the contract with or 
    without this rider as set forth in SPOUSAL CONTINUATION. 
    
2 . If there are Joint Owners, upon the death of the first Joint Owner to die, the surviving Joint Owner 
may elect one of the following: 
a. receive the GMWB Death Benefit as set forth below; or 
b. if the surviving Joint Owner is Your Spouse, Your Spouse may continue the contract with or 
    without this rider as set forth in SPOUSAL CONTINUATION. 
  
The GMWB Death Benefit is equal to the greatest of: 
  
1 . the contract accumulated value as of the Valuation Date on which We receive the proof of death 
and all required documents; 
  
2 . the total premium payments minus each Withdrawal taken on or before the Valuation Date on 
which We receive the proof of death and all required documents; 
  
3 . the contract accumulated value that was in effect on any prior Contract Anniversary that is 
divisible equally by 7, plus any premium payments made after that Contract Anniversary minus 
each Withdrawal taken after that Contract Anniversary. 
  
NOTE:   For 2. and 3. above, a Withdrawal that is not a "For Life" Excess Withdrawal will reduce the 
GMWB Death Benefit by the amount of the Withdrawal. Then, each "For Life" Excess 
 Withdrawal will proportionately reduce the GMWB Death Benefit by the ratio of the "For Life" 

 Excess Withdrawal taken to the contract accumulated value immediately prior to the "For Life" 
 Excess Withdrawal. 
  
If You die after the contract accumulated value has reduced to zero: 
  
1 . If You elected "Single Life" For Life Withdrawal Benefit Payments, all payments stop and the 
contract is terminated. 
  
2 . If You elected "Joint Life" For Life Withdrawal Benefit Payments, We will continue payments to 
the surviving Covered Life until the date of the surviving Covered Life's death. 
  
SPOUSAL CONTINUATION 
  
If You die while this rider is attached to Your contract, Your Spouse can NOT continue the contract with 
this rider if any of the following apply: 
  
1 . The contract accumulated value is zero. 
  
2 . The contract and this rider have been previously continued. 
  
3 . You were the sole Owner and Your Spouse is not a primary beneficiary. 
  
4 . There were Joint Owners and Your Spouse is not the surviving Joint Owner. 
    
5 . Your Spouse does not meet the minimum age requirement of Our rider eligibility guidelines on the 
date of the continuation election. 
   
6 . Withdrawals have been taken and You locked in "Single Life" For Life Withdrawal Benefit 
 Payments. As explained in "SINGLE LIFE" AND "JOINT LIFE" WITHDRAWAL BENEFIT 
 PAYMENTS, "Single Life" Withdrawals cease upon the death of the first Owner to die. 
   
7 . Withdrawals have been taken and You locked in "Joint Life" For Life Withdrawal Benefit 
 Payments and Your Spouse is not an eligible Covered Life. As explained in COVERED LIFE 
 CHANGE, after "Joint Life" Withdrawals have been taken, no one, including Your Spouse, may 
 become a new Covered Life. 

Note: Although spousal continuation may be available under the contract for a subsequent Spouse, this 
rider may only be continued once. 
 
Note: If Your Spouse is not eligible to continue this rider, or elects not to continue this rider, this rider and 
all rights, benefits and charges under the rider will terminate. 
 
If none of the statements above apply and Your Spouse elects to continue the contract with the rider: 
 
If Withdrawals have not been taken: 
   
1 . Withdrawal Benefit Payments will be calculated as "Single Life". 
   
2 . You will be removed as a Covered Life and Your Spouse will be the sole Covered Life. 
   
3 . Your Spouse can NOT add a new Covered Life or elect "Joint Life" Withdrawal Benefit Payments. 
   
4 . The Withdrawal Benefit Payment percentage will be based on Your Spouse's age and will lock in 

        at the "Single Life" percentage applicable on the date of Your Spouse's first Withdrawal. 
   
5 . Withdrawal Benefit Payments will continue to be available until the death of Your Spouse. 
   
6 . All other provisions of this rider will continue as in effect on the date of Your death. 
 
If Withdrawals have been taken and You have locked in "Joint Life" Withdrawal Benefit Payments: 
   
1 . The Withdrawal Benefit Payment percentage will continue to be based on the original Covered 
        Lives. 
   
2 . Your Spouse can NOT add a new Covered Life. 
   
3 . Withdrawal Benefit Payments will continue to be available until the death of Your Spouse. 
   
4 . All other provisions of this rider will continue as in effect on the date of Your death. 
 
COVERED LIFE CHANGE 
 
Any ownership, beneficiary designation or other contract or rider change before the Annuitization Date 
which would cause a change in the Covered Life (a "Change") will result in termination of this rider, 
except for the following permissible Changes. 
   
1 . Spousal continuation of this rider as described above in SPOUSAL CONTINUATION. 
   
2 . If Withdrawals have not been taken and You have not previously elected to continue this rider as 
provided in SPOUSAL CONTINUATION: 
a. You may add a Joint Owner or primary beneficiary as a Covered Life, provided that the new 
    Joint Owner or primary beneficiary is an eligible Covered Life as set forth in "SINGLE LIFE" 
    AND "JOINT LIFE" WITHDRAWAL BENEFIT PAYMENTS. 
b. You may remove a Joint Owner or primary beneficiary as a Covered Life.
c. The Withdrawal Benefit Payment percentage will be calculated based on the age of the 
    Covered Lives and will lock in at the percentage applicable on the date of Your first 
    Withdrawal. 
  
3 . If Withdrawals have been taken and You have locked in "Single Life" Withdrawal Benefit 
Payments: 
a. You may remove a Joint Owner as a Covered Life and Withdrawal Benefit Payments will 
    cease upon Your death. 
b. You may add a primary beneficiary to Your contract; however, You may not add a primary 
     beneficiary as a Covered Life for purposes of this rider. 
 c. The Withdrawal Benefit Payment percentage will remain locked at the percentage applicable 
     on the date of Your first Withdrawal and will not be reset to reflect the removal of the Covered 
     Life. 
  
4 . If Withdrawals have been taken and You have locked in "Joint Life" Withdrawal Benefit 
Payments: 
a. You may remove a Joint Owner or primary beneficiary as a Covered Life and Withdrawal 
    Benefit Payments will cease upon Your death. 
b. You may add a primary beneficiary to Your contract; however, You may not add a primary 
    beneficiary as a Covered Life for purposes of this rider. 
c. The Withdrawal Benefit Payment percentage will remain locked at the percentage applicable 
    on the date of Your first Withdrawal and will not be reset to reflect the removal of the Covered Life. 

  
5 . If You have previously elected to continue the Rider as provided in SPOUSAL CONTINUATION, 
You may add a primary beneficiary to Your contract; however, You may not add a primary 
 beneficiary as a Covered Life for purposes of this rider. 
  
No Change is effective until approved by Us in writing. Upon Our approval, the Change is effective as of 
the date You signed the Notice requesting the Change. 
  
An assignment of the contract or this rider shall be deemed a request for a Change. If the Change is not 
one of the above permissible Changes, this rider will be terminated as of the date of the assignment. 
  
EFFECT OF DIVORCE ON THE RIDER 
  
Generally, in the event of a divorce, the Spouse who retains ownership of the contract will continue to be 
entitled to all rights and benefits of this rider while the former Spouse will no longer have any such rights 
or be entitled to any benefits under this rider. If You take a Withdrawal to satisfy a court order to pay a 
portion of the contract to Your former Spouse, any portion of such Withdrawal that exceeds the available 
Withdrawal Benefit Payment shall be an Excess Withdrawal under this rider. 
  
TERMINATION 
  
You may terminate this rider anytime after this rider has been in force for five full Contract Years. 
  
We will terminate this rider when any of the following occurs: 
  
1 . the contract terminates; 
  
2 . You fully annuitize the contract; 
  
3 . the Withdrawal Benefit Base is zero; 

4 . there is a Change of Covered Life or Owner, except as permitted in COVERED LIFE CHANGE; 
or 
  
5 . Your surviving Spouse continues the contract without this rider. 
  
REINSTATEMENT 
  
If this rider terminates for any reason other than Your full surrender of Your contract, this rider may not be 
reinstated. 
  
If You surrender Your contract with this rider attached and the contract is later reinstated, this rider also 
must be reinstated. If the contract and rider are reinstated, this rider will be reinstated as of the date of 
the termination. At the time this rider is reinstated, We will deduct rider charges scheduled during the 
period of termination and make any other adjustments necessary to reflect any changes in the amount 
reinstated and the contract accumulated value as of the date of termination.

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