Document:

Exhibit 10.1

 

U.S. Energy Corp.

Amended and Restated 2012 Equity
and Performance Incentive Plan

 

Adopted By the Board: April 24,
2010, March 20, 2015, April 27, 2017

Approved by the Shareholders:  June
29, 2012 June 19, 2015, July 17, 2017

Effective: July 1, 2012
2015 July 17, 2017

 

1.       Purpose.
The purpose of the 2012 Equity and Performance Incentive Plan is to attract and retain officers and other employees of U.S.
Energy Corp., a Wyoming corporation, and its Subsidiaries and to provide to such persons incentives and rewards for superior performance.

 

2.       Definitions.
As used in this Plan,

 

(a)         "Award"
means any Option, Stock Appreciation Right, Restricted Stock, Performance Share, Performance Unit, Other Share-Based Award, or
any other right, interest or option related to Shares or other property (including cash) granted pursuant to the provisions of
this Plan.

 

(b)        "Base
Price" means the price to be used as the basis for determining the Spread upon the exercise of a Free-Standing Appreciation
Right and a Tandem Appreciation Right.

 

(c)        "Board"
means the Board of Directors of the Company and, to the extent of any delegation by the Board to a committee (or subcommittee thereof)
pursuant to Section 14 of this Plan, such committee (or subcommittee).

 

(d)        "Change
in Control" has the meaning set forth in Section 11.

 

(e)        "Code"
means the Internal Revenue Code of 1986, as amended from time to time, and the rules and regulations thereunder, as such law, rules
and regulations may be amended from time to time.

 

(f)        "Common
Stock" means the Common Stock, par value $0.01 per share, of the Company or any security into which such Common Stock may
be changed by reason of any transaction or event of the type referred to in Section 13 of this Plan.

 

(g)        "Company"
means U.S. Energy Corp., a Wyoming corporation, and its successors.

 

(h)        "Date
of Grant" means the date specified by the Board on which a grant of Options, Stock Appreciation Rights, Performance Shares,
Performance Units or other awards contemplated by Section 9 of this Plan, or a grant or sale of Restricted Stock, Restricted Stock
Units, or other awards contemplated by Section 9 of this Plan, will become effective (which date will not be earlier than the date
on which the Board takes action with respect thereto).

 

(i)        "Director"
means a member of the Board of Directors of the Company.

 

(j)        "Effective
Date" means July 1, 2012.  As amended, the Effective Date shall be the later of (1) July 1, 2015, or (2) the date
that shareholder approval is obtained for the Amended and Restated 2012 Equity and Performance Incentive Plan.

 

(k)        "Eligible
Individual" means an officer, or employee or Director of the Company or any one or more of its
Subsidiaries.

 

     

     

    

 

(l)        "Evidence
of Award" means an agreement, certificate, resolution or other type or form of writing or other evidence approved by the Board
that sets forth the terms and conditions of the Awards granted. An Evidence of Award may be in an electronic medium, may be limited
to notation on the books and records of the Company and, unless otherwise determined by the Board, need not be signed by a representative
of the Company or a Participant.

 

(m)        "Exchange
Act" means the Securities Exchange Act of 1934, as amended, and the rules and regulations thereunder, as such law, rules and
regulations may be amended from time to time.

 

(n)        "Free-Standing
Appreciation Right" means a Stock Appreciation Right granted pursuant to Section 5 of this Plan that is not granted in tandem
with an Option.

 

(o)        "Incentive
Stock Options" means Options that are intended to qualify as "incentive stock options" under Section 422 of the
Code or any successor provision.

 

(p)        "Management
Objectives" means the measurable performance objective or objectives established pursuant to this Plan for Participants who
have received grants of Performance Shares or Performance Units or, when so determined by the Board, Options, Stock Appreciation
Rights, Restricted Stock, Restricted Stock Units, dividend credits or other awards pursuant to this Plan. Management Objectives
may be described in terms of Company-wide objectives or objectives that are related to the performance of the individual Participant
or of the Subsidiary, division, department, region or function within the Company or Subsidiary in which the Participant is employed.
The Management Objectives may be made relative to the performance of one or more other companies or subsidiaries, divisions, departments,
regions or functions within such other companies, and may be made relative to an index of one or more of the performance objectives
themselves.

 

If the Board determines
that a change in the business, operations, corporate structure or capital structure of the Company, or the manner in which it conducts
its business, or other events or circumstances render the Management Objectives unsuitable, the Board may in its discretion modify
such Management Objectives or the related level or levels of achievement, in whole or in part, as the Board deems appropriate and
equitable.

 

(q)        "Market
Value per Share" means, as of any particular date, the closing sale price of a share of Common Stock as reported on the principal
national securities exchange on which the Common Stock is listed. If the Common Stock is not traded on a given date, the Market
Value per Share means the closing price for a share of Common Stock on the principal national securities exchange on which the
Common Stock is traded for the immediately preceding date on which the Common Stock is traded. If the Common Stock is not listed
on a national securities exchange, the Market Value per Share shall be the fair market value of a share of Common Stock as determined
in good faith by the Board in accordance with the fair market value pricing rules set forth in Section 409A of the Code.

 

(r)        "Optionee"
means the Eligible Individual named in an Evidence of Award evidencing an outstanding Option.

 

(s)        "Option
Price" means the purchase price per Share payable on exercise of an Option.

 

     

     

    

 

(t)        "Option"
means an option to purchase Common Stock granted pursuant to Section 4 of this Plan.

 

(u)        "Participant"
means an Eligible Individual who has received an Award under this Plan.

 

(v)        "Performance
Period" means, in respect of a Performance Share or Performance Unit, a period of time established pursuant to Section 8 of
this Plan within which the Management Objectives relating to such Performance Share or Performance Unit are to be measured.

 

(w)        "Performance
Share" means a bookkeeping entry that records the equivalent of one share of Common Stock awarded pursuant to Section 8 of
this Plan.

 

(x)        "Performance
Unit" means a bookkeeping entry awarded pursuant to Section 8 of this Plan that records a unit equivalent to $1.00 or such
other value as is determined by the Board.

 

(y)        "Plan"
means this U.S. Energy Corp. 2012 Equity and Performance Incentive Plan, as may be amended from time to time.

 

(z)        "Restricted
Stock" means Common Stock granted or sold pursuant to Section 6 of this Plan as to which the applicable Restriction Period
has not yet lapsed.

 

(aa)        "Restriction
Period" means the period of time during which Restricted Stock is subject to a substantial risk of forfeiture or Restricted
Stock Units are subject to restrictions, as provided in Section 6 and Section 7 of this Plan.

 

(bb)        "Restricted
Stock Unit" means an award made pursuant to Section 7 of this Plan of the right to receive Common Stock or cash at the end
of a specified period.

 

(cc)        "Share"
means one share of Common Stock.

 

(dd)        "Spread"
means, on any applicable measurement date, the excess of the Market Value per Share over the Option Price or Base Price provided
for in an Option or Stock Appreciation Right, respectively.

 

(ee)        "Separation
from Service" means a Participant's Termination of Employment with the Company and any of its Subsidiaries or affiliates that
qualifies as a "separation from service" for purposes of Section 409A of the Code. A Separation from Service will
be deemed to occur where the Participant and the Company, its Subsidiary or affiliate, reasonably anticipate that the bona fide
level of services the Participant will perform (whether as an employee or as an independent contractor) will be permanently reduced
to a level that is less than thirty-seven and a half percent (37.5%) of the average level of bona fide services the Participant
performed during the immediately preceding 36 months (or the entire period the Participant has provided services if the Participant
has been providing services to the Company and any of its Subsidiaries or affiliates for less than 36 months).

 

     

     

    

 

(ff)         "Stock
Appreciation Right" means a right granted pursuant to Section 5 of this Plan, and includes both Tandem Appreciation Rights
and Free-Standing Appreciation Rights.

 

(gg)         "Subsidiary"
means a corporation, company or other entity (i) more than 50 percent of whose outstanding shares or securities (representing the
right to vote for the election of directors or other managing authority) are, or (ii) which does not have outstanding shares or
securities (as may be the case in a partnership, joint venture or unincorporated association), but more than 50 percent of whose
ownership interest representing the right generally to make decisions for such other entity is, now or hereafter, owned or controlled,
directly or indirectly, by the Company except that for purposes of determining whether any person may be a Participant for purposes
of any grant of Incentive Stock Options, "Subsidiary" means any corporation in which at the time the Company owns or
controls, directly or indirectly, more than 50 percent of the total combined voting power represented by all classes of stock issued
by such corporation.

 

(hh)        "Tandem
Appreciation Right" means a Stock Appreciation Right granted pursuant to Section 5 of this Plan that is granted in tandem
with an Option.

 

(ii)        "Termination
of Employment" means the termination of a Participant's employment with, or performance of services for, the Company and any
of its Subsidiaries or affiliates. Unless otherwise determined by the Board, if a Participant's employment with the Company and
its affiliates terminates but such Participant continues to provide services to the Company and its affiliates in a non-employee
capacity, such change in status shall not be deemed a Termination of Employment. A Participant shall be deemed to incur a Termination
of Employment in the event of the disaffiliation of such Participant's subsidiary, affiliate, or division unless the Board specifies
otherwise. Temporary absences from employment because of illness, vacation or leave of absence and transfers among the Company
and its Subsidiaries and affiliates do not constitute a Termination of Employment. If an Award is subject to Section 409A
of the Code, however, Termination of Employment for purposes of that Award shall mean the Participant's Separation from Service.

 

3.       Shares
Available Under the Plan.

 

(a)        Maximum
Shares Available Under Plan.

 

	 	(i)	Subject to adjustment as provided in Section 13 of this Plan, a maximum of 1,533,333 shares of Common Stock may be delivered pursuant to Awards granted under this Plan.  All of the shares reserved for issuance may be subject to Incentive Stock Options.

 

	 	(ii)	Shares of Common Stock covered by an Award shall not be counted as used unless and until they are actually issued to a Participant and, therefore, the total number of shares of Common Stock available under the Plan as of a given date shall not be reduced by any Common Stock relating to prior Awards that have expired or have been forfeited or cancelled.  If the Award is to be settled in cash, the number of shares of Common Stock on which the Award is based shall not count toward the share limits set forth in this Section 3.  Notwithstanding anything to the contrary contained herein: (A) if shares of Common Stock are tendered or otherwise used in payment of the Option Price of an Option or the Base Price of a Stock Appreciation Right, the total number of shares of Common Stock covered by the Option or Stock Appreciation Right being exercised shall count against the aggregate Plan limit described above and (B) shares of Common Stock withheld by the Company to satisfy the tax withholding obligation shall count against the aggregate Plan limit described above.

 

     

     

    

 

(b)        Limitations
on Grants to Individual Participant.

 

	 	(i)	Subject to adjustment as provided in Section 13 of this Plan, the maximum number of Shares with respect to which Awards may be granted hereunder to any Participant or Director during any fiscal year of the Company shall be 400,000 shares (the "Limitation"). If an Option is canceled, the canceled Option shall continue to be counted toward the Limitation for the year granted. An Option (or a Stock Appreciation Right) that is repriced during any fiscal year is treated as the cancellation of the Option (or Stock Appreciation Right) and a grant of a new Option (or Stock Appreciation Right) for purposes of the Limitation for that fiscal year.

 

4.       Options.
The Board may, from time to time and upon such terms and conditions as it may determine, grant to Eligible Individuals options
to purchase Common Stock.  Each grant of Options will be evidenced by an Evidence of Award which shall contain such terms
and conditions as the Board may approve that are not inconsistent with the following terms and conditions and those of the remainder
of the Plan:

 

(a)        Each
Evidence of Award will specify the number of shares of Common Stock to which it pertains subject to the limitations set forth in
Section 3 of this Plan.

 

(b)        Each
Evidence of Award will specify an Option Price per share, which may not be less than the Market Value per Share on the Date of
Grant (or 110% of the Market Value Per Share in the case of an Incentive Stock Option issued to the owner of 10% or more of the
voting power of the Company or any of its Subsidiaries).

 

(c)        Each
Evidence of Award will specify whether the Option Price will be payable, to the extent permitted by applicable statutes and regulations,
either (a) in cash or by certified or bank check at the time the Option is exercised or (b) in the discretion of the Committee,
in any form of lawful consideration  approved by the Committee.  As of the Effective Date (and subject to any future
action by the Committee to restrict the forms of consideration that may be used to pay the Option Price) the Committee has approved
the following:: (i) by delivery to the Company of other Common Stock, duly endorsed for transfer to the Company, with a Market
Value per Share on the date of delivery equal to the Option Price (or portion thereof) due for the number of Shares being acquired,
or by means of attestation whereby the Participant identifies for delivery specific shares of Common Stock that have an aggregate
Market Value per Share on the date of attestation equal to the Option Price (or portion thereof) and receives a number of shares
of Common Stock equal to the difference between the number of shares thereby purchased and the number of identified attestation
shares of Common Stock; (ii) a "cashless" exercise program established with a broker; (iii) reduction in the number of
shares of Common Stock otherwise deliverable upon exercise of such Option with a Market Value per Share equal to the aggregate
Option Price at the time of exercise; (iv) any combination of the foregoing methods; or (v) any other form of legal consideration
that may be acceptable to the Committee including but not limited to "net" or "immaculate" exercise. Unless
otherwise specifically provided in the Evidence of Award, the exercise price of Common Stock acquired pursuant to an Option that
is paid by delivery (or attestation) to the Company of other Common Stock acquired, directly or indirectly from the Company, shall
be paid only by shares of Common Stock of the Company that have been held for more than six months (or such longer or shorter period
of time required to avoid a charge to earnings for financial accounting purposes). Notwithstanding the foregoing, during any period
for which the Common Stock is publicly traded (i.e., the Common Stock is listed on any established stock exchange or a national
market system) an exercise by a Director or officer that involves or may involve a direct or indirect extension of credit or arrangement
of an extension of credit by the Company, directly or indirectly, in violation of Section 402(a) of the Sarbanes-Oxley Act of 2002
shall be prohibited with respect to any Award under this Plan.

 

     

     

    

 

(d)    Successive grants
may be made to the same Participant whether or not any Options previously granted to such Participant remain unexercised.

 

(e)    Each Evidence
of Award will specify the period or periods of continuous service by the Optionee with the Company or any Subsidiary, if any, that
is necessary before the Options or installments thereof will become exercisable. The Evidence of Award may provide for the earlier
exercisability of such Options in the event of the retirement, death or disability of a Participant, or a Change of Control.

 

(f)    Any Evidence of
Award Option may specify Management Objectives that must be achieved as a condition to the Options becoming exercisable.

 

(g)    Options granted
under this Plan may be (i) options, including, without limitation, Incentive Stock Options that are intended to qualify under particular
provisions of the Code, (ii) options that are not intended so to qualify, or (iii) combinations of the foregoing. Incentive Stock
Options shall be designated as such in the Evidence of Award and may only be granted to Participants who meet the definition of
"employees" under Section 3401(c) of the Code.

 

(h)    No grant of Options
may be accompanied by a tandem award of dividend equivalents or provide for dividends, dividend equivalents or other distributions
to be paid on such Options.

 

(i)    The exercise of
an Option will result in the cancellation on a share for-share basis of any Tandem Appreciation Right authorized under Section
5 of this Plan.

 

(j)    Each Evidence
of Award shall specify the period during which the Option may be exercisable; provided, however that no Option will be exercisable
more than 10 years from the Date of Grant (5 years for any Incentive Stock Option issued to any owner of 10% or more of the outstanding
voting securities of the Company or any of its Subsidiaries). Each Evidence of Award may provide for accelerated expiration of
the Option upon the Participant's Termination of Employment.

 

     

     

    

 

5.       Stock
Appreciation Rights.

 

(a)        The
Board may, from time to time and upon such terms and conditions as it may determine, authorize the granting (i) to any Optionee,
of Tandem Appreciation Rights in respect of Options granted hereunder, or (ii) to any Eligible Individual, of Free-Standing Appreciation
Rights. A Tandem Appreciation Right will be a right of the Optionee, exercisable by surrender of the related Option, to receive
from the Company an amount determined by the Board, which will be expressed as a percentage of the Spread (not exceeding 100 percent)
of the Tandem Appreciation Right at the time of exercise. Tandem Appreciation Rights may be granted at any time prior to the exercise
or termination of the related Options; provided, however, that a Tandem Appreciation Right awarded in relation to an Incentive
Stock Option must be granted concurrently with such Incentive Stock Option. A Free-Standing Appreciation Right will be a right
of the Participant to receive from the Company an amount determined by the Board, which will be expressed as a percentage of the
Spread (not exceeding 100 percent) of the Free Standing Appreciation Right at the time of exercise.

 

(b)        Each
grant of Stock Appreciation Rights will be evidenced by an Evidence of Award which shall identify the Stock Appreciation Right
as a Free-Standing Appreciation Right or a Tandem Appreciation Right (and in the case of Tandem Appreciation Rights shall identify
the related Option) and shall contain such terms and conditions as the Board may approve that are not inconsistent with the following
terms and conditions of this section and section 5(c) and 5(d) below (as applicable), and those of the remainder of the Plan:

 

	 	(i)	Each Evidence of Award shall specify the amount payable upon exercise of the Stock Appreciation Right and may provide that such may be paid by the Company in cash, in Common Stock or in any combination thereof and may retain in the Board the right to elect among those alternatives.

 

	 	(ii)	Any Evidence of Award may specify that the amount payable on exercise of a Stock Appreciation Right may not exceed a maximum specified by the Board at the Date of Grant.

 

	 	(iii)	No grant of Stock Appreciation Rights may be accompanied by a tandem award of dividend equivalents or provide for dividends, dividend equivalents or other distributions to be paid on such Stock Appreciation Rights.

 

(c)        Each
Evidence of Award of Tandem Appreciation Rights shall specify the Base Price of such Tandem Appreciation Rights (which shall generally
equal the Option Price of the Related Option) and will provide that such Tandem Appreciation Rights may be exercised only at a
time and during the period when the related Option is also exercisable and at a time when the Spread is positive, and by surrender
of the related Option for cancellation. Successive grants of Tandem Appreciation Rights may be made to the same Participant regardless
of whether any Tandem Appreciation Rights previously granted to the Participant remain unexercised.

 

(d)        Regarding
Free-Standing Appreciation Rights only:

 

	 	(i)	Each Evidence of Award will specify in respect of each Free-Standing Appreciation Right a Base Price, which will be equal to or greater than the Market Value per Share on the Date of Grant;

 

	 	(ii)	Each Evidence of Award will specify the period or periods of continuous service by the Participant with the Company or any Subsidiary, if any, that is necessary before the Free-Standing Appreciation Right or installments thereof will become exercisable. The Evidence of Award may provide for the earlier exercisability of such Free-Standing Appreciation Rights in the event of the retirement, death or disability of a Participant, or a Change of Control;

 

     

     

    

 

	 	(iii)	Any Evidence of Award of Free-Standing Appreciation Rights may specify Management Objectives that must be achieved as a condition of the Free-Standing Appreciation Rights becoming exercisable;

 

	 	(iv)	Each Evidence of Award shall specify the period during which the Free-Standing Appreciation Right may be exercisable; provided, however that no Free-Standing Appreciation Right will be exercisable more than 10 years from the Date of Grant. Each Evidence of Award may provide for accelerated expiration of the Free-Standing Appreciation Right upon the Participant's Termination of Employment; and

 

	 	(v)	Successive grants of Free-Standing Appreciation Rights may be made to the same Participant regardless of whether any Free-Standing Appreciation Rights previously granted to the Participant remain unexercised.

 

6.       Restricted
Stock. The Board may, from time to time and upon such terms and conditions as it may determine, grant or sell Restricted Stock
to Participants. Each grant or sale of Restricted Stock will be evidenced by an Evidence of Award which shall contain such terms
and conditions as the Board may approve that are not inconsistent with the following terms and conditions and those of the remainder
of the Plan:

 

(a)        Each
such grant or sale will constitute an immediate transfer of the ownership of Common Stock to the Participant in consideration of
the performance of services, entitling such Participant to voting, dividend and other ownership rights, but subject to the substantial
risk of forfeiture and restrictions on transfer hereinafter referred to.

 

(b)        Each
such grant or sale may be made without additional consideration or in consideration of a payment by such Participant that is less
than or equal to the Market Value per Share at the Date of Grant.

 

(c)        Each
Evidence of Award will provide that the Restricted Stock covered by such grant or sale will be subject to a "substantial risk
of forfeiture" within the meaning of Section 83 of the Code during the Restriction Period, which "substantial risk of
forfeiture" may lapse upon the passage of time and/or upon achievement of Management Objectives referred to in subparagraph
(e) below.

 

(d)        Each
such grant or sale will provide that during the Restriction Period for which such substantial risk of forfeiture is to continue,
the transferability of the Restricted Stock will be prohibited or restricted in the manner and to the extent prescribed by the
Board in the Evidence of Award (which restrictions may include, without limitation, rights of repurchase or first refusal in the
Company or provisions subjecting the Restricted Stock to a continuing substantial risk of forfeiture in the hands of any transferee).

 

     

     

    

 

(e)        Any
Evidence of Award may specify Management Objectives that, if achieved, will result in termination or early termination of the restrictions
applicable to such Restricted Stock. Each Evidence of Award may specify in respect of such Management Objectives a minimum acceptable
level of achievement and may set forth a formula for determining the number of shares of Restricted Stock on which restrictions
will terminate if performance is at or above the minimum or threshold level or levels, or is at or above the target level or levels,
but falls short of maximum achievement of the specified Management Objectives.

 

(f)        Notwithstanding
anything to the contrary contained in this Plan, any Evidence of Award may provide for the earlier termination of restrictions
on such Restricted Stock in the event of the retirement, death or disability of a Participant, or a Change of Control.

 

(g)        Any
such grant or sale of Restricted Stock may require that any or all dividends or other distributions paid thereon during the Restriction
Period be subject to the same restrictions as the underlying award and/or reinvested or deemed reinvested in additional shares
of Restricted Stock.  In the event such dividends are not reinvested or deemed reinvested in additional shares of Restricted
Stock, they shall be paid in cash (without interest) on the date on which the Restricted Period lapses.

 

(h)        Unless
otherwise directed by the Board, (i) all certificates representing shares of Restricted Stock will be held in custody by the Company
until all restrictions thereon will have lapsed, together with a stock power or powers executed by the Participant in whose name
such certificates are registered, endorsed in blank and covering such Shares, or (ii) all shares of Restricted Stock will be held
at the Company's transfer agent in book entry form with appropriate restrictions relating to the transfer of such shares of Restricted
Stock.

 

7.        Restricted
Stock Units. The Board may, from time to time and upon such terms and conditions as it may determine, grant Restricted Stock
Units to Eligible Individuals.  Each grant of Restricted Stock Units will be evidenced by an Evidence of Award which shall
contain such terms and conditions as the Board may approve that are not inconsistent with the following terms and conditions and
those of the remainder of the Plan:

 

(a)        Each
such grant will constitute the agreement by the Company to deliver one share of Common Stock per Restricted Stock Unit (or to deliver
the cash equivalent thereof) to the Participant in the future in consideration of the performance of services, but subject to the
fulfillment of such conditions (which may include the achievement of Management Objectives) during the Restriction Period as the
Board may specify in the Evidence of Award. Each Evidence of Award may specify in respect of such Management Objectives a minimum
acceptable level of achievement and may set forth a formula for determining the number of Common Shares subject to the Restricted
Stock Units as to which restrictions will terminate if performance is at or above the minimum or threshold level or levels, or
is at or above the target level or levels, but falls short of maximum achievement of the specified Management Objectives.

 

(b)        Notwithstanding
anything to the contrary contained in this Plan, any Evidence of Award may provide for the earlier lapse or modification of the
Restriction Period in the event of the retirement, death or disability of a Participant, or a change of Control.

 

     

     

    

 

(c)        During
the Restriction Period, the Participant will have no right to transfer any rights under his or her award and will have no rights
of ownership in the Restricted Stock Units and will have no right to vote the Common Shares subject to the Restricted Stock Units,
but the Board may in the Evidence of Award authorize the payment of dividend equivalents on either a current, deferred or contingent
basis, either in cash or in additional shares of Common Stock,  provided that dividend equivalents shall not be paid in a
manner that would cause any tax to be due under 409A of the Code.

 

(d)        Each
Evidence of Award Unit will specify the time and manner of payment of the Restricted Stock Units that have been earned. Each Evidence
of Award will specify that the amount payable with respect thereto will be paid by the Company in Common Stock or cash.  If
a cash payment is made in lieu of delivering shares of Common Stock, the amount of such payment shall be based on the Market Value
per Share as of the date on which the Restriction Period lapsed with respect to each Restricted Stock Unit.

 

8.       Performance
Shares and Performance Units. The Board may, from time to time and upon such terms and conditions as it may determine, grant
Performance Shares and Performance Units that will become payable to a Participant upon achievement of specified Management Objectives
during the Performance Period. Each grant or sale of Performance Shares and Performance Units will be evidenced by an Evidence
of Award which shall contain such terms and conditions as the Board may approve that are not inconsistent with the following terms
and conditions and those of the remainder of the Plan:

 

(a)        Each
Evidence of Award will specify the number of Performance Shares or Performance Units to which it pertains, which number may be
subject to adjustment to reflect changes in compensation or other factors.

 

(b)       The Performance
Period with respect to each Performance Share or Performance Unit will be such period of time as will be determined by the Board
at the time of grant, and may be subject to earlier lapse or other modification in the event of the retirement, death or disability
of a Participant, or a Change of Control.

 

(c)        Any Evidence of
Award will specify Management Objectives which, if achieved, will result in payment or early payment of the award, and each Evidence
of Award may specify in respect of such Management Objectives a minimum acceptable level of achievement and may set forth a formula
for determining the number of Performance Shares or Performance Units that will be earned if performance is at or above the minimum
or threshold level or levels, or is at or above the target level or levels, but falls short of maximum achievement of the specified
Management Objectives. The grant of Performance Shares or Performance Units will specify that, before the Performance Shares or
Performance Units will be earned and paid, the Board must certify that the Management Objectives have been satisfied.

 

(d)        Each Evidence
of Award will specify the payment to be made pursuant to any award of Performance Shares or Performance Units and the time and
manner of such payment. Any Evidence of Award may specify that the amount payable with respect thereto may be paid by the Company
in cash, in Common Stock or in any combination thereof and may retain in the Board the right to elect among those alternatives.

 

(e)        Any Evidence of
Award may specify that the amount payable or the number of shares of Common Stock issued with respect thereto may not exceed maximums
specified by the Board at the Date of Grant.

 

     

     

    

 

(f)         The Evidence of
Award may provide for the payment of dividend equivalents to the holder thereof either in cash or in additional shares of Common
Stock subject in all cases to payment on a contingent basis based on the Participant's earning of the Performance Shares with respect
to which such dividend equivalents are paid, provided that dividend equivalents shall not be paid in a manner that would cause
any tax to be due under 409A of the Code.

 

9.       Other
Awards.

 

(a)        The
Board may, subject to limitations under applicable law, grant to any Eligible Individual such other awards that may be denominated
or payable in, valued in whole or in part by reference to, or otherwise based on, or related to, shares of Common Stock or factors
that may influence the value of such shares, including, without limitation, convertible or exchangeable debt securities, other
rights convertible or exchangeable into Common Stock, purchase rights for Common Stock, awards with value and payment contingent
upon performance of the Company or specified Subsidiaries, affiliates or other business units thereof or any other factors designated
by the Board, and awards valued by reference to the book value of shares of Common Stock or the value of securities of, or the
performance of specified Subsidiaries or affiliates or other business units of the Company. The Board shall determine the terms
and conditions of such awards. Shares of Common Stock delivered pursuant to an award in the nature of a purchase right granted
under this Section 9 shall be purchased for such consideration, paid for at such time, by such methods, and in such forms, including,
without limitation, cash, shares of Common Stock, other awards, notes or other property, as the Board shall determine.

 

(b)        Cash
awards, as an element of or supplement to any other award granted under this Plan, may also be granted pursuant to this Section
9 of this Plan.

 

(c)        The
Board may grant Common Stock as a bonus, or may grant other awards in lieu of obligations of the Company or a Subsidiary to pay
cash or deliver other property under this Plan or under other plans or compensatory arrangements, subject to such terms as shall
be determined by the Board in a manner that complies with Section 409A of the Code.

 

(d)        Share-based
awards pursuant to this Section 9 are not required to be subject to any minimum vesting period.

 

10.     Transferability.

 

(a)        Except
as otherwise determined by the Board, no Option, Stock Appreciation Right or other Award shall be transferable by the Participant
except by will or the laws of descent and distribution, and in no event shall any such Award be transferred for value. Except as
otherwise determined by the Board, Options and Stock Appreciation Rights will be exercisable during the Participant's lifetime
only by him or her or, in the event of the Participant's legal incapacity to do so, by his or her guardian or legal representative
acting on behalf of the Participant in a fiduciary capacity under state law and/or court supervision.

 

(b)        Any
Evidence of Award may provide that part or all of the shares of Common Stock that are (i) to be issued or transferred by the Company
upon (A) the exercise of Options or Stock Appreciation Rights, (B) upon the termination of the Restriction Period applicable to
Restricted Stock Units or (C) upon payment under any grant of Performance Shares or Performance Units or (ii) no longer subject
to the substantial risk of forfeiture and restrictions on transfer referred to in Section 6 of this Plan, will be subject to further
restrictions on transfer that are consistent with applicable law.

 

     

     

    

 

11.     Change
in Control.

 

(a)        In
the event of a Change in Control, but notwithstanding any other provision of the Plan to the contrary, the Board may, in its discretion,
take any of the actions listed in this Section 11.

 

	 	(i)	provide that any Options and Stock Appreciation Rights outstanding which are not then exercisable and vested shall become immediately vested and fully exercisable;

 

	 	(ii)	provide that any Restricted Stock, Restricted Stock Unit and other Awards shall become vested in full;

 

	 	(iii)	provide that Performance Criteria applicable to Performance Shares and Performance Units or Management Objectives applicable to other Awards shall be deemed to be satisfied and such Awards shall be considered to be earned and payable in full;

 

	 	(iv)	provide for the assumption or substitution of equal or greater value of any Award on such terms and conditions as the Board deems appropriate and consistent with Section 409A of the Code;

 

	 	(v)	make such settlements of outstanding Awards as it deems appropriate, including, without limitation, the cancellation of outstanding Awards in exchange for payments of cash, property or a combination thereof having an aggregate value equal to the value of such Awards, as determined by the Board in its sole discretion; and

 

	 	(vi)	provide for the cancellation without payment of each Option or Stock Appreciation Right or other Award with an Option Price or Base Price (or similar amount) greater than the consideration offered in connection with any such Change in Control.

 

	 	(a)	The Board's actions need not be uniform, and may result in disparate treatment among Participants, Awards, and portions of the same Award, as the Board determines in its sole and absolute discretion.

 

	 	(b)	Notwithstanding the foregoing, in the event the Board does not, for any reason, provide for the assumption or substitution with an award of equal or greater value of any Award (or portion thereof) pursuant to the Change in Control transaction, such Award (or portion thereof) shall become vested in full immediately prior to such Change in Control.

 

     

     

    

 

	 	(c)	To the extent the Board provides for the assumption or substitution with an award of equal or greater value of an outstanding Award (or portion thereof), then, to the extent not otherwise vested by the Board in accordance with the provisions of this Section 11 and notwithstanding any other provision of this Plan to the contrary, during the 12-month period following a Change in Control: (i) upon the involuntary termination of an Optionee or Participant's employment other than termination for Cause; (ii) upon the voluntary termination of employment by the Participant following a material and adverse change in the Optionee or Participant's compensation, responsibilities, functions or reporting relationship; or (iii) in the event an Optionee or  Participant resigns rather than accept a mandatory relocation greater than 50 miles; then, in any such event, all outstanding Awards held by such Optionee or Participant shall become vested as of the Date of Termination. Any Option or Stock Appreciation Right held by the Optionee or Participant as of the date of the Change in Control that remains outstanding as of the date of Termination of Employment may thereafter be exercised, until the earlier of (i) the third anniversary of the date of Termination of Employment; or (ii) the expiration of the Term of such Option or Stock Appreciation Right. Restricted Stock shall immediately be vested free and transferable. Restricted Stock Units, Performance Shares, Performance Units and other Awards shall be vested as of the Termination of Employment and settled as soon as practicable as specified in the Evidence of Award; provided, however, that if the Award is subject to Section 409A and the Optionee or Participant is a Specified Employee, the Award shall be settled on the first day of the seventh month following the Participant's Termination of Employment.

 

	 	(d)	For purposes of the Plan, a "Change in Control" shall mean any of the following events:

 

	 	(i)	The acquisition by any individual, entity or group (within the meaning of Section 13(d)(3) or 14(d)(2) of the Exchange Act (a "Person")) of beneficial ownership (within the meaning of Rule 13d-3 promulgated under the Exchange Act) of 25% or more of the then-outstanding Shares of Common Stock plus any other outstanding shares of stock of the Corporation entitled to vote in the election of directors (the "Outstanding Company Voting Securities"); provided, however, that the Company and any employee benefit plan (or related trust) sponsored by it shall not be deemed to be a Person; or

 

	 	(ii)	A change in the composition of the Board such that the individuals who constitute the Board (the "Incumbent Board") cease for any reason to constitute at least a majority of the Board. For this purpose, any individual whose election or nomination for election by the Company's shareholders was approved by a vote of at least two-thirds of the directors then comprising the Incumbent Board shall be considered a member of the Incumbent Board; or

 

	 	(iii)	The consummation of a reorganization, merger, statutory share exchange or consolidation or similar corporate transaction involving the Company or any of its Subsidiaries or a sale or other disposition of substantially all of the assets of the Company or a material acquisition of assets or stock of another entity by the Company or any of its Subsidiaries, (each, a "Business Combination") if:

 

     

     

    

 

	 	(A)	the individuals and entities that were the beneficial owners of the Outstanding Company Voting Securities immediately prior to such Business Combination do not beneficially own, directly or indirectly, more than 50% of the then-outstanding shares of stock and the combined voting power of the then-outstanding voting securities of the corporation resulting from such Business Combination; or

 

	 	(B)	a Person beneficially owns, directly or indirectly, 25% or more of the then-outstanding shares of stock of the corporation resulting from such Business Combination; or

 

	 	(C)	members of the Incumbent Board do not comprise at least a majority of the members of the board of directors of the corporation resulting from such Business Combination; or

 

	 	(iv)	A complete liquidation or dissolution of the Company.

 

	 	(e)	If an Award is subject to Section 409A of the Code, any provision regarding the timing or form of payment upon a Change in Control shall be set forth in the Award Agreement when the Award is granted.  The payment or settlement of any such Award that is subject to Section 409A of the Code shall accelerate upon a Change in Control only if the event also constitutes a "change in ownership," "change in effective control," or "change in the ownership of a substantial portion of the Company's assets" as defined under Section 409A of the Code. Any adjustment to the Award that does not affect the Award's status under Section 409A (including, but not limited to, accelerated vesting or adjustment of the amount of the Award) may occur upon a Change-in-Control as defined in the Plan without regard to this paragraph, even if the event does not constitute a "change in ownership," "change in effective control," or "change in the ownership of a substantial portion of the Company's assets" under Section 409A.

 

12.        Securities
Act Compliance.

 

(a)        If
the Board deems it necessary to comply with the Securities Act of 1933, as amended, and the regulations and rulings thereunder,
the Board may require a written investment intent representation by the Optionee or Participant and may require a restrictive legend
be affixed to certificates for shares of Common Stock.

 

(b)        If,
based upon the opinion of counsel for the Company, the Committee determines that the exercise or nonforfeitability of, or delivery
of benefits pursuant to, any Award would violate any applicable provision of (i) U.S. federal, state or local securities law
or (ii) the listing requirements of any national securities exchange on which are listed any of the Company's equity securities,
then the Committee may postpone any such exercise, nonforfeitability or delivery, as the case may be, until such provisions would
be satisfied.  Nothing herein shall require the Company to take any actions to cause such exercise, nonforfeitability or delivery
to comply with all such provisions.

 

     

     

    

 

13.     Adjustments.
The Board shall make or provide for such adjustments in the numbers of shares of Common Stock covered by outstanding Awards,
the Option Price of Options and the Base Price of Stock Appreciation Rights, Options and in the kind of shares covered thereby,
as the Board, in its sole discretion, exercised in good faith, may determine is equitably required to prevent dilution or enlargement
of the rights of Participants or Optionees that otherwise would result from (a) any stock dividend, stock split, combination of
shares, recapitalization or other change in the capital structure of the Company, (b) any merger, consolidation, spin-off, split-off,
spin-out, split-up, reorganization, partial or complete liquidation or other distribution of assets, issuance of rights or warrants
to purchase securities, or (c) any other corporate transaction or event having an effect similar to any of the foregoing. The Board
shall also make or provide for such adjustments in the numbers of shares of Common Stock specified in Section 3 of this Plan as
the Board in its sole discretion, exercised in good faith, may determine is appropriate to reflect any transaction or event described
in this Section 13;  provided, however, that any such adjustment to the number specified in Section 3(a)(i)
will be made only if and to the extent that such adjustment would not cause any Option intended to qualify as an Incentive Stock
Option to fail to so qualify.

 

14.     Administration
of the Plan.

 

(a)        This
Plan will be administered by the Board, which may from time to time delegate all or any part of its authority under this Plan to
the Compensation Committee (the "Committee") of the Board (or a subcommittee thereof), as constituted from time to time.
To the extent of any such delegation, references in this Plan to the Board will be deemed to be references to such Committee or
subcommittee. A majority of the Board or Committee (or subcommittee), as applicable, will constitute a quorum, and the action of
the members of the Board or Committee (or subcommittee) present at any meeting at which a quorum is present, or acts unanimously
approved in writing, will be the acts of the Board or Committee (or subcommittee).

 

(b)        The
interpretation and construction by the Board of any provision of this Plan or of any agreement, notification or document evidencing
the grant of Options, Stock Appreciation Rights, Restricted Stock, Restricted Stock Units, Performance Shares, Performance Units
or other awards pursuant to Section 9 of this Plan and any determination by the Board pursuant to any provision of this Plan or
of any such agreement, notification or document will be final and conclusive. No member of the Board will be liable for any such
action or determination made in good faith.

 

(c)        The
Board or, to the extent of any delegation as provided in Section 14(a), the Committee, may delegate to one or more of its members
or to one or more officers of the Company, or to one or more agents or advisors, such administrative duties or powers as it may
deem advisable, and the Board, the committee, or any person to whom duties or powers have been delegated as aforesaid, may employ
one or more persons to render advice with respect to any responsibility the Board, the Committee or such person may have under
the Plan. The Board or the Committee may, by resolution and consistent with applicable law, authorize one or more officers of the
Company to do one or both of the following on the same basis as the Board or the Committee: (i) designate employees to be recipients
of awards under this Plan; (ii) determine the size of any such awards; provided, however, that (A) the Board or the
Committee shall not delegate such responsibilities to any such officer for awards granted to an employee who is an officer, Director,
or more than 10% beneficial owner of any class of the Company's equity securities that is registered pursuant to Section 12 of
the Exchange Act, as determined by the Board in accordance with Section 16 of the Exchange Act; (B) the resolution providing for
such authorization sets forth the total number of shares of Common Stock such officer(s) may grant; and (C) the officer(s) shall
report periodically to the Board or the Committee, as the case may be, regarding the nature and scope of the awards granted pursuant
to the authority delegated.

 

     

     

    

 

15.     Clawback. 
Any benefits the Optionee or Participant may receive under this Plan shall be subject to repayment or forfeiture as may be required
to comply with (i) any applicable listing standards of a national securities exchange adopted in accordance with Section 954
of the Dodd-Frank Wall Street Reform and Consumer Protection Act (regarding recovery of erroneously awarded compensation) and any
implementing rules and regulations of the U.S. Securities and Exchange Commission adopted thereunder, (ii) similar rules under
the laws of any other jurisdiction and (iii) any policies adopted by the Company to implement such requirements, all to the
extent determined by the Company in its discretion to be applicable to the Optionee or Participant.

 

16.     Recapture
Provisions. Any Evidence of Award may provide for the cancellation or forfeiture of an award or the forfeiture and repayment
to the Company of any gain related to an award, or other provisions intended to have a similar effect, upon such terms and conditions
as may be determined from time to time by the Board.

 

17.     Non
U.S. Participants. In order to facilitate the making of any grant or combination of grants under this Plan, the Board may provide
for such special terms for awards to Participants who are foreign nationals or who are employed by the Company or any Subsidiary
outside of the United States of America or who provide services to the Company under an agreement with a foreign nation or agency,
as the Board may consider necessary or appropriate to accommodate differences in local law, tax policy or custom. Moreover, the
Board may approve such supplements to or amendments, restatements or alternative versions of this Plan (including without limitation,
sub-plans) as it may consider necessary or appropriate for such purposes, without thereby affecting the terms of this Plan as in
effect for any other purpose, and the Secretary or other appropriate officer of the Company may certify any such document as having
been approved and adopted in the same manner as this Plan. No such special terms, supplements, amendments or restatements, however,
will include any provisions that are inconsistent with the terms of this Plan as then in effect unless this Plan could have been
amended to eliminate such inconsistency without further approval by the stockholders of the Company.

 

18.     Withholding
Taxes. To the extent that the Company is required to withhold federal, state, local or foreign taxes in connection with any
payment made or benefit realized by a Participant or other person under this Plan, and the amounts available to the Company for
such withholding are insufficient, it will be a condition to the receipt of such payment or the realization of such benefit that
the Participant or such other person make arrangements satisfactory to the Company for payment of the balance of such taxes required
to be withheld, which arrangements (in the discretion of the Board) may include relinquishment of a portion of such benefit. If
a Participant fails to make arrangements for the payment of tax, the Company may withhold such tax from any other form of remuneration
payable to the Participant, including, if it determines in its sole and absolute discretion, from shares of Common Stock payable
pursuant to the Award having a value equal to the amount required to be withheld. When a Participant is required to pay the Company
an amount required to be withheld under applicable income and employment tax laws, the Participant may elect to satisfy the obligation,
in whole or in part, by electing to have withheld, from the shares required to be delivered to the Participant, shares of Common
Stock having a value equal to the amount required to be withheld, or by delivering to the Company other shares of Common Stock
held by such Participant. The shares used for tax withholding will be valued at an amount equal to the Market Value per Share of
such Common Stock on the date the benefit is to be included in Participant's income. In no event shall the Market Value per Share
of the Common Stock to be withheld and delivered pursuant to this Section 18 to satisfy applicable withholding taxes in connection
with the benefit exceed the minimum amount of taxes required to be withheld. Participants shall also make such arrangements as
the Company may require for the payment of any withholding tax obligation that may arise in connection with the disposition of
shares of Common Stock acquired upon the exercise of Options.

 

     

     

    

 

19.     Amendments,
Termination Etc.

 

(a)        The
Board may at any time and from time to time amend the Plan in whole or in part; provided, however, that if an amendment to the
Plan (i) would materially increase the benefits accruing to participants under the Plan, (ii) would materially increase the number
of securities which may be issued under the Plan, (iii) would materially modify the requirements for participation in the Plan
or (iv) must otherwise be approved by the stockholders of the Company in order to comply with applicable law or the rules of the
principal national securities exchange upon which the Common Stock is traded or quoted, then, such amendment will be subject to
stockholder approval and will not be effective unless and until such approval has been obtained.

 

(b)        Except
in connection with a corporate transaction or event described in Section 13 of this Plan, the terms of outstanding awards may not
be amended to reduce the Option Price of outstanding Options or the Base Price of outstanding Stock Appreciation Rights, or cancel
outstanding Options or Stock Appreciation Rights in exchange for cash, other awards or Options or Stock Appreciation Rights with
an Option Price or Base Price, as applicable, that is less than the Option Price of the original Options or Base Price of the original
Stock Appreciation Rights, as applicable, without stockholder approval.

 

(c)        If
permitted by Section 409A of the Code, but subject to Section 20d) hereof, in case of termination of employment by reason of death,
disability or normal or early retirement, or in the case of unforeseeable emergency or other special circumstances, of a Participant
who holds an Option or Stock Appreciation Right not immediately exercisable in full, or any shares of Restricted Stock as to which
the substantial risk of forfeiture or the prohibition or restriction on transfer has not lapsed, or any Restricted Stock Units
as to which the Restriction Period has not been completed, or any Performance Shares or Performance Units which have not been fully
earned, or any other awards made pursuant to Section 9 subject to any vesting schedule or transfer restriction, or who holds Common
Stock subject to any transfer restriction imposed pursuant to Section 10(b) of this Plan, or in the case of a change of control,
the Board may, in its sole discretion, accelerate the time at which such Option, Stock Appreciation Right or other award may be
exercised or the time at which such substantial risk of forfeiture or prohibition or restriction on transfer will lapse or the
time when such Restriction Period will end or the time at which such Performance Shares or Performance Units will be deemed to
have been fully earned or the time when such transfer restriction will terminate or may waive any other limitation or requirement
under any such award.

 

(d)        Subject
to Section 20(b) hereof, the Board may amend the terms of any award theretofore granted under this Plan prospectively or retroactively.
Subject to Section 13 above, no such amendment shall impair any material right of any Participant without his or her consent. The
Board may, in its discretion, terminate this Plan at any time. Termination of this Plan will not affect the rights of Participants
or their successors under any awards outstanding hereunder and not exercised in full on the date of termination.

 

     

     

    

 

20.     Compliance
with Section 409A of the Code.

 

(a)        To
the extent applicable, it is intended that this Plan and any grants made hereunder comply with the provisions of Section 409A of
the Code, so that the income inclusion provisions of Section 409A(a)(1) of the Code do not apply to the Participants. This Plan
and any grants made hereunder shall be administered in a manner consistent with this intent. Any reference in this Plan to Section
409A of the Code will also include any regulations or any other formal guidance promulgated with respect to such Section by the
U.S. Department of the Treasury or the Internal Revenue Service.

 

(b)        Neither
a Participant nor any of a Participant's creditors or beneficiaries shall have the right to subject any deferred compensation (within
the meaning of Section 409A of the Code) payable under this Plan and grants hereunder to any anticipation, alienation, sale, transfer,
assignment, pledge, encumbrance, attachment or garnishment. Except as permitted under Section 409A of the Code, any deferred compensation
(within the meaning of Section 409A of the Code) payable to a Participant or for a Participant's benefit under this Plan and grants
hereunder may not be reduced by, or offset against, any amount owing by a Participant to the Company or any of its affiliates.

 

(c)        If,
at the time of a Participant's separation from service (within the meaning of Section 409A of the Code), (i) the Participant shall
be a specified employee (within the meaning of Section 409A of the Code and using the identification methodology selected by the
Company from time to time) and (ii) the Company shall make a good faith determination that an amount payable hereunder constitutes
deferred compensation (within the meaning of Section 409A of the Code) the payment of which is required to be delayed pursuant
to the six-month delay rule set forth in Section 409A of the Code in order to avoid taxes or penalties under Section 409A of the
Code, then the Company shall not pay such amount on the otherwise scheduled payment date but shall instead pay it, without interest,
on the earlier of the tenth business day following (i) the seventh month after such Separation of Service, (ii) the Participant's
death, (iii) or such earlier date or event on which such amount may be paid without violating the provisions of Code Section 409A.

 

(d)        Notwithstanding
any provision of this Plan and grants hereunder to the contrary, in light of the uncertainty with respect to the proper application
of Section 409A of the Code, the Company reserves the right to make amendments to this Plan and grants hereunder as the Company
deems necessary or desirable to avoid the imposition of taxes or penalties under Section 409A of the Code. In any case, a Participant
shall be solely responsible and liable for the satisfaction of all taxes and penalties that may be imposed on a Participant or
for a Participant's account in connection with this Plan and grants hereunder (including any taxes and penalties under Section
409A of the Code), and neither the Company nor any of its affiliates shall have any obligation to indemnify or otherwise hold a
Participant harmless from any or all of such taxes or penalties.

 

21.        Code
Section 162(m) Provisions.

 

(a)        Covered
Employees.

 

	 	(i)	Notwithstanding any other provision of the Plan, if the Committee determines that any Award is being granted to a Participant who is, or is likely to be, as of the end of the tax year in which the Company would claim a tax deduction in connection with such Award, a "covered employee" (within the meaning of 162(m) (3) of the Code), then the Committee may provide that this Section 21 is applicable to such Award.

 

     

     

    

 

(b)        Performance
Goals.

 

	 	(i)	If an Award is subject to this Section 18, then the lapsing of restrictions thereon and the distribution of Shares or other property pursuant thereto, as applicable, shall be subject to the achievement of one or more specified levels of Performance Criteria as defined in Appendix A. Such Performance Criteria may be based solely by reference to the Company's performance or the performance of a division or business unit of the Company, or based upon the relative performance of other companies or upon comparisons of any of the indicators of performance relative to other companies. The Committee may also exclude the impact of an event or occurrence which the Committee determines should appropriately be excluded, including (a) restructurings, discontinued operations, extraordinary items, and other unusual or non-recurring charges, (b) an event either not directly related to the operations of the Company or not within the reasonable control of the Company's management, or (c) a change in accounting standards required by generally accepted accounting principles; provided that the Committee may not make any adjustment to the extent it would adversely affect the qualification of any compensation payable under such Performance Criteria as "performance-based compensation" under Section 162(m). Such Performance Criteria shall be set by the 

 

Committee within the time period prescribed
by, and shall otherwise comply with the requirements of, Section 162(m) of the Code, or any successor provision thereto, and the
regulations thereunder. Before any payments are made with respect to any Awards subject to this Section 21, the Committee shall
certify in writing whether and to what extent the Performance Criteria relating to such payment have been met.

 

(c)      Other
Restrictions.

 

	 	(i)	The Committee shall have the power to impose such other restrictions on Awards subject to this Section 21 as it may deem necessary or appropriate to ensure that such Awards satisfy all requirements for "performance-based compensation" within the meaning of Section 162(m)(4)(C) of the Code, or any successor provision thereto.

 

22.     Code
Section 280G Reduction in Awards.

 

(a)        Notwithstanding
anything to the contrary contained in this Plan, in the event the Company determines, in its sole discretion, that any payment
or distribution by the Company to or for the benefit of any Participant (whether paid or payable or distributed or distributable
pursuant to the terms of this Plan or otherwise) (collectively, "Payments") would be subject to the excise tax imposed
by Section 4999 of the Code or any interest or penalties are incurred by the Participant with respect to such excise tax (such
excise tax, together with any such interest and penalties, are hereinafter collectively referred to as the "Excise Tax"),
then there shall be made a calculation under which such Payments provided to the Participant are reduced to the extent necessary
so that no portion thereof shall be subject to the Excise Tax (the "4999 Limit").  A comparison shall then
be made between (A) Participant's Net After-Tax Benefit (as defined below) assuming application of the 4999 Limit; and (B) Participant's
Net After-Tax Benefit without application of the 4999 Limit.  If (B) exceeds (A), then no limit on the Payments received by
Participant under this Agreement shall be imposed by this Section 22.  Otherwise, the amount payable to Executive pursuant
to this Agreement shall be reduced so that no such Payment is subject to the Excise Tax.  "Net After-Tax Benefit"
shall mean the sum of (x) all payments that Participant receives or is entitled to receive that are in the nature of compensation
and contingent on a change in the ownership or effective control of the Company or in the ownership of a substantial portion of
the assets of the Company within the meaning of Code Section 280G(b)(2) (either, a "Section 280G Transaction"),
less (y) the amount of federal, state, local and employment taxes and Excise Tax (if any) imposed with respect to such payments. 

 

     

     

    

 

(b)        In
the event that a reduction in Payments is required pursuant to the immediately preceding paragraph, then, except as provided below
with respect to Payments that consist of health and welfare benefits, the reduction in Payments shall be implemented by determining
the "Parachute Payment Ratio" (as defined below) for each Payment and then reducing the Payments in order beginning with
the Payment with the highest Parachute Payment Ratio.  For Payments with the same Parachute Payment Ratio, such Payments shall
be reduced based on the time of payment of such Payments, with amounts being paid furthest in the future being reduced first. 
For Payments with the same Parachute Payment Ratio and the same time of payment, such Payments shall be reduced on a pro-rata basis
(but not below zero) prior to reducing Payments next in order for reduction.  For purposes of this Section, "Parachute
Payment Ratio" shall mean a fraction, the numerator of which is the value of the applicable Payment as determined for purposes
of Code Section 280G, and the denominator of which is the financial present value of such Parachute Payment, determined at the
date such payment is treated as made for purposes of Code Section 280G (the "Valuation Date").  In determining the
denominator for purposes of the preceding sentence (1) present values shall be determined using the same discount rate that applies
for purposes of discounting payments under Code Section 280G; (2) the financial value of payments shall be determined generally
under Q&A 12, 13 and 14 of Treasury Regulation 1.280G-1; and (3) other reasonable valuation assumptions as determined by Company
shall be used.  Notwithstanding the foregoing, Payments that consist of health and welfare benefits shall be reduced after
all other Payments, with health and welfare Payments being made furthest in the future being reduced first.

 

Notwithstanding the
foregoing, if a Participant is a party to an employment or other agreement with the Company or participates in a severance program
sponsored by the Company or one of its affiliates that contains express provisions regarding Section 280G or Section 4999 of the
Code (or any similar successor provision), the Section 280G or Section 4999 provisions of such employment or other agreement or
plan, as applicable, shall control as to any Payments due that Participant.

 

23.     Governing
Law. The Plan and all grants and awards and actions taken thereunder shall be governed by and construed in accordance with
the internal substantive laws of the State of Wyoming.

 

24.     Effective
Date/Expiration. This Plan will be effective as of the Effective Date, which is the date on which the Plan is adopted by the Board. 
The Plan shall be submitted to the Company's stockholders for approval. Unless the Plan is approved by the Company's stockholders
within twelve (12) months before or after the Effective Date, the Plan and all Awards made under it shall be void and of no force
and effect. No grant will be made under this Plan more than ten (10) years from the date the Plan is adopted, or the date the Plan
is approved by the Company's shareholders, whichever is earlier but all grants made on or prior to such date will continue in effect
thereafter subject to the terms thereof and of this Plan.  The provisions of this Section 24 shall be applied to the Plan,
as amended and restated, as if the Plan were originally established on the date that the Amended and Restated 2012 Equity and Performance
Incentive Plan is adopted, and accordingly, the Plan will not expire until ten (10) years following the date the Amended and Restated
2012 Equity and Performance Incentive Plan is adopted.

 

     

     

    

 

25.     Miscellaneous.

 

(a)        The
Company will not be required to issue any fractional shares of Common Stock pursuant to this Plan. The Board may provide for the
elimination of fractions or for the settlement of fractions in cash.

 

(b)        This
Plan will not confer upon any Participant any right with respect to continuance of employment or other service with the Company
or any Subsidiary, nor will it interfere in any way with any right the Company or any Subsidiary would otherwise have to terminate
such Participant's employment or other service at any time.

 

(c)        To
the extent that any provision of this Plan would prevent any Option that was intended to qualify as an Incentive Stock Option from
qualifying as such, that provision will be null and void with respect to such Option. Such provision, however, will remain in effect
for other Options and there will be no further effect on any provision of this Plan.

 

(d)        No
award under this Plan may be exercised by the holder thereof if such exercise, and the receipt of cash or stock thereunder, would
be, in the opinion of counsel selected by the Board, contrary to law or the regulations of any duly constituted authority having
jurisdiction over this Plan.

 

(e)        Absence
or leave approved by a duly constituted officer of the Company or any of its Subsidiaries shall not be considered interruption
or termination of service of any employee for any purposes of this Plan or awards granted hereunder.

 

(f)        No
Participant shall have any rights as a stockholder with respect to any shares subject to awards granted to him or her under this
Plan prior to the date as of which he or she is actually recorded as the holder of such shares upon the stock records of the Company.

 

(g)        The
Board may, to the extent compliant with applicable law, condition the grant of any award or combination of awards authorized under
this Plan on the surrender or deferral by the Participant of his or her right to receive a cash bonus or other compensation otherwise
payable by the Company or a Subsidiary to the Participant.

 

(h)        If
any provision of the Plan is or becomes invalid, illegal or unenforceable in any jurisdiction, or would disqualify the Plan or
any award under any law deemed applicable by the Board, such provision shall be construed or deemed amended or limited in scope
to conform to applicable laws or, in the discretion of the Board, it shall be stricken and the remainder of the Plan shall remain
in full force and effect.

 

     

     

    

 

Exhibit A

 

Section 162(m) Performance Criteria

 

Pursuant to Section 18(b)(i), performance
goals established for purposes of conditioning the grant of an Award shall be based on one or more of the following performance
criteria ("Performance Criteria") and need not be the same for each Participant: (i) the attainment of certain target
levels of, or a specified percentage increase in, revenues, operating earnings, income before income taxes and extraordinary items,
net income, earnings before income tax, earnings before interest, taxes, depreciation and amortization, or a combination of any
or all of the foregoing; (ii) the attainment of certain target levels of, or a percentage increase in, after-tax or pre-tax profits
including that attributable to continuing and/or other operations; (iii) the attainment of certain target levels of, or a specified
increase in, operational cash flow; (iv) the achievement of a certain level of, reduction of, or other specified objectives with
regard to limiting the level of increase in, all or a portion of, the Company's bank debt or other long-term or short-term public
or private debt or other similar financial obligations of the Company, which may be calculated net of such cash balances and/or
other offsets and adjustments as may be established by the Committee; (v) the attainment of a specified level of, or specified
percentage increase in, earnings per share or earnings per share from continuing operations; (vi) the attainment of certain target
levels of, or a specified increase in, return on capital employed or return on invested capital; (vii) the attainment of certain
target levels of, or a percentage increase in, after-tax or pre-tax return on stockholders' equity; (viii) the attainment of certain
target levels of, or a specified increase in, economic value added targets based on a cash flow return on investment formula; (ix)
the attainment of certain target levels in the fair market value of the Company's shares; (x) the growth in the value of an investment
in the Company's shares assuming the reinvestment of dividends;  (xi) the attainment of certain target levels of, or a percentage
increase in, oil and gas proved developed and proved undeveloped reserves;  (xii) the attainment of certain target levels
of, or a percentage increase in, average daily oil and gas production, (xiii) the attainment of certain target levels of mineral
reserve and resource replacement, and (xiv) the attainment of certain target levels of mineral production.  For purposes of
item (i) above, "extraordinary items" shall mean all items of gain, loss or expense for the fiscal year determined to
be extraordinary or unusual in nature or infrequent in occurrence or related to a corporate transaction (including a disposition
or acquisition) or related to a change in accounting principle, all as determined in accordance with standards established by Opinion
No. 30 of the Accounting Principles Board.

 

In addition, such Performance Criteria
may be based upon the attainment of specified levels of Company (or Subsidiary, division or other operational unit of the Company)
performance under one or more of the measures described above relative to the performance of other peer companies. To the extent
permitted under Code Section 162(m) (including compliance with any requirements for stockholder approval) and Code Section 409A,
the Committee may: (i) designate additional business criteria on which the Performance Criteria may be based or (ii) adjust, modify
or amend the aforementioned business criteria.EX-4.1

 Exhibit 4.1 
  

			
	 

	  	 GREAT-WEST LIFE & ANNUITY

INSURANCE COMPANY
  

A Stock Company
 [8515 East Orchard Road]

[Greenwood Village, CO 80111]

[1-877-723-8723]

  
  

PLEASE READ THIS ANNUITY CONTRACT CAREFULLY. 

THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (THE “COMPANY”). 

INTEREST CREDITED IS BASED ON EXTERNAL INDICES. CONTRACT VALUES MAY BE AFFECTED BY AN EXTERNAL INDEX AND ARE NOT GUARANTEED, HOWEVER THIS CONTRACT
DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENTS. THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT PROVISION. THE AMOUNT PAYABLE UPON FULL SURRENDER OR PARTIAL WITHDRAWAL OF THE CONTRACT VALUE MAY BE ADJUSTED UPWARD OR DOWNWARD BASED
ON A MARKET VALUE ADJUSTMENT FORMULA. 
 PLEASE REVIEW THE CONTRACT DATA PAGE AND THE SURRENDERS AND PARTIAL WITHDRAWALS SECTION OF THIS
CONTRACT. A 10% FEDERAL TAX PENALTY MAY APPLY IF A SURRENDER, PARTIAL WITHDRAWAL OR DISTRIBUTION IS TAKEN PRIOR TO THE OWNER’S ATTAINMENT AGE OF 59 1⁄2.
PLEASE CONSULT A COMPETENT TAX ATTORNEY. 
 The Company holds reserves for guarantees under this Contract in a non-unitized separate account.
The assets in the Separate Account shall not be chargeable with liabilities arising out of any other business that the Company may conduct in the separate account. 

RIGHT TO CANCEL 
 There is a 10 day right to cancel. If the
Contract is issued as a replacement of existing life insurance or annuity coverage, the right to cancel period is extended to 30 days from the date of receiving it. If you are not satisfied with the Contract, return it to the Retirement Resource
Operations Center or an agent of the Company. The Contract will be void from the start, and the Company will refund the Purchase Payment. 

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

 

			
	 

	  	 

	 [Richard Schultz],

[Secretary]
	  	 [Robert L. Reynolds],
 [President and
Chief Executive Officer]

 [Marketing Name] 

INDIVIDUAL SINGLE PREMIUM DEFFERED INDEX LINKED VARIABLE ANNUITY 

The Owner is as shown on the Contract Data Page. This Contract is non- participating and not eligible to share in the Company’s divisible surplus.
This Contract is issued in consideration of the application and payment of the Purchase Payment. 

							
	 CONTRACT DATA PAGE

	 ANNUITY INFORMATION
  
	  	 OWNER INFORMATION
  

	Annuity Contract Number:	  	[1234567]	  	Owner:	  	[JOHN C. DOE]
				
	Effective Date:	  	[July 1, 2017]	  	Date of Birth:	  	[April 1, 1969]
				
	Status of Annuity:	  	[Non-Qualified	  	Tax ID Number:	  	[XXX-XX-1111]
		  	Annuity ]	  	Joint Owner:	  	[JANE B. DOE]
				
	Purchase Payment:	  	[$50,000]	  	Date of Birth:	  	[November 12, 1973]
				
	Annuity Commencement Date:	  	[April 1, 2079]	  	Tax ID Number:	  	[XXX-XX-3333]
				
	State of Delivery:	  		  	[Colorado]	  	
			
	Department of Insurance Telephone Number:	  	[303-123-4567]	  	

  

							
	ANNUITANT INFORMATION	  		  	
	 Annuitant:
	 	[JOHN C. DOE]	  	Joint Annuitant:	  	[JANE C. DOE]
				
	 Date of Birth:
	 	 [March 22, 1967]
	  	Date of Birth:	  	[March 22, 1967]
				
	 Tax ID Number:
	 	 [XXX-XX-1234]
	  	Tax ID Number:	  	[XXX-XX-1234]
				
	 Contingent Annuitant:
	 	[DAVID J. DOE]	  		  	
				
	 Date of Birth:
	 	 [June 6, 1989]
	  		  	
				
	 Tax ID Number:
	 	 [XXX-XX-7777]
	  		  	

  

							
			
	BENEFICIARY INFORMATION	  	 	  	 
	 Beneficiary:
	 	[Sally Smith]	  		  	
				
	 Date of Birth:
	 	 [January 17, 1981]
	  		  	
				
	 Tax ID Number:
	 	 [XXX-XX-1789]
	  		  	
				
	 Contingent Beneficiary:
	 	[Sammy Smith]	  		  	
				
	 Date of Birth:
	 	 [January 17, 1981]
	  		  	
				
	 Tax ID Number:
	 	 [XXX-XX-1794]
	  		  	

  

							
			
	TRANSFERS (ALLOWED AT END OF EACH CONTRACT YEAR ONLY)	  	 	  	 
				
	 Transfer Minimum Amount
	 	 [$500 per each Strategy]
	  		  	

  

							
	 PURCHASE PAYMENTS
	 		  		  	
	 Minimum Purchase Payment Amount:
	 	 $[5,000]
	  		  	
				
	 Maximum Total Purchase Payment:
	 	 $[1,000,000]
	  		  	
				
	 ANNUITY PAYMENT
	 		  		  	
	 Minimum Annuity Payment:
	 	 [$50]
	  		  	
	 Annuity Mortality Table:
	 	[2012 IAR Mortality Table]	  		  	
	 Minimum Guaranteed Interest Rate:
	 	 [1%]
	  		  	
				
	 MISSTATEMENT OF AGE OR SEX
	 		  		  	
	 Interest Rate to be Applied in Adjusting
	 		  		  	
	 for Misstatement of Age or Sex
	 	 [1%]
	  		  	

  

  

			
		  	1

 CONTRACT DATA PAGE (Cont) 

 
 CHARGES: Contract Fee Percentage: [1.20%] per
Contract Year. 
 MARKET VALUE ADJUSTMENT: 
 Interest MVA Term –
[6] Years 
 Interest MVA Term Start Date: [July 14, 2017] 

Interest MVA Term End Date: [July 13, 2023] 
 Market Value Adjustment
Inputs (for the current Market Value Adjustment Term) : 
 Interest MVA Index 1: [Constant Maturity Treasury] 

Interest MVA Rate 1: [0.00%] 

Interest MVA Index 2: [Bank of America/Merrill Lynch C3A0-OAS] 

Interest MVA Rate 2: [0.00%] 
 Maximum
Issue Age: [90] 
 Minimum Dollar Amount for any Transfer per Strategy [$500] 

Minimum Partial Withdrawal Amount [$500] 
 Strategy minimum amount [$2 000]

 [Fixed Interest Rate for allocation of Purchase Payment during the right to cancel period only [1%]] 

Free Annual Withdrawal Amount [10% of Purchase Payment Annually, beginning in Contract Year 2] 

SELECTED INDEX/INDICES: 
 [S&P 500 Price Index-*The
Standard & Poor’s 500 Composite Stock Price Index (S&P 500). “Standard & Poor’s®”,
“S&P®”, “S&P 500®”, “Standard & Poor’s
500®” are trademarks of the McGraw-Hill Companies, Inc. and have been licensed for use by Great-West Life & Annuity Insurance Company. This Product is not sponsored, endorsed,
sold or promoted by Standard & Poor’s and Standard & Poor’s makes no representation regarding the advisability of investing in the Product. The S&P 500 Index does not include dividends paid by the underlying
companies.] 
 [MSCI EAFE Price Index - The MSCI EAFE Price Return Index is a free float-adjusted market capitalization index that is designed to
measure the equity market performance of developed markets, excluding the US and Canada. As of the date of this prospectus, the MSCI EAFE consists of the following 21 developed market country indices: Australia, Austria, Belgium, Denmark, Finland,
France, Germany, Hong Kong, Ireland, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, and the United Kingdom. The MSCI EAFE Price Return Index does not include dividends declared by any of
the companies included in this Index.] 
 [The The Russell 2000® Price Return Index (the
“Index”) is a trademark of Frank Russell Company (“Russell”) and have been licensed for use by Great-West Life & Annuity Insurance Company. “The [Great-West Capital Market ProtectorTM Select-Advisor] is/are not in any way sponsored, endorsed, sold or promoted by Russell or the London Stock Exchange Group companies (“LSEG”) (together the “Licensor Parties”) and
none of the Licensor Parties make any claim, prediction, warranty or representation whatsoever, expressly or impliedly, either as to (i) the results to be obtained from the use of the Index (upon which the [Great-West Capital Market ProtectorTM Select-Advisor] is based), (ii) the figure at which the Index is said to stand at any particular time on any particular day or otherwise, or (iii) the suitability of the Index for the
purpose to which it is being put in connection with the [Great-West Capital Market ProtectorTM Select-Advisor]. None of the Licensor Parties have provided or will provide any financial or
investment advice or recommendation in relation to the Index to Great-West Life & Annuity Insurance Company or to its clients. The Index is calculated by Russell or its agent. None of the Licensor Parties shall be (a) liable (whether
in negligence or otherwise) to any person for any error in the Index or (b) under any obligation to advise any person of any error therein.] 

[NASDAQ-100® Price Index - The NASDAQ-100 Price Return Index® includes 100 of the largest domestic and international non-financial securities listed on The Nasdaq Stock Market based on market capitalization. The Index reflects companies across major
industry groups including computer hardware and software, telecommunications, retail/wholesale trade and biotechnology. It does not contain securities of financial companies including investment companies. The NASDAQ-100 Price Return Index® does not include dividends declared by any of the companies included in this Index.] 
 [The Bank
of America/Merrill Lynch Index for Corporates is a trademark of the Bank of America and has been licensed for use by Great-West Life & Annuity Insurance Company. This Product is not sponsored, endorsed, sold or promoted by Bank of America,
and Bank of America makes no representation regarding the advisability of investing in the Product.] 
 [Custom Index] 

  

			
	 ILVA-RIA-Core
	  	2

 Minimum Cap (set by the Company. This percentage will not be set until the Purchase Payment is received
and the Strategy(ies) are selected): [1.2%] 
 STRATEGIES: 
 Strategy
Term – [1] Years 
 [ 

							
	 	  	Selected Index, Floor and Buffer	  	Purchase Payment Allocation	  	Cap
	 SELECTED INDEX [S&P
500]

	     [A]    
	  	 [0%] Floor
	  	[   ]	  	[   ]
	[B]	  	 [-2.5%] Floor
	  	[   ]	  	[   ]
	[C]	  	 [-5.0%] Floor
	  	[   ]	  	[   ]
	[D]	  	 [-7.5%] Floor
	  	[   ]	  	[   ]
	[E]	  	 [-10%] Floor
	  	[   ]	  	[   ]
	[F]	  	 [10%] Buffer
	  	[   ]	  	[   ]
	SELECTED INDEX [MSCI EAFE]
	[A]	  	 [0%] Floor
	  	[   ]	  	[   ]
	[B]	  	 [-2.5%] Floor
	  	[   ]	  	[   ]
	[C]	  	 [-5.0%] Floor
	  	[   ]	  	[   ]
	[D]	  	 [-7.5%] Floor
	  	[   ]	  	[   ]
	[E]	  	 [-10%] Floor
	  	[   ]	  	[   ]
	[F]	  	 [10%] Buffer
	  	[   ]	  	[   ]
	SELECTED INDEX [Russell 2000]
	[A]	  	 [0%] Floor
	  	[   ]	  	[   ]
	[B]	  	 [-2.5%] Floor
	  	[   ]	  	[   ]
	[C]	  	 [-5.0%] Floor
	  	[   ]	  	[   ]
	[D]	  	 [-7.5%] Floor
	  	[   ]	  	[   ]
	[E]	  	 [-10%] Floor
	  	[   ]	  	[   ]
	[F]	  	 [10%] Buffer
	  	[   ]	  	[   ]
	SELECTED INDEX [NASDAQ]
	[A]	  	 [0%] Floor
	  	[   ]	  	[   ]
	[B]	  	 [-2.5%] Floor
	  	[   ]	  	[   ]
	[C]	  	 [-5.0%] Floor
	  	[   ]	  	[   ]
	[D]	  	 [-7.5%] Floor
	  	[   ]	  	[   ]
	[E]	  	 [-10%] Floor
	  	[   ]	  	[   ]
	[F]	  	 [10%] Buffer
	  	[   ]	  	[   ]
	SELECTED INDEX [CUSTOM]
	[A]	  	 [0%] Floor
	  	[   ]	  	[   ]
	[B]	  	 [-2.5%] Floor
	  	[   ]	  	[   ]
	[C]	  	 [-5.0%] Floor
	  	[   ]	  	[   ]
	[D]	  	 [-7.5%] Floor
	  	[   ]	  	[   ]
	[E]	  	 [-10%] Floor
	  	[   ]	  	[   ]
	[F]	  	 [10%] Buffer
	  	[   ]	  	[   ]

 ] 
 CONTRACT INFORMATION

 These Contract Data Pages, together with the applicable Strategies, Crediting Factors, Selected Indices, and allocation confirmation reflects
the information with which the Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Retirement Resource Operations Center. 

  

			
	 ILVA-RIA-Core
	  	3

 TABLE OF CONTENTS 

 

					
		
	CONTRACT DATA PAGES	  	1
			
	  Section 1	  	 DEFINITIONS
	  	5
			
	  Section 2	  	 OWNERSHIP AND BENEFICIARY
	  	10
			
	  Section 3	  	 PURCHASE PAYMENTS
	  	12
			
	  Section 4	  	 CONTRACT VALUE AND STRATEGY VALUE
	  	13
			
	  Section 5	  	 ALLOCATION, RENEWAL AND TRANSFER
	  	15
			
	  Section 6	  	 DEATH BENEFIT
	  	16
			
	  Section 7	  	 SURRENDERS AND WITHDRAWALS
	  	18
			
	  Section 8	  	 MARKET VALUE ADJUSTMENT
	  	21
			
	  Section 9	  	 GENERAL PROVISIONS
	  	23
			
	  Section 10	  	 ANNUITY PAYMENT OPTIONS
	  	25      

  

			
	 ILVA-RIA-Core
	  	4

 SECTION 1: DEFINITIONS 

 
  

Accumulation Period - The time period between the Effective Date and the earlier of the Annuitant’s 110th birthday or the Payment Election
Date. 
 Annuitant (Joint Annuitant) - The person named in the application, and listed on the Contract Data Page, upon whose life the payment
of an annuity is based and who will receive annuity payments. The Annuitant will be the Owner unless otherwise indicated in the application. Joint Annuitants may be named in the application or any time before the Annuity Commencement Date, and must
be one another’s Spouse as of the Effective Date. If you select a Joint Annuitant, ‘Annuitant’ means the older Joint Annuitant or the sole surviving Joint Annuitant. If you name a Contingent Annuitant, the Annuitant will be considered
the ‘Primary Annuitant’. If an IRA custodian or trustee owns the Contract, the Underlying IRA Holder must be the Annuitant and if there are two Annuitants, the Joint Annuitant must be the Underlying IRA Holder’s Spouse and the
designated Beneficiary of the custodial or trusteed account. 
 Annuity Commencement Date - The date annuity payments begin, as shown on the
Contract Data Page, which is either the Payment Election Date or no later than the Annuitant’s 110th birthday if no Payment Election Date has been established. The Owner may change the Annuity Commencement Date if annuity payments have not
already begun. Upon death of the Owner, the Beneficiary may change the Annuity Commencement Date only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. 

Annuity Payment Options – The annuity payment options available including a series of income payments as set out in Section 10.03. 

Annuity Payment Period - The period beginning on the Annuity Commencement Date and continuing until all annuity payments have been made under
this Contract. 
 Beneficiary – The person(s) designated by the Owner to receive death proceeds which may become payable upon the death of
an Owner. If the surviving Spouse of an Owner is the surviving Joint Owner, the surviving Spouse will be deemed to be the Beneficiary upon such Owner’s death and may take the death benefit or elect to continue this Contract in force. The
Beneficiary is shown on the Contract Data Page unless later changed by the Owner (see Change of Beneficiary provision). 
 Buffer – The
maximum negative Index Performance that the Company will absorb before applying a negative Strategy Credit, as shown on the Contract Data Page (if offered).  

Business Day - Any day, and during the hours, which the New York Stock Exchange is open for trading. If that date falls on a non-Business Day,
the following Business Day will be used, except as otherwise provided. 
 Cap – The maximum positive index performance that will apply to
determine a positive Strategy Credit. This rate may change at the beginning of a Contract Year. The minimum Cap will always be greater than or equal to the Contract Fee Percentage. 

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

 Contingent Annuitant – The person named in the application who will become the Annuitant upon the death of the primary Annuitant. The
Contingent Annuitant is the person named in the Contract Data Page, unless later changed by the Owner (see Contingent Annuitant provision). 

Contingent Beneficiary – The person designated by the Owner to become the Beneficiary when the primary Beneficiary dies. 

Contract – The document issued to the Owner, which specifies the rights and obligations of the Owner, together with any riders,
endorsements, and amendments, if applicable. 
 Contract Anniversary – The same day and month as the Effective Date for each year the
Contract remains in force. 
 Contract Base – The sum of the Strategy Base(s). 

  

			
	 ILVA-RIA-Core
	  	5

 Contract Base Withdrawal – The amount of Contract Base that is withdrawn as the result of a
Request for a partial withdrawal. 
 Contract Fee – The total fee assessed to the Contract Value on the Strategy Term End Date. The
Contract Fee is equal to the sum of the Strategy Fee(s). 
 Contract Fee Percentage – The fee, expressed as a percentage, as shown on the
Contract Data Page, that is used to calculate the Contract Fee. 
 Contract Value – The current value of the Contract. On any Business
Day, the Contract Value is equal to the sum of all Strategy Values. 
 Contract Year – Any twelve-month period beginning on the
Effective Date or Contract Anniversary and ending one day before the next Contract Anniversary. 
 Crediting Factors – The specific
factors, as shown on the Contract Data Page, used by a Strategy to calculate a Strategy Credit. These may include, but are not limited to a Cap, and a Buffer or a Floor. 

Due Proof of Death – (i) an original or certified copy of a death certificate; (ii) a copy of a certified decree of a court of
competent jurisdiction as to the finding of death; or (iii) any other proof satisfactory to the Company. 
 Effective Date – The date
on which the Purchase Payment is credited to the Strategy(ies). Contract Years, anniversaries, and quarters are measured from the Effective Date. 

Floor – The maximum negative index performance that may apply to determine a negative Strategy Credit (if offered). 

Free Annual Withdrawal Amount – A percentage of the Purchase Payment, which may be withdrawn during the Contract Year without incurring a
Market Value Adjustment. The Free Annual Withdrawal Amount is not available in Contract Year 1. 
 Grantor – The natural person who is
treated under Sections 671 through 679 of the Code as owning the assets of a Grantor Trust. All Grantors must be individuals. 
 Grantor Trust
– A trust, the assets of which are treated under Sections 671 through 679 of the Code as being owned by the Grantor(s). We allow a Grantor Trust to be an Owner only if it either has a single Grantor who is a natural person, or two Grantors who
are one another’s Spouse as of the Effective Date. 
 Great-West Life & Annuity Insurance Company (the “Company”)
– The issuer and underwriter for this Contract. 
 Gross Withdrawal – The amount of Contract Value that is withdrawn as the result of
a Request for a partial withdrawal. 
 Guaranteed Minimum Death Benefit – The Purchase Payment reduced proportionally for any partial
withdrawals prior to the date the Request for payment is received. 
 Hospital – A facility that is licensed and operated as a hospital
according to the law of the jurisdiction in which it is located. 
 Index Performance – On any Business Day, the percentage change in the
Index Value of the Selected Index as measured from the Strategy Term Start Date. 
 Index Value – Associated with the Strategy and is
equal to the closing value of the Selected Index/Indices as of the current Business Day. 
 Interest MVA Indices – The indices used to
determine the rates used to calculate the Strategy Interest MVA Factor. Rates based on the beginning of the initial Interest MVA Term are shown on the Contract Data Page. 

Interest MVA Term – The period beginning on the Effective Date and renewing for the same time period, 

  

			
	 ILVA-RIA-Core
	  	6

 
stated on the Contract Data Page, during which the Interest MVA Factor will be calculated. 

Interest MVA Term End Date – The last day of the Interest MVA Term. 

Interest MVA Term Start Date – The first day of the Interest MVA Term. At issue, the Interest MVA Term Start Date is equal to the Effective
Date. At the end of the initial Interest MVA Term, the Contract will renew into a new Interest MVA Term of the same length. The Interest MVA Term Start Date of the renewal Interest MVA Term is equal to the Interest MVA Term End Date of the prior
Interest MVA Term. 
 MVA (Market Value Adjustment) – The amount of adjustment (increase or decrease) that will apply when a Contract Base
Withdrawal in excess of the Free Annual Withdrawal Amount is taken from the Contract. The MVA is equal to the sum of the Strategy MVA(s). The MVA may not apply in certain situations as detailed in Section 7.04. 

Minimum Guaranteed Interest Rate – A minimum interest rate applied to the Contract Value when annuitized, as shown on the Contract Data
Page. 
 Non-Qualified Annuity Contract – An annuity Contract which is not intended to satisfy the requirements of Section 408(b)
(IRAs) or Section 408A (Roth IRAs) of the Code. This Contract may be issued as a Non- Qualified Annuity Contract. 
 Nursing Home – A
facility that is licensed and operates as a nursing facility according to the law of the jurisdiction in which it is located. 
 Owner
– The person or persons named on the Contract Data Page and rider Data Page, if applicable. The Owner must be age 90 or younger at the time the Contract is issued. The Owner is entitled to exercise all rights and privileges under the Contract
while the Annuitant is living. Joint Owners must be one another’s Spouse as of the Effective Date and must both be natural persons. The Annuitant will be the Owner unless otherwise indicated in the application. The Owner must be a natural
person, an IRA custodian or trustee, or a Grantor Trust. If the Owner is a Grantor Trust, all references in the Contract and Rider to the life, age or death of the Owner shall pertain to the life, age or death of the Grantor(s). If the Owner is an
IRA custodian or trustee, all references to the life, age, or death of the Owner pertain to the life, age, or death of the Underlying IRA Holder. 

Payment Election Date – The date on which annuity payments or periodic withdrawals begin. Payment Election Date must occur before the
Annuitant’s 110th birthday. 
 Point-to-point – The comparison of the changes to the Index between two points of time. 

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

Purchase Payment – Purchase amount received from the Owner and allocated to the Strategy(ies) prior to any other deductions. 

Qualified Annuity Contract – An annuity contract that is intended to qualify under Section 408(b) (IRAs) or 

Section 408A (Roth IRAs) of the Code. This Contract may be issued as a Qualified Annuity Contract. 

Remaining Purchase Payment – The Purchase Payment reduced for partial withdrawals taken. The Remaining Purchase Payment will not be less
than zero. 
 Request – Any written, telephoned, electronic or computerized instruction in a form satisfactory to the Company and received
at the Retirement Resource Operations Center from the Owner or the Owner’s designee (as specified in a form acceptable to the Company), or the Beneficiary (as applicable), as required by any provision of this Contract. The Request is subject to
any action taken or payment made by the Company before it is processed. A written Request will be deemed to include electronic mail transmissions only if such transmissions include PDF or other facsimile transmissions clearly reproducing the manual
signature. 
 Retirement Resource Operations Center – [P.O. Box 173920 Denver, CO 80217-3920]. The toll-free telephone number is
[1-877-723-8723.] 
 Selected Index/Indices – The Index/Indices as elected to be linked to Strategy(ies). 

  

			
	 ILVA-RIA-Core
	  	7

 Separate Account – The segregated asset account, established by Great-West under Colorado Law
in which the Company holds reserves for guarantees under the Contract and the Company’s other general obligations under the Separate Account. The Separate Account is not registered under the Investment Company Act of 1940. 

Spouse – A person recognized as a spouse in the state where the couple was legally married. The term does not include a party to a
registered domestic partnership, civil union, or similar formal relationship recognized under state law that is not denominated a marriage under that state’s law Do we want to amend this or expand it or do we want to leave it as a
“marriage”?. 
 Strategy(ies) – The combination of a Selected Index and Crediting Factors to which the Owner can allocate their
Contract Value. 
 Strategy Base – The amount on which the Strategy Credit and Strategy Fees are calculated and, as may be applicable,
either assessed or applied. On the Effective Date, the Strategy Base is set equal to the Purchase Payment allocated to that Strategy. 
 Strategy
Base Withdrawal – The amount of Strategy Base that is withdrawn as the result of a Request for a partial withdrawal. 
 Strategy Credit
– The amount credited to the Strategy Base on the Strategy Term End Date. The amount credited depends, in part, on the Index Performance of the Selected Index and the Crediting Factors associated with the Strategy. 

Strategy Credit Rate – On any Business Day, the rate measuring the performance of the Strategy since the Strategy Term Start Date as
determined by the Crediting Factors and the Index Performance of the Selected Index. 
 Strategy Fee – The amount of the Contract Fee
assessed to the Strategy Base on the Strategy Term End Date. 
 Strategy Gross Withdrawal – The amount of Strategy Value that is withdrawn
as the result of a Request for a partial withdrawal. 
 Strategy Index MVA Factor – The factor used, in combination with the Strategy
Interest MVA Factor, to calculate the Strategy MVA. 
 Strategy Interest MVA Factor – The factor used, in combination with the Strategy
Index MVA Factor, to calculate the Strategy MVA. 
 Strategy MVA – The MVA calculated for each Strategy when a Contract Base Withdrawal in
excess of the Free Annual Withdrawal Amount is taken from the Contract. The sum of the Strategy MVA(s) is equal to the MVA. 
 Strategy Option
Value – The estimated market value, expressed as a percentage of the Strategy Base, of a set of put and call options as determined by an option pricing formula. 

Strategy Term – A period of time, expressed in years, equal to the time between the Strategy Term Start Date and when the Strategy Credit is
applied. The length of the Strategy Term is shown on the Contract Data Page. 
 Strategy Term End Date – The last day of the Strategy
Term. 
 Strategy Term Start Date – The first day of the Strategy Term. At issue, the Strategy Term Start Date is equal to the Effective
Date. At the end of the initial Strategy Term, the Contract will renew into a new Strategy Term of the same length. The Strategy Term Start Date of the renewal Strategy Term is equal to the Strategy Term End Date of the prior Strategy Term. 

Strategy Value – On any Business Day, the total value of all the Owner’s interests in the Strategy prior to any MVAs, as may be
applicable, either assessed or applied. 
 Surrender Value – Equal to the total Contract Value, with any MVAs calculated and either
deducted or added to the total, as applicable. Taxes may also be deducted. 
 Transaction Date – The date on which any Purchase Payment or
Request from the Owner will be processed. 

  

			
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Purchase Payment and Requests received after the close of regular trading on the New York Stock Exchange (generally 4:00 p.m. ET) will be deemed to have been received on the next Business Day.
Requests will be processed and the Strategy Value will be valued on each day that the New York Stock Exchange is open for trading. 
 Transfer
– The moving of amounts between and among the Strategies. 
 Underlying IRA Holder – The natural person who is treated under the Code
as having a beneficial interest in the assets of a custodial or trusteed IRA account. All Underlying IRA Holders must be individuals. 

  

			
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 SECTION 2: OWNERSHIP AND BENEFICIARY 

 
  

2.01  RIGHTS OF OWNER 
 The Owner has the sole and
absolute power to exercise all rights and privileges in this Contract. Upon the death of an Owner or the Annuitant, the Death Benefit Provisions section will apply. 

2.02  CHANGE OF OWNERSHIP 
 The Owner may, by written
Request, change the ownership. The Company shall not be bound by any change of ownership unless it is made in writing in a form satisfactory to the Company and recorded. A change in ownership will take effect as of the date the written Request is
signed, unless otherwise specified by the Owner, subject to payments made or actions taken by the Company prior to receipt of the Request. Any change of ownership is subject to any action taken or payout made by the Company before the change was
recorded. 
 2.03  ASSIGNMENT 
 The Owner may Request
to assign this Contract by contacting the Retirement Resource Operations Center in writing. Any Request for assignment is subject to the Company’s acceptance. The Company will not record an assignment until the original or a certified copy is
received at the Retirement Resource Operations Center. The assignment will be effective on the date the Request is signed, unless otherwise specified by the Owner subject to payments made or actions taken by the Company prior to receipt of the
Request. When recorded, the Owner’s rights and those of the Beneficiary are subject to the assignment. The Company is not responsible for the validity of any assignment or any rights or obligations between the Owner and the assignee. 

2.04  DESIGNATION OF BENEFICIARY 
 Unless changed as
provided below, or as otherwise required by law, the Beneficiary (and the Contingent Beneficiary, as applicable) will be as shown on the Contract Data Page. Unless otherwise indicated, if more than one Beneficiary is designated, then each such
Beneficiary so designated will share equally in any benefits and or rights granted by the Contract to such Beneficiary, or allowed by the Company. The Company may rely on an affidavit by any responsible person to identify a Beneficiary or verify the
non-existence of a Beneficiary not identified by name. 
 2.05  CHANGE OF BENEFICIARY 

The Owner may change the Beneficiary by written Request at any time before the Payment Election Date. The Company shall not be bound by any change of
Beneficiary unless it is made in writing and recorded at the Retirement Resource Operations Center. A change of Beneficiary will take effect as of the date the written Request was signed, subject to receipt at the Retirement Resource Operations
Center, unless a certain date is specified by the Owner. 
 If an Owner dies before the date the Request was processed, the change will take effect as
of the date of the Request, unless the Company has already made a payment or has otherwise taken action on a designation or change before receipt or processing of such Request. If an Owner dies, and the surviving Joint Owner is the surviving Spouse
of the deceased Owner, the surviving Spouse will become the Beneficiary and may take the death benefit or elect to continue this Contract in-force. 

An irrevocable Beneficiary designation may not be changed without the written consent of that Beneficiary, except to the extent required by law. 

2.06  CONTINGENT BENEFICIARY 
 While the Annuitant is
alive, the Owner may, by written Request, designate or change a Contingent Beneficiary from time to time. The Company shall not be bound by any change of Contingent Beneficiary unless it is made in writing and recorded at the Retirement Resource
Operations Center. 
 2.07  DEATH OF BENEFICIARY 
 The
interest of any Beneficiary who dies before an Owner or the Annuitant will terminate at the death of such Beneficiary and the Contingent Beneficiary, if any, will become the Beneficiary. The interest of any Beneficiary who dies at the time of, or
within 30 days after, the death of an Owner or the Annuitant will also terminate if no benefits have been paid to such Beneficiary, unless the Owner has indicated otherwise by Request. The benefits will then be paid as though the Beneficiary had
died before the deceased Owner or Annuitant. 

  

			
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 2.08  SUCCESSIVE BENEFICIARIES 

If an Owner dies, and the surviving Joint Owner is the surviving Spouse of the deceased Owner, the surviving Spouse will become the Beneficiary and may
take the death benefit or elect to continue this Contract in force. If there is no surviving Joint Owner, and no named Beneficiary is alive at the time of an Owner’s death, any benefits payable will be paid to the Owner’s estate. 

2.09  ANNUITANT 
 While the Annuitant is living and at
least 30 days prior to the Annuity Commencement Date, the Owner may, by Request, change the Annuitant. The Company shall not be bound by a change of Annuitant unless it is made in writing and recorded at the Retirement Resource Operations Center. If
this is a Qualified Annuity Contract, the Annuitant will at all times be the Owner of the Contract. 
 2.10  CONTINGENT ANNUITANT 

While the Annuitant is living and at least 30 days prior to the Annuity Commencement Date, the Owner may, by Request, designate or change a Contingent
Annuitant. The Company shall not be bound by a change of Annuitant unless it is made in writing and recorded at the Retirement Resource Operations Center. 
 2.11
 OWNERSHIP OF SEPARATE ACCOUNT 
 The Company has absolute ownership of the assets of the Separate Account. The portion of the assets of the
Separate Account equal to the reserves and other Contract liabilities with respect to the Separate Account are not chargeable with liabilities arising out of any other business the Company may conduct. The income, gains and losses, realized or
unrealized, from assets allocated to the Separate Account shall be credited to or charged against such account, without regard to other income, gains or losses of the Company. The Separate Account is not registered under the Investment Company Act
of 1940. 

  

			
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 SECTION 3: PURCHASE PAYMENT 

 
  

3.01 EFFECTIVE DATE 
 The Effective Date, shown on the
Contract Data Page is the date the Purchase Payment is allocated to the Strategy(ies). 
 3.02 PURCHASE PAYMENT 

The Purchase Payment can be made through the Retirement Resource Operations Center. The Contract Data Page will reflect the minimum and maximum Purchase
Payment amount accepted by the Company. The Contract will begin on the Effective Date. The Company may modify these limitations, by lowering minimum applicable requirements or accepting a larger maximum Purchase Payment. This will be done on a
nondiscriminatory basis. 
 If a Purchase Payment is cancelled or if a check for a Purchase Payment is returned due to insufficient funds, the Owner
will be responsible for any losses or fees imposed by the bank and losses that may be incurred as a result of any decline in the value of the cancelled purchase. The Company reserves the right to refrain from allocating the Purchase Payment to the
selected Strategy(ies) during the right to cancel period until notification is received that the check for the Purchase Payment has cleared. 
 3.03 ALLOCATION OF
PURCHASE PAYMENT 
 If the application is in good order, the Purchase Payment will be allocated within five Business Days of receipt of the payment
at the Retirement Resource Operations Center. On the Effective Date, the Purchase Payment will be allocated to the Strategy(ies) in the proportions as elected on the application. The Crediting Factors for each Strategy will be those determined on
the Effective Date. 

  

			
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 SECTION 4: CONTRACT VALUE AND STRATEGY VALUE 

 
  

4.01 CONTRACT VALUE AND CONTRACT BASE 
 The Contract Value for
the Owner on any date during the Accumulation Period will be the sum of all Strategy Values. 
 The Contract Base on any date during the Accumulation
Period will be the sum of the Strategy Base(s). 
  

	4.02	 STRATEGY VALUE AND STRATEGY BASE 

On any Business Day, the Strategy Value is equal to A x (1 + B – C x D), where: 

A = Strategy Base, 
 B
= Strategy Credit Rate, 
 C = Contract Fee Percentage, and 

D = the number of years (whole and partial) that have elapsed since the Strategy Term Start Date. 

On the Effective Date, the Strategy Base is equal to the Purchase Payment allocated to the Strategy. The Strategy Base will be reduced by partial
withdrawals as described in Section 7.02. On the Strategy Term End Date the Strategy Credit will be applied to the Strategy Base as described in Section 4.04. On the Strategy Term End Date, after the application of the Strategy Credit, a
Strategy Fee will be assessed as described in Section 4.08, as applicable. 
  

	4.03	 STRATEGY CREDIT RATE 

The Strategy Credit Rate is the rate measuring the performance of the Strategy since the Strategy Term Start Date as determined by the Crediting Factors
and the Index Performance of the Selected Index. On the Strategy Term End Date, after application of the Strategy Credit to the Strategy Base, the Strategy Credit Rate is set to zero. 

The calculation of the Strategy Credit Rate varies by Strategy and is subject to the declared Crediting Factors. The Strategy Credit Rate is a function
of the Index Performance. On any Business Day, Index Performance is calculated as A / B – 1, where: 
 A = Index Value on that
Business Day, and 
 B = Index Value on the Strategy Term Start Date. 

The Strategy Credit Rate for the Point-to-Point Cap and Floor Strategy equals the greater of A and B, where: 

A = Floor, and 
 B =
the lesser of Index Performance and Cap. 
 The Strategy Credit Rate for the Point-to-Point Cap and Buffer Strategy equals the lesser of A and B if
Index Performance is greater than or equal to zero, where: 
 A = Index Performance, and 

B = Cap. 
 The Strategy Credit Rate
for the Point-to-Point Cap and Buffer Strategy equals the lesser of A + B and zero if Index Performance is less than zero, where: 
 A
= Index Performance, and 
 B = Buffer. 
 Examples
of these calculations are as follows: 
 Example 1 – Point-to-Point Cap and Floor Strategy 

Floor = -10% 
 Cap = 8% 

Index Value on Strategy Term Start Date = 2,000 
 Index Value on the date of the
calculation = 2,200 
 Index Performance = 2,200/2,000 - 1 = 10% (0.10) 
 Strategy
Credit Rate = 8% 

  

			
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 Example 2 – Point-to-Point Cap and Floor Strategy 

Floor = -10% 
 Cap = 8% 

Index Value on Strategy Term Start Date = 2,000 
 Index Value on the date of the
calculation = 1,600 
 Index Performance = 1,600/2,000 - 1 = -20% (-0.20) 

Strategy Credit Rate = -10% 
 Example 3 – Point-to-Point Cap and Buffer
Strategy 
 Buffer = 10% 
 Cap = 8% 

Index Value on Strategy Term Start Date = 2,000 
 Index Value on the date of the
calculation = 1,700 
 Index Performance = 1,700/2,000 - 1 = -15% (-0.15) 

Strategy Credit Rate = -5% 
 Example 4 – Point-to-Point Cap and Buffer
Strategy 
 Buffer = 10% 
 Cap = 8% 

Index Value on Strategy Term Start Date = 2,000 
 Index Value on the date of the
calculation = 2,100 
 Index Performance = 2,100/2,000 - 1 = 5% (0.05) 
 Strategy
Credit Rate = 5% 
 Example 5 – Point-to-Point Cap and Buffer Strategy 

Buffer = 10% 
 Cap = 8% 

Index Value on Strategy Term Start Date = 2,000 
 Index Value on the date of the
calculation = 1,900 
 Index Performance = 1,900/2,000 - 1 = -5% (-0.05) 
 Strategy
Credit Rate = 0% 
  

	4.04	 STRATEGY CREDIT 

The Strategy Credit is calculated on the Strategy Term End Date as the Strategy Credit Rate multiplied by the Strategy Base prior to the assessment of
any Strategy Fees due to be assessed on that date. Once calculated, the Strategy Credit is added to the Strategy Base and the Strategy Credit Rate is set to zero. 

4.05  STRATEGIES 
 Each Strategy is linked to a Selected
Index and a combination of Crediting Factors. The Company reserves the right to add Strategy(ies) at their discretion. The Company reserves the right to restrict allocations to Strategy(ies) at their discretion. 

 

	4.06	 CREDITING FACTORS 

Each Strategy will define a combination of Crediting Factors. Crediting Factors for the initial Strategy Term for each available Strategy are declared on
the Contract Data Page. The Company reserves the right to change any and all Crediting Factors for any Strategy Term after the initial Strategy Term. 
 4.07 INDEX
UNAVAILABLE, DISCONTINUED OR CHANGED 
 If any Selected Index becomes unavailable, or is discontinued or if the calculation of the Selected Index
is changed substantially, the Company reserves the right to substitute a comparable index. The Company will seek approval by the insurance commissioner of the state in which the Contract is issued, as required, and give written notice before making
any substitutions. The Company will send notification in advance of such change. 
 Additional indices may be added at the Company’s discretion,
subject to approval of the insurance commissioner if required by state law. 

  

			
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	4.08	 CONTRACT FEE AND STRATEGY FEE 

The Contract Fee is equal to the sum of the Strategy Fee(s). 

For each Strategy, the Strategy Fee is calculated on the Strategy Term End Date, prior to the application of the Strategy Credit, as the Contract Fee
Percentage multiplied by the Strategy Base multiplied by the number of years in the Strategy Term. 
 Once calculated, the Strategy Fee is deducted
from the Strategy Base. 
 SECTION 5: ALLOCATON, RENEWAL AND TRANSFER 

 
  

5.01 ALLOCATIONS ON STRATEGY TERM START DATE 
 Allocations and
Transfers to and from the Strategy(ies) may only be made on the Strategy Term Start Date. The Company will give notice of this date no later than 60 days prior to the Strategy Term End Date. Allocations must be made in whole percentages or dollar
amounts. The minimum dollar amount for any Transfer is the amount shown in the Contract Data Page for each Strategy. 
 A notice showing any changes
to the Crediting Factors for each Strategy, as may be applicable, will be sent no later than 15 days prior to the Strategy Term End Date. 
 5.02 REQUESTING AND
ACCEPTING CHANGES PRIOR TO THE STRATEGY TERM START DATE 
 The Owner may Request that changes be made to the Strategy allocations effective on the
Strategy Term Start Date by contacting the Retirement Resource Operations Center in writing, by telephone and, if available, via the website or electronically. The Request (if any) must be received by the Retirement Resource Operations Center no
less than 2 business days prior to the Strategy Term Start Date in order to be effective by the Strategy Term Start Date. Any Requests received after this period will not be effected. If no reallocation or transfers are requested by the Strategy
Term Start Date, or if the acceptance is not received within the requisite time to effect changes, the Strategy(ies) will remain allocated in the same Strategy(ies) as of the Strategy Term Start Date, unless the rebalancer option is elected as
described in Section 5.04. 
  

	5.03	 RENEWAL OF CONTRACT AND MVA TERM 

The Contract and Interest MVA Term may be renewed on the Interest MVA Term End Date. The Company will notify the Owner of the Interest MVA Term End Date
no less than 60 days prior to such date. Further, the Company will send a second, follow-up notice no less than 15 days prior to the Interest MVA Term End Date describing renewal options, including all available Strategies and the Crediting Factors
declared for that Strategy. The renewal form must be returned to the Company to be received no later than 2 Business Days prior to the Interest MVA Term End Date. Thereafter, the Company will send a confirmation notice detailing all changes and
elections made. 
 If no election is made and received by the Company within 2 Business Days prior to the Interest MVA Term End Date, then the
Contract will automatically renew subject to the previous Strategy(ies) as were elected by the Owner during the immediately preceding Interest MVA Term. The MVA will reset to reflect new Interest MVA Rates based on the value of the Interest MVA
Indices on the Interest MVA Term End Date. The allocations to the Strategy(ies) will be based on the most recent allocations, as specified by the Owner at the end of the immediately preceding Contract Year or as was last allocated in terms of the
rebalancer option as described in Section 5.04. 
  

	5.04	 THE REBALANCER OPTION 

By Request, the Owner may elect the rebalancer option in order to automatically reallocate among the Strategy(ies) to maintain a particular percentage
allocation, on a periodic basis, as selected by the Owner and subject to the provisions of Section 5.01. If elected, the rebalancer option will be triggered on each Strategy Term Start Date if new allocations are not otherwise made. If the
rebalancer option is triggered, the percentage allocations among the Strategies will be based upon the most recent allocations as specified by the Owner. The amount allocated to each Strategy will increase or decrease at different rates depending on
the investment experience and the structure of the Strategy, including applicable Caps, Floors, and Buffers. 
 The rebalancer option will terminate upon the Annuity
Commencement Date. 

  

			
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 SECTION 6: DEATH BENEFIT 

 
  

6.01   PAYMENT OF DEATH BENEFIT 
 Upon Due Proof of
Death of an Owner and while this Contract is in force, the death benefit will become payable in accordance with these provisions and subject to Section 72(s) of the Code following the Company’s receipt of a Request. 

When an Owner dies before the Annuity Commencement Date and a death benefit is payable to a Beneficiary, the death benefit proceeds will remain invested
in accordance with the allocation instructions given by the Owner until new allocation instructions are requested by the Beneficiary or until the death benefit is actually paid to the Beneficiary. The death benefit will be determined as of the date
of the Request if Option 1 below is selected. The death benefit will be determined as of the date payments commence if Option 2 below is selected. Distribution of the death benefit may be made as follows (subject to the distribution rules set forth
below): 
  

	 	1.	 payment in a single, lump-sum; or 

 

	 	2.	 payment under any of the annuity options provided under the Contract. 

The death benefit will be the greatest of: 
  

	 	•	 	 the Contract Value as of the applicable date, less Premium Tax, if any; or 

	 	•	 	 the Surrender Value as of the applicable date, less Premium Tax, if any; or 

	 	•	 	 the Guaranteed Minimum Death Benefit as of the applicable date, less Premium Tax, if any. 

The Guaranteed Minimum Death Benefit will be reduced due to partial withdrawals as described Section 7.02. 

The death benefit will comply with the minimum nonforfeiture requirements as described in the NAIC Variable Annuity Model Regulation. 

6.02   DISTRIBUTION RULES 
 If Annuitant Dies Before Annuity
Commencement Date 
 If the Owner is living and the Annuitant dies before the Annuity Commencement Date, the Contract will continue and no death
benefit will be payable. If no Contingent Annuitant has been named, the Owner (or the Grantor if the Owner is a Grantor Trust, or the Underlying IRA holder if the Owner is the Custodian or Trustee of an IRA account) will become the Annuitant. 

If an Owner Dies Before Annuity Commencement Date 
 If an
Owner dies before the Annuity Commencement Date, and such Owner was not the Annuitant, the following provisions shall apply: 
 (1) If
there is a Joint Owner who is the surviving Spouse of the deceased Owner, the Joint Owner will become the Owner and Beneficiary and may take the death benefit or elect to continue this Contract in force. 

(2) In all other cases, the Company will pay the death benefit to the Beneficiary even if a former Spouse Joint Owner, the Annuitant
and/or the Contingent Annuitant are alive at the time of the Owner’s death, unless the sole Beneficiary is the deceased Owner’s surviving Spouse and such Beneficiary Requests to become the Owner and the Annuitant and to continue the
Contract in force. 
 Any death benefit payable to the Beneficiary upon an Owner’s death will be distributed as follows: 

(1) If the Owner’s surviving Spouse is the person entitled to receive benefits upon the Owner’s death, the surviving Spouse
will be treated as the Owner and will be allowed to take the death benefit or continue the Contract in force; or 
 (2) If a non-Spouse
individual is the person entitled to receive benefits upon the Owner’s death, such individual may elect, not later than one year after the Owner’s date of death, to receive the death benefit in either a single sum or payment under any of
the annuity options available under the Contract, provided that: (a) such annuity is distributed in substantially equal installments over the life or life expectancy of such Beneficiary; and (b) such distributions begin no later than one
year after the Owner’s date of death. If no election is received by the Company from an individual non-Spouse Beneficiary such that substantially equal installments have begun no later than one year after the Owner’s date of death, then
the entire amount must be distributed within five years of the Owner’s date of death. 

  

			
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 The death benefit will be determined as of the date the payments commence. 

If Annuitant Dies After Annuity Commencement Date 
 Upon the
death of any Annuitant after the Annuity Commencement Date, any benefit payable must be distributed to the Beneficiary in accordance with and at least as rapidly as under the annuity option then in effect. 

If an Owner Dies After Annuity Commencement Date and While the Annuitant is Living 

Upon the death of an Owner after the Annuity Commencement Date and while the Annuitant is living, any benefit payable will continue to be distributed to
the Annuitant at least as rapidly as under the annuity option then in effect. All of the Owner’s rights granted under the Contract or allowed by the Company will pass to any surviving Joint Owner and, if none, to the Annuitant. 

6.03   COMPLIANCE WITH CODE SECTION 72(s) 
 In any
event, no payment of benefits provided under the Contract will be allowed that does not satisfy the requirements of Code Section 72(s), as amended from time to time, and any other applicable federal or state law, rules or regulations. These
death benefit provisions will be interpreted and administered in accordance with such requirements. 

  

			
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 SECTION 7: SURRENDERS AND WITHDRAWALS 

 
  

7.01   SURRENDER 
 At any time prior to the Annuity
Commencement Date and subject to the provisions of this Contract, the Owner may surrender this Contract for the Surrender Value which will be computed as of the Transaction Date. 

The Surrender Value is equal to A + B – C, where: 

A = Contract Value, 

B = MVA, and 
 C =
Premium Tax, if any. 
 The MVA applied on surrender is described in Section 8.01. 

The Surrender Value will comply with the minimum nonforfeiture requirements as described in the NAIC Variable Annuity Model Regulation Section 7.
The date the Request to surrender is received in good order will be the effective date of computation of Surrender Value. The Company will generally pay the Surrender Value in a single sum within 7 days after receipt of the Request. A full surrender
of this Contract will terminate the Contract, endorsements and all benefits therein. Any delays in payment will be made in accordance with the laws of the state in which this Contract is issued and if required by the state, interest will be paid on
any amounts delayed. The written consent of all Owners and irrevocable Beneficiaries must be obtained prior to payment of a full surrender. 
 7.02
  PARTIAL WITHDRAWALS 
 The Owner, by Request, may make a partial withdrawal from the Contract prior to the Annuity Commencement Date.
The minimum partial withdrawal amount (expressed as a Contract Base Withdrawal) is as shown on the Contract Data Page. After any partial withdrawal, if the remaining Contract Value is less than the amount detailed on the Contract Data Page, then a
full surrender of Contract may be required. 
 On the date of the Request, the Company will calculate the corresponding Contract Base Withdrawal. The
Contract Base Withdrawal is the amount of Contract Base to be withdrawn as a result of the withdrawal Request. 
 A partial withdrawal will reduce the
Remaining Purchase Payment. The Remaining Purchase Payment after a partial withdrawal is equal to the greater of zero and A – B, where: 

A = Remaining Purchase Payment as of the date the Request for payment is received, prior to the Request, and 

B = Contract Base Withdrawal. 
 A
partial withdrawal will reduce the Guaranteed Minimum Death Benefit. The Guaranteed Minimum Death Benefit after a partial withdrawal is equal to A x (1 - B / C), where: 

A = Guaranteed Minimum Death Benefit as of the date the Request for payment is received, prior to the Request, 

B = Contract Base Withdrawal, and 

C = Contract Base as of the date the Request for payment is received, prior to the partial withdrawal. 

The Contract Base Withdrawal will be split proportionally among the Strategies. For each Strategy, the Strategy Base Withdrawal is equal to A x B / C,
where: 
 A = Contract Base Withdrawal, 

B = Strategy Base as of the date the Request for payment is received, and 

C = Contract Base as of the date the Request for payment is received. 

A partial withdrawal will reduce the Strategy Base for each Strategy. The Strategy Base after a partial withdrawal is equal to A – B, where: 

A = Strategy Base as of the date the Request for payment is received, and 

B = Strategy Base Withdrawal. 
 The
Strategy Gross Withdrawal is the amount of Strategy Value that is withdrawn as a result of a partial withdrawal. The Strategy Gross Withdrawal is equal to A x (1 + B – C x D), where: 

A = Strategy Base Withdrawal, 

B = Strategy Credit Rate as of the date the Request for payment is received, 

C = Contract Fee Percentage, and 

  

			
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 D = = the number of years (whole and partial) that have elapsed since the Strategy Term
Start Date. 
 The Gross Withdrawal is the amount of Contract Value that is withdrawn as a result of a withdrawal Request and is equal to the sum of
the Strategy Gross Withdrawal(s). 
 The amount paid as a result of a Request for a partial withdrawal, prior to income tax withholding, is equal to A
+ B – C, where: 
 A = Gross Withdrawal, 

B = MVA, as described in Section 8.01, and 

C = Premium Tax, if any. 
 The following terms apply:

	(a)	 If a partial withdrawal is made within 30 days of the date annuity payments are scheduled to commence, the Company may
delay the Annuity Commencement Date by 30 days. 

	(b)	 A partial withdrawal will be effective upon the Transaction Date, including the calculation of the MVA.

	(c)	 Any withdrawal amount will be made on a pro-rata basis from all Strategies. 

	(d)	 All withdrawals (except for those detailed in Section 7.04) are subject to a MVA. 

7.04   NO MVA 
 The following withdrawals or
distributions may be made without incurring a MVA. 

	(a)	 surrender of the Contract due to Nursing Home or Hospital confinement or terminal illness as described in
Section 7.06; 

	(b)	 a partial withdrawal that produces a Contract Base Withdrawal less than or equal to the Free Annual Withdrawal Amount as
described in Section 7.05; 

	(c)	 amounts withdrawn or disbursed as required minimum distributions; however these distributions will be deducted from the
Free Annual Withdrawal Amount as described in Section 7.05; and 

	(d)	 income payments during the payment period as described in Section 10.03. 

	(e)	 Asset management fees to pay for asset management and/or advisory service fees associated with the Contract and as
described in Section 7.07. These distributions will be deducted from the Free Annual Withdrawal Amount as described in Section 7.05. 

7.05   FREE ANNUAL WITHDRAWAL AMOUNT 
 An amount
equal to a percentage of the Purchase Payment as shown on the Contract Data Page, can be withdrawn each Contract Year, beginning in the second Contract Year, without incurring a MVA. 

A partial withdrawal will reduce the Free Annual Withdrawal Amount available for the remainder of the Contract Year. The Free Annual Withdrawal Amount
after a partial withdrawal is equal to the greater of zero and A – B, where: 
 A = Free Annual Withdrawal Amount prior to the
Gross Withdrawal, and 
 B = Contract Base Withdrawal. 

On each Contract Anniversary, the Free Annual Withdrawal Amount is set equal to the percentage of the Purchase Payment as shown on the Contract Data
Page multiplied by the Purchase Payment. The Free Annual Withdrawal Amount is limited to and cannot exceed the Surrender Value of the Contract. 
 7.06
  NURSING HOME, HOSPITAL OR TERMINAL CONDITION WAIVER 
 This is not intended to provide long term care, hospital or nursing home
insurance. A surrender made under the terms of this provision may be subject to tax. MVAs will be waived if the Contract is surrendered for the following reasons: 

(a) Confinement to a Nursing Home or Hospital: 
 The
Owner has been admitted to a licensed Nursing Home or Hospital and has been confined to such Nursing Home or Hospital for at least 180 consecutive days. The following is required: 

	 	•	 	 proof that the confinement, beginning after the Effective Date, in a Nursing Home or Hospital is recommended by a
physician who is duly licensed by the state to treat the injury or sickness causing the confinement and who is not an employee of the Nursing Home or Hospital where the Owner is confined; and 

 

	 	•	 	 a request for a surrender waiver, accompanied by written proof of confinement and the physician’s recommendation
described above is received by the Retirement Resource Operations Center no later than 90 days following the date that the qualifying confinement has ended. 

(b) Terminal Condition: 

  

			
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 The Owner has a terminal condition which is a condition that is expected to result in the death of the
Owner in 12 months or less from the date of the Request for surrender. Before any Surrender Value is paid under this provision, the Company will require: 

	 	•	 	 the Owner to provide proof, satisfactory to the Company, of the Insured’s Terminal Condition. This proof must
include, but is not limited to, a completed claim form and a physician’s statement signed by a licensed physician certifying that the Owner has been diagnosed with a Terminal Condition that will result in a life expectancy of 12 months or less.
This form must be completed and the statement provided after the Contract Effective Date; and 

  

	 	•	 	 the licensed physician must not be the Owner or a member of the Owner’s family. 

If the MVA is not waived in terms of this provision for any reason then the surrender will not be processed until written confirmation to proceed with
the surrender is received. 
 7.07 ASSET MANAGEMENT FEES 

The Owner may take a partial withdrawal to pay for asset management and/or advisory service fees associated with the Contract without incurring a MVA.
Amounts will be withdrawn pro rata from the Strategy Values based on the Contract Value as of the date the Request is received. A withdrawal Request for this purpose must meet the minimum partial withdrawal amount described in the Contract Data
Page. Withdrawals to pay asset management fees count toward the Free Annual Withdrawal Amount described in Section 7.05. Amounts withdrawn in excess of the Free Annual Withdrawal Amount will be subject to the provisions of
Section 7.02 and such withdrawals will be subject to an MVA. 
 7.08 POSTPONEMENT 

If the Company receives a Request for surrender or partial withdrawal, the Company will generally pay in a single sum within 7 days after receipt of the
Request for a surrender or partial withdrawal. The Company may however postpone the payment. Any postponement in payment will be made in accordance with the laws of the state in which this Contract is issued and if required by the state, interest
will be paid on any amounts delayed. The Company may, subject to obtaining approval by the state commissioner, postpone payment of any surrender amount for up to 6 months after the Request to surrender is received. 

The Company may delay payment for: 

	(a)	 any period during which the New York Stock Exchange is closed (other than customary weekend and holding closings) or
trading on the New York Stock Exchange is restricted; 

	(b)	 any period during which an emergency exists such that the disposal of or the determination of the Index Value is not
reasonably practicable; or 

	(c)	 any other period as the Securities and Exchange Commission may by order permit for the protection of security holders.

  

			
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 SECTION 8: MARKET VALUE ADJUSTMENT (MVA) 

 
  

 

	8.01	 MVA 

The MVA is the amount of adjustment (increase or decrease) that will apply when a Request produces a Contract Base Withdrawal in excess of the Free
Annual Withdrawal Amount. A full surrender of the Contract is equivalent to a Contract Base Withdrawal equal to the Contract Base on the date of the Request. A Contract Base Withdrawal less than or equal to the Free Annual Withdrawal Amount on the
date of the Request will not incur an MVA. A Contract Base Withdrawal greater than the Free Annual Withdrawal Amount on the date of the Request and made in accordance with Section 7.04 will not be subject to the MVA. 

The MVA is calculated as the sum of the Strategy MVAs. 
 For each
Strategy, the Strategy MVA is calculated as A multiplied by the greater of zero and B – C x D / E, where: 

	 	A =	 Strategy MVA Factor, 

	 	B =	 Strategy Base Withdrawal, 

	 	C =	 Free Annual Withdrawal Amount as of the date of the Request, prior to the Request, 

	 	D =	 Strategy Base as of the date of the Request, prior to the Request, and 

	 	E =	 Contract Base as of the date of the Request, prior to the Request. 

The Strategy MVA Factor is calculated as A + B, where: 

	 	A =	 Strategy Interest MVA Factor, and 

	 	B =	 Strategy Index MVA Factor. 

The Strategy Interest MVA Factor is calculated as [ ((1 + A + B) / (1 + C + D))E ] – 1, where: 

	 	A =	 Interest MVA Rate 1 as calculated on the Interest MVA Term Start Date using Interest MVA Index 1 assuming a
term-to-maturity equal to the Interest MVA Term, 

	 	B =	 Interest MVA Rate 2 as calculated on the Interest MVA Term Start Date using Interest MVA Index 2, 

	 	C =	 Interest MVA Rate 1 as calculated on the date of the Request using Interest MVA Index 1 assuming a term-to-maturity
equal to the number of years (whole and partial) from the date of the Request until the Interest MVA Term End Date, 

	 	D =	 Interest MVA Rate 2 as calculated on the date of the Request using Interest MVA Index 2, and 

	 	E =	 The number of years (whole and partial) from the date of the Request to the Interest MVA Term End Date.

 If the specified term-to-maturity is not published, then the rate used will be found by interpolating the rates from next highest
and next lowest published maturities (the 30-day rate will be used for a term-to-maturity of less than 30 days). 
 The Strategy Index MVA Factor is calculated as A
– B – C x D / E, where: 

	 	A =	 Strategy Option Value as of the date of the Request, 

	 	B =	 Strategy Credit Rate as of the date of the Request, 

	 	C =	 Strategy Option Value as calculated on the Strategy Term Start Date, 

	 	D =	 The number of years (whole and partial) from the date of the Request to the Strategy Term End Date, and

	 	E =	 Strategy Term. 

On each Business Day the Strategy Option Value is calculated based on the estimated market value of a set of put and call options as determined by an
option pricing formula. 
 If any reference used in the calculation of the Strategy Interest MVA Factor or Strategy Index MVA Factor is not published
on the day or year the MVA is calculated, the transaction will be postponed until the reference is published. If any publication for any reference used in the calculation of the Strategy Interest MVA Factor or Strategy Index MVA Factor is
discontinued or the calculation of the reference is materially changed then the Company will substitute a suitable reference and send notification of this change, subject to approval from the state insurance commissioner if required. 

  

			
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	8.02	 MVA EXPIRATION 

The Interest MVA Term is stated on the Contract Data Page. On the Interest MVA Term End Date, the Owner can, without incurring being subject to the MVA:

	 	(a)	 Annuitize the Contract, or 

	 	(b)	 Surrender the Contract, or 

	 	(c)	 Renew subject to the provisions of Section 5.03, or 

	 	(d)	 Make a partial withdrawal and renew subject to the provisions of Section 5.03. 

  

			
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 SECTION 9: GENERAL PROVISIONS 

 
  

9.01 ENTIRE CONTRACT 
 This Contract, Contract Data Page,
tables, riders, endorsements, and amendments, if any, form the entire Contract between the Owner and the Company. This entire Contract supersedes all prior representations, statements, warranties, promises and agreements of any kind, whether oral or
written, relating to the subject matter of this Contract. Nothing is incorporated by reference unless a copy is endorsed upon or attached to the Contract. All statements in the application, made by an Owner or the Annuitant, in the absence of fraud,
will be considered representations and not warranties. 
 9.02 ELECTRONIC DELIVERY OF INFORMATION 

The Company will deliver information electronically only if the Owner has consented to receiving information in electronic form. The Company will use
reasonable procedures to maintain the security of electronically delivered information. Information will be considered to be delivered to the Owner when an e-mail is received. If the Owner consents to receipt of information by electronic means, the
Owner agrees to provide an e-mail address to the Company and to keep that e-mail address current. Upon notice to the Owner, the Company reserves the right to modify, suspend or terminate delivery of information in electronic form at any time. 

9.03 CONTRACT MODIFICATION 
 Upon receiving State approval and
30 days notice to the Owner, the Company may at any time and without the consent of the Owner or any other person, make any changes, including retroactive changes, in this Contract to the extent that the change is required to meet requirements of
any law or regulation issued by a governmental agency to which the Company or the Owner are subject. 
 The Company may cease offering existing
annuity payment options. Only the President, Vice-President, or Secretary of the Company can modify or waive any provision of this Contract. 
 9.04
NON-PARTICIPATING 
 This Contract is non-participating. It is not eligible to share in the Company’s divisible surplus. 

9.05 MISSTATEMENT OF AGE OR SEX 
 If the age or sex of the
Annuitant has been misstated, the annuity payments established will be made on the basis of the correct age or sex. If payments were too large because of misstatement, the difference may be deducted by the Company from the next payment or payments.
If payments were too small, the difference may be added by the Company to the next payment. Any overpayments or underpayments made by the Company will be charged or credited with interest at the rate shown on the Contract Data Page. Such interest
will be deducted from or added to future payments. 
 9.06 NOTICE AND PROOF 

If the Owner has elected electronic delivery of regulatory information, any notice or demand by the Company to or upon the Owner, or any other person,
may be given by posting it in the Owner’s personal folder and electronically mailing it to that person’s last known email address. If the Owner has elected paper delivery of regulatory information, such notice will be sent to the Owner at
the last address of record. In the event of the death of an Owner or the Annuitant, the Company will require Due Proof of Death. 
 Any application,
report, Request, election, direction, notice or demand by the Owner, or any other person, must be made in a form satisfactory to the Company. 
 9.07 TAX
CONSEQUENCES OF PAYMENTS 
 The Owner or Beneficiary, as the case may be, must determine the timing and amount of any benefit payable. Payments
elected by the Owner in the form of periodic withdrawals, surrenders and partial withdrawals will be tax reported to the Owner. Annuity payments are payable to the Annuitant and will be tax reported to the Annuitant. Payments made to a Beneficiary
will be tax reported to the Beneficiary. 
 It is recommended that a competent tax advisor be consulted prior to obtaining any distribution from this
Contract. A 10% federal tax penalty may apply if a surrender, withdrawal or distribution is taken prior to the taxpayer’s attainment of age 59 1⁄2.

  

			
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 Nothing contained herein will be construed to be tax or legal advice. The Company does not assume any
responsibility or liability for any damages or costs, including, but not limited to taxes, penalties, interest or attorney fees incurred by the Owner, the Annuitant, the Beneficiary, or any other person arising out of any such determination. 

9.08 CURRENCY 
 All Purchase Payments and all transactions
will be in the currency of the United States of America. 
 9.09 TERMINATION 

This Contract will terminate: 

	 	(a)	 on the date the Contract is surrendered; or 

	 	(b)	 upon the death of the Owner subject to the death benefit provisions of Section 6, or 

	 	(c)	 on the date the Contract Value is reduced to zero. 

9.10 INCONTESTABILITY 
 This Contract will not be contested
after it has been in force during the Owner’s lifetime for 2 years from the Contract Effective Date. Any rider attached to the Contract will not be contested after 2 years from the date that the rider was issued. 

9.11 ANNUAL REPORT 
 The Company will mail to the Owner at
least once in each Contract Year after the first, at the Owner’s last known address, a statement(s) reporting the following information: 

	 	(a)	 the beginning and end dates of the current report period; 

	 	(b)	 the Strategy Value(s), if any, at the beginning of the current report period and at the end of the current report
period; 

	 	(c)	 the amounts that have been credited or debited to the Strategy(ies) during the current report period by type;

	 	(d)	 any withdrawals taken and MVAs applied, if applicable; 

	 	(d)	 the current death benefit amount; and 

	 	(e)	 the Surrender Value, if any, at the end of the current report period; 

The Owner may Request an additional report free of charge. 

  

			
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 SECTION 10: ANNUITY PAYMENT OPTIONS 

 
  

10.01 HOW TO ELECT 
 The Request of the Owner is required to
elect, or change the election of, a payment option and must be received by the Company at least 30 days prior to the Annuity Commencement Date. 
 On
the Annuity Commencement Date, the Surrender Value will be applied under the Annuity Payment Option elected by the Owner. Your annuity rates will not be less than those guaranteed in your Contract on the Effective Date. The amount of any income
payout, on the Annuity Commencement Date, will never be less than that which would have been provided by applying the Surrender Value to purchase a single premium immediate annuity at the annuity rates then offered by the Company to the same class
of annuitants. If an option has not been elected within 30 days of the Annuity Commencement Date, the Contract Value will be applied under Annuity Payment Option 3 in Section 10.03 to provide for payments for life with 10 years period certain.

 10.02 SELECTION OF PAYMENT OPTIONS 
 Either a single lump
sum payment or Annuity Payment Option set out in Section 10.03 must commence no later than the Annuitant’s 110th birthday. 

If a single sum payment is elected, the amount to be paid is the Surrender Value. No partial annuitization is allowed. 

The Company reserves the right to change the payment frequency if payments are less than $250. If the Contract Value drops to an amount less than that
set out in the Contract Data Page a lump sum amount will be paid. 
 Payments can be made monthly, quarterly, semi-annually or annually. 

10.03 ANNUITY PAYMENT OPTIONS 
 The following Annuity Payment
Options are available. Minimum interest rates are shown on the Contract Data Page. Illustrative annuity tables are attached to the Contract. The age for which an Annuitant’s payment will be calculated will be adjusted as follows: The actual age
as of the date of the first payment minus 5 years, then subtracted by 2 additional years for each 5 full years elapsed between 1/1/2017 and the Payment Election Date. Actuarially equivalent calculations are available upon request. 

	(a)	 Option 1: Life only 

	(b)	 Option 2: Life with cash refund 

	(c)	 Option 3: Life with 10 years period certain 

	(d)	 Option 4: Any Annuity Payment Option as may be approved by both the Owner and the Company. 

The Annuity Payment Options are described as follows: 
  

	 	(1)	 Life Only 

	 	•	 	 Single life annuity for life only: Payable only while the Annuitant is living. 

	 	•	 	 Joint life and 100% to survivor for life only: Payable while either Annuitant is living. Annuity payments will cease
after the death of the last surviving Annuitant. 

	 	•	 	 Joint life & percent payable to survivor for life only: Payable while both Annuitants are living. Reduced after
the death of either Annuitant. When the surviving Annuitant dies, payments will cease. 

  

	 	(2)	 Life with Cash Refund 

	 	•	 	 Single life annuity with cash refund: Payable while the Annuitant is living. 

	 	•	 	 Joint life and 100% to survivor with cash refund: Payable while either Annuitant is living. 

	 	•	 	 Joint life and percent payable to survivor with cash refund: Payable while both Annuitants are living or for the refund
period, whichever is later. Reduced after the refund period or after the death of either Annuitant, whichever is later. When the surviving Annuitant dies, payments will cease. 

Death Benefit after the Annuity Commencement Date 

	 	o	 If the sum of the annuity income payments received is less than the amount applied to determine the annuity payments,
the difference will be paid to the Beneficiary(ies) in a single sum 

	 	o	 If the sum of the annuity income payments received equals or exceeds the amount applied to determine the annuity
payments, there will be no death benefit. 

  

			
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	 	(3)	 Life with 10 year Period Certain 

	 	•	 	 Single life annuity with 10 years certain: Payable while either the Annuitant is living or for 10 Years, whichever is
later 

	 	•	 	 Joint life and 100 percent to survivor with 10 years certain: Payable while either Annuitant is living or for 10 Years,
whichever is later. 

  

	 	•	 	 Joint life & percent payable to survivor with 10 years certain: Payable while both Annuitants are living or for
10 Years, whichever is later. Reduced after 10 Years or after the death of either Annuitant, whichever is later. When surviving Annuitant dies, payments will cease. 

Death Benefit After the Annuity Commencement Date 

	 	o	 If death occurs before the guaranteed period ends, scheduled annuity income payments will be paid to the
Beneficiary(ies) for the remainder of the guaranteed period. 

	 	o	 If death occurs after the guaranteed period ends, there will be no death benefit. 

  

			
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 Annuity Tables 

Monthly Payment for Each $1,000 of Amount Applied 
 [ 

 

											
		 	Male	  	Life Only	  	Life w/ CashRefund	  	Life w/ 10 years period certain	 	
		 	50	  	2.46	  	2.36	  	2.46	 	
		 	55	  	2.74	  	2.59	  	2.73	 	
		 	60	  	3.09	  	2.87	  	3.07	 	
		 	65	  	3.56	  	3.23	  	3.51	 	
		 	70	  	4.18	  	3.70	  	4.09	 	
		 	75	  	5.06	  	4.35	  	4.86	 	
		 		  		  		  		 	
		 		  		  		  		 	
		 	Female	  	Life Only	  	Life w/ CashRefund	  	Life w/ 10 years period certain	 	
		 	50	  	2.37	  	2.30	  	2.37	 	
		 	55	  	2.62	  	2.51	  	2.62	 	
		 	60	  	2.94	  	2.77	  	2.93	 	
		 	65	  	3.37	  	3.11	  	3.34	 	
		 	70	  	3.93	  	3.53	  	3.86	 	
		 	75	  	4.70	  	4.11	  	4.56	 	
		 		  		  		  		 	
		 		  		  		  		 	
		 	Unisex	  	Life Only	  	Life w/ CashRefund	  	Life w/ 10 years period certain	 	
		 	50	  	2.42	  	2.30	  	2.41	 	
		 	55	  	2.68	  	2.51	  	2.67	 	
		 	60	  	3.02	  	2.78	  	3.00	 	
		 	65	  	3.47	  	3.11	  	3.43	 	
		 	70	  	4.06	  	3.53	  	3.98	 	
	 [
	 	75	  	4.88	  	4.11	  	4.71	 	 ]

	 		  		  		  		 

  

			
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 [8515 East Orchard Road Greenwood Village, CO 80111] 

INDIVIDUAL SINGLE PREMIUM INDEX LINKED ANNUITY. 

The Owner is as shown on the Contract Data Page. The Company will pay the Annuitant the annuity payment(s) on the Annuity Commencement Date. This
Contract is non-participating and is not eligible to share in the Company’s divisible surplus. 

  

			
	 ILVA-RIA-Core

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