Document:

EXHIBIT (4)(J)

 EXHIBIT (4)(j) 

FORM OF POLICY RIDER (GPS) 

									
	

		 		 		 Home Office:

4333 Edgewood Road N.E.

Cedar Rapids, Iowa 52499
 (319)390-8511

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

 LIVING BENEFITS RIDER 

This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an
individual annuity or the group certificate if the rider is attached to a group annuity. 
 Rider Data Specification 

 

									
	 Policy Number:  
 Rider
Date:  
 “Principal Back” Withdrawal Percentage:   

“For Life” Withdrawal Percentage:*   

Rider Fee Percentage:   

Guaranteed Future Value Date:  
		 		 07 - 12345
 01-05-2015

7.00%
 5.00%

0.60%
 01-05-2015
		 		

  

	*	Percentage will be zero until the Rider Anniversary that occurs after the Annuitant’s [59th] birthday. 

ARTICLE I 
 We provide a combination of two
separate guarantees in this rider: a Guaranteed Minimum Accumulation Benefit and a Guaranteed Minimum Withdrawal Benefit. 
 You can terminate this rider
any time after the [third] Rider Anniversary. This rider will terminate if You surrender Your policy, elect to upgrade (as described in Article V of this rider), or elect to receive annuity payments under Your policy. This rider will also terminate
if the policy to which this rider is attached is assigned or if the owner is changed without our prior approval. 
 A Rider Fee will be deducted on each
Rider Anniversary and upon rider termination as described below. 
 DEFINITIONS: 

Terms used that are not defined in this rider shall have the same meaning as those in Your policy. 

Gross Partial Withdrawal 
 The amount which will be
deducted from Your Policy Value as a result of each Partial Withdrawal. 
 Investment Options 

One or more Subaccounts of the Separate Account available under Your policy which we designate. 

Portfolio Allocation Method Investment Options 
 One or
more Fixed Account options, Guaranteed Period options, or Separate Account options that we will use to provide rider guarantees. 
 Rider Anniversary

 The anniversary of the Rider Date. 
 Rider Fee

 The Rider Fee is the Rider Fee Percentage referenced above, multiplied by the Total Withdrawal Base at the time the fee is deducted. For purposes of
calculating this fee, we will use the Total Withdrawal Base for the “Principal Back” withdrawal guarantee. This fee will be deducted from each Investment Option and Fixed Account option in proportion to the amount of Policy Value in that
Investment Option or Fixed Account option on each Rider Anniversary. A portion of this fee will also be deducted when the rider is terminated based on the number of months that have elapsed since it was last deducted. 

Rider Year 
 Each twelve-month period following the Rider
Date. 
 Total Withdrawal Base 
 The amount as defined
in Article IV of this rider. 
 Valuation Period 
 The
period of time from one determination of the value of a Subaccount to the next. Such determinations are made when the value of the assets and liabilities of each Subaccount is calculated. This is generally the close of business on each day on which
the New York Stock Exchange is open. 

  

					
	 RGMB 4 0504
				Rev

 ARTICLE II 

When this rider is attached to Your policy, we require the Portfolio Allocation Method to be used. Under the Portfolio Allocation Method we compare Your Policy
Value to the rider guarantees once per Valuation Period. 
 Based on the relationship of the rider guarantees to Your Policy Value, we will determine how
much Policy Value to transfer out of Your Investment Options to one or more Portfolio Allocation Method Investment Options. Transfers out of Your Investment Options will be pro rata. We will continue to transfer Policy Value to and/or among the
Portfolio Allocation Method Investment Options to the extent necessary to maintain the rider guarantees. 
 Likewise, we will determine how much Policy Value
to transfer out of the Portfolio Allocation Method Investment Options into Your Investment Options. Transfers into Your Investment Options will be pro rata. 

You cannot allocate premiums or transfers to the Portfolio Allocation Method Investment Options. 

Transfers pursuant to this Article will be subject to any provisions of the policy concerning transfers of Policy Value. 

ARTICLE III 
 GUARANTEED MINIMUM ACCUMULATION
BENEFIT 
 We guarantee that Your Policy Value will be at least as great as the Guaranteed Future Value on the Guaranteed Future Value Date shown on page
one of this rider. 
 On the Guaranteed Future Value Date, if Your Policy Value is less than the Guaranteed Future Value, we will add the difference to Your
Policy Value pro rata at the end of the next Valuation Period. This addition will not be considered premium. We will provide no benefit under the Guaranteed Minimum Accumulation Benefit after the Guaranteed Future Value Date. 

Guaranteed Future Value 
 The Guaranteed Future Value on
the Rider Date is equal to Your Policy Value (less any premium enhancements if this rider is added in the first Policy Year). The Guaranteed Future Value after the Rider Date and before the Guaranteed Future Value Date, is equal to the Guaranteed
Future Value on the Rider Date, plus a percentage of premiums added after the Rider Date as shown in the table below, (not including premium enhancements, if any) less any adjustments for withdrawals described below. 

 

																	
	 During
 Rider

Year
	  	 	  	 Percent of Subsequent

Premiums added to

Guaranteed Future Value

		 		 		  		  		  		 		 		  	
	 	 	1	 	 	  		  		  	 	 	100%	 	 	  	
	 	 	2	 	 	  		  		  		 	90%	 	 	  	
	 	 	3	 	 	  		  		  		 	80%	 	 	  	
	 	 	4	 	 	  		  		  		 	70%	 	 	  	
	 	 	5	 	 	  		  		  		 	60%	 	 	  	
	 	 	6	 	 	  		  		  		 	50%	 	 	  	
	 	 	7	 	 	  		  		  		 	50%	 	 	  	
	 	 	8	 	 	  		  		  		 	50%	 	 	  	
	 	 	9	 	 	  		  		  		 	50%	 	 	  	
	 	 	10	 	 	  		  		  	 	 	0%	 	 	  	

 The Guaranteed Future Value after the Guaranteed Future Value Date is zero. 

Guaranteed Minimum Accumulation Benefit Adjustments 

Gross Partial Withdrawals will reduce the Guaranteed Future Value pro rata. The amount of the reduction is equal to the greater of: 

 

	1)	the Gross Partial Withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A	is the amount of Gross Partial Withdrawal; 

  

	 	B	is the Policy Value immediately prior to the Gross Partial Withdrawal; and 

  

	 	C	is the Guaranteed Future Value immediately prior to the Gross Partial Withdrawal. 

  

					
	 RGMB 4 0504 (2)
	 		 	Rev

 ARTICLE IV 

GUARANTEED MINIMUM WITHDRAWAL BENEFIT 
 We guarantee that
You may take a specified annual withdrawal amount regardless of the Policy Value under the Guaranteed Minimum Withdrawal Benefit. The two withdrawal guarantees under this rider are: 

“Principal Back” Withdrawal Guarantee 

You can withdraw up to the Maximum Annual Withdrawal Amount each Rider Year until the Minimum Remaining Withdrawal Amount is zero. 

“For Life” Withdrawal Guarantee 

Starting with the Rider Anniversary following the Annuitant’s [59th] birthday, You
can withdraw up to the Maximum Annual Withdrawal Amount each Rider Year until the later of: 
  

	 	(i)	the Annuitant’s death, or 

  

	 	(ii)	the Minimum Remaining Withdrawal Amount is zero. 

 We will calculate a Maximum Annual Withdrawal Amount,
Minimum Remaining Withdrawal Amount, and Total Withdrawal Base as described below, for each of the two withdrawal guarantees we provide and the amounts may differ. 

Withdrawals will reduce the Policy Value. Once the Policy Value equals zero, You cannot make subsequent premium payments and all other policy features,
benefits and guarantees are terminated except those provided by this rider. Withdrawals guaranteed by this rider can be continued by selecting an amount and frequency of payment in a manner acceptable to Us. Once the payment amount and frequency are
established, they cannot be changed. 
 Maximum Annual Withdrawal Amount 

The Maximum Annual Withdrawal Amount that can be withdrawn each Rider Year under this rider is equal to the sum of the Total Withdrawal Base on the most recent
Rider Anniversary plus any premiums added after that Rider Anniversary (not including premium enhancements, if any), multiplied by the withdrawal percentage shown on page one of this rider. 

Minimum Remaining Withdrawal Amount 
 The Minimum
Remaining Withdrawal Amount is the total minimum dollar amount of guaranteed withdrawals You have remaining, provided withdrawals do not exceed the Maximum Annual Withdrawal Amount each Rider Year. The Minimum Remaining Withdrawal Amount on the
Rider Date is equal to the Policy Value (less any premium enhancements, if the rider is added in the first Policy Year). After the Rider Date, the Minimum Remaining Withdrawal Amount is equal to the Minimum Remaining Withdrawal Amount on the Rider
Date, plus any premiums added after the Rider Date (not including premium enhancements, if any), less any adjustments for withdrawals described below. 

Minimum Remaining Withdrawal Amount Adjustments 
 Gross
Partial Withdrawals up to the Maximum Annual Withdrawal Amount will reduce the Minimum Remaining Withdrawal Amount by the same amount (dollar for dollar). Gross Partial Withdrawals in excess of the Maximum Annual Withdrawal Amount will reduce the
Minimum Remaining Withdrawal Amount pro rata. The amount of the reduction is equal to the greater of: 
  

	 	1)	the excess Gross Partial Withdrawal amount; and 

  

	 	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A	is the excess Gross Partial Withdrawal (the amount in excess of the Maximum Annual Withdrawal Amount remaining prior to the withdrawal); 

 

	 	B	is the Policy Value after the Maximum Annual Withdrawal Amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C	is the Minimum Remaining Withdrawal Amount after the Maximum Annual Withdrawal Amount has been withdrawn, but prior to the withdrawal of the excess amount. 

  

					
	 RGMB 4 0504 (3)
				Rev

 ARTICLE IV CONTINUED 

Total Withdrawal Base 
 The Total Withdrawal Base on the
Rider Date is equal to the Policy Value (less any premium enhancements, if the rider is added within the first Policy Year). After the Rider Date, the Total Withdrawal Base is equal to the Total Withdrawal Base on the Rider Date, plus the full
amount of any premiums added after the Rider Date (not including premium enhancements, if any), less any adjustments for withdrawals described below. 

Total Withdrawal Base Adjustments 
 Gross Partial
Withdrawals up to the Maximum Annual Withdrawal Amount will not reduce the Total Withdrawal Base. Gross Partial Withdrawals in excess of the Maximum Annual Withdrawal Amount will reduce the Total Withdrawal Base pro rata. The amount of the reduction
is equal to the greater of: 
  

	 	1)	the excess Gross Partial Withdrawal amount; and 

  

	 	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A	is the excess Gross Partial Withdrawal (the amount in excess of the Maximum Annual Withdrawal Amount remaining prior to the withdrawal); 

 

	 	B	is the Policy Value after the Maximum Annual Withdrawal Amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C	is the Total Withdrawal Base prior to the withdrawal of the excess amount. 

 ARTICLE V 

RIDER UPGRADE 
 You may elect, in writing, to upgrade the
Total Withdrawal Base and Guaranteed Future Value to the Policy Value, after the third Rider Anniversary. At this same time, the Minimum Remaining Withdrawal Amounts will also be upgraded to the Policy Value and the Maximum Annual Withdrawal Amounts
will be recalculated based on the new Total Withdrawal Base. 
 If an upgrade is elected, this Rider will terminate and a new rider will be issued with a
new Rider Date, Guaranteed Future Value Date, and its own Rider Fee Percentage which may be higher than this rider’s Rider Fee Percentage. The “Principal Back” Withdrawal Percentage and “For Life” Withdrawal Percentage for
the new rider will be the same as indicated on this rider. 
 The new Rider Effective Date will be the date the Company receives all information necessary,
in a written form acceptable to the Company, to process the upgrade. While the Company currently allows an upgrade at any time after the third Rider Anniversary, the Company reserves the right to limit upgrade requests to a 30 calendar day window
after your third and subsequent Rider Anniversaries. 
 Signed for us at our home office. 

 

			
	

		

	SECRETARY		PRESIDENT

  

					
	 RGMB 4 0504 (4)
				RevEXHIBIT (4)(O)

 EXHIBIT (4)(o) 

FORM OF POLICY RIDER (INCOME SELECT FOR LIFE) 

							
	

				Home Office:		
		 		 4333 Edgewood Road N.E.

Cedar Rapids, Iowa 52499
 (319)398-8511
		 
	 A Stock Company (Hereafter called the Company, we, our or us)
		 			 

 GUARANTEED MINIMUM WITHDRAWAL BENEFIT PLUS GROWTH 

AND DEATH BENEFIT RIDER 
 This rider is
issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the rider is attached to a group annuity. 

Rider Data Specification 
  

									
	 Policy Number:  

Rider Date:  
 Growth Rate
Percentage:  
 Rider Fee Percentage:  

Annuitant:  
		 		 12345
 01/03/2006

5.00%
 1.40%

John Doe
		 		
		 		 	
	 Annuitant’s Issue Age/Sex:  

Annuitant’s Spouse:  

Annuitant’s Spouse’s Issue Age/Sex:  
		 		 35 / Male
 Jane Doe

35 / Female
		 		

 ARTICLE I 
 This
rider is not available for an existing qualified policy which has been continued by a surviving spouse or beneficiary as the new owner. This rider will terminate upon the later of the annuitant’s or annuitant’s spouse’s (as of the
rider date) death, if you surrender your policy, elect to upgrade (as described in Article III of this rider), or elect to receive annuity payments under your policy. This rider will also terminate if the policy to which this rider is attached is
assigned or if the owner is changed without our approval. You can terminate this rider within [30 days] after the [first] rider anniversary and [30 days] after each rider anniversary thereafter. Termination of the rider will result in the loss of
all benefits provided by the rider. 
 If you elect this rider, [100%] of your policy value must be in one or more of the designated funds. You can
generally transfer between the designated funds as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated fund while this rider is in force. If you wish to make a transfer to a
non-designated fund, this rider must be terminated, as described above, prior to making the transfer. 
 The annuitant’s spouse as of the rider date is
hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse can not be changed. The annuitant’s spouse must be the sole primary beneficiary and/or a joint owner. The only
living owners allowed on the contract to which this rider is attached are the annuitant and the annuitant’s spouse. 
 A rider fee will be deducted on
each rider anniversary and upon rider termination as described below. 

  

					
	 RGMB 18 0106
		(1)		(Income/Growth/Death-Joint)

 ARTICLE I CONTINUED 

DEFINITIONS: 
 Terms used that are not defined in this
rider shall have the same meaning as those in your policy. 
 Gross Partial Withdrawal 

The amount which will be deducted from your policy value as a result of each partial withdrawal. 

Rider Anniversary 
 The anniversary of the rider date.

 Rider Fee 
 The rider fee is the rider fee percentage
referenced above, multiplied by the total withdrawal base at the time the fee is deducted. This fee will be deducted from each investment option in proportion to the amount of policy value in that investment option on each rider anniversary. A
portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since it was last deducted. 
 Rider
Year 
 Each twelve-month period following the rider date. 

ARTICLE II 
 GROWTH BENEFIT AND GROWTH PERIOD

 The total withdrawal base will accumulate using the growth rate percentage as described in this Article. The growth period is the period of time from
the rider date until the earlier of the first withdrawal of any amount from the policy value or the [10th] rider anniversary. The growth rate percentage applies only to the total withdrawal base. 

FOR LIFE GUARANTEED MINIMUM WITHDRAWAL BENEFIT 
 Under
this rider, we guarantee that you can withdraw up to the maximum annual withdrawal amount each year, regardless of the policy value, until the annuitant’s or the annuitant’s spouse’s death, whichever is later. 

The “For Life” Withdrawal Percentage is determined by the attained age of the younger of the living spouses at the time of the first withdrawal of
any amount from the policy value taken on or after January 1st following the younger of the living spouse’s [59th] birthday: 
  

													
	 Attained Age at
	 	 	  	For Life” Withdrawal
	 First Withdrawal
	 	  	  	 Percentage

		 		 		 		  		 		 	
	 	 	59 - 64	 	 	 		  	 	 	4.5%	 	 
	 	 	65 - 69	 	 	 		  		 	5.0%	 	 
	 	 	70 - 74	 	 	 		  		 	5.5%	 	 
	 	 	75 - 79	 	 	 		  		 	6.0%	 	 
	 	 	80 - 84	 	 	 		  		 	6.5%	 	 
	 	 	85 - 89	 	 	 		  		 	7.0%	 	 
	 	 	90 - 94	 	 	 		  		 	7.5%	 	 
	 	 	95 +	 	 	 		  	 	 	8.0%	 	 

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, then this percentage will
be zero until the January 1st following the younger of the living spouse’s [59th] birthday. 
 Withdrawals will reduce the policy value of the
policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Withdrawals guaranteed by this rider can be
continued by selecting an amount and frequency of payment in a manner acceptable to us. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be paid. 

Maximum Annual Withdrawal Amount 
 On the rider date the
maximum annual withdrawal amount will be equal to the greater of 1 and 2, where: 
  

	1)	is A multiplied by B multiplied by C where: 

  

	 	A)	is the total withdrawal base on the rider date, 

  

	 	B)	is the “For Life” withdrawal percentage as determined and shown above. If the younger of the annuitant or the annuitant’s spouse is not yet [59] on the rider date, this percentage will be equal to 0%, and

  

	 	C)	is equal to the number of days between the rider date and January 1st of the next calendar year, divided by the number of days in the current calendar year. 

  

					
	 RGMB 18 0106
	 	(2)	 	(Income/Growth/Death-Joint)

 ARTICLE II CONTINUED 
  

	2)	is an amount equal to the minimum required distribution amount (based on the premium paid to the policy to which this rider is attached) for the current calendar year using the annuitant’s age only if all of the
following are true: 

  

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required distributions can not be based on the age of someone who is
deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

  

	 	F)	the minimum required distributions are only for the current calendar year. Amounts carried over from past calendar years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a maximum annual withdrawal amount. An amount in addition
to the amount described in 2 above, may need to be taken to satisfy minimum required distributions, in certain situations. Such additional withdrawal amount will be considered an excess gross partial withdrawal (as described under “Total
Withdrawal Base Adjustments” below). 
 On January 1st of each subsequent calendar year following the rider date, the maximum annual withdrawal
amount will be reset equal to the greater of 1 and 2 where: 
  

	1)	is A multiplied by B where: 

  

	 	A)	is the total withdrawal base as of this date, and 

  

	 	B)	is the “For Life” withdrawal percentage as determined and shown above. If the younger of the annuitant or the annuitant’s spouse is not yet [59] on January 1st of the current calendar year, this
percentage will be equal to 0%. 

  

	2)	is an amount equal to the minimum required distribution amount for this policy for the current calendar year using the annuitant’s age only if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required distributions can not be based on the age of someone who is
deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

  

	 	F)	the minimum required distributions are only for the current calendar year. Amounts carried over from past calendar years are not considered. 

If any of the above are not true, then 2) is equal to zero and the minimum required distribution is not available as a maximum annual
withdrawal amount. An amount in addition to the amount described in 2 above, may need to be taken to satisfy minimum required distributions. Such additional withdrawal amount will be considered an excess gross partial withdrawal (as described under
“Total Withdrawal Base Adjustments” below). 
 Minimum Remaining Withdrawal Amount 

The minimum remaining withdrawal amount is the total minimum dollar amount of guaranteed withdrawals you have remaining, provided withdrawals do not exceed the
maximum annual withdrawal amount each rider year. The minimum remaining withdrawal amount on the rider date is equal to the policy value (less premium enhancements, if the rider is added in the first policy year). The minimum remaining withdrawal
amount after the rider date is equal to the minimum remaining withdrawal amount on the rider date plus any premiums added after the rider date (not including premium enhancements, if any) less any adjustments for withdrawals (as described under
“Minimum Withdrawal Amount Adjustments” below). 

  

					
	 RGMB 18 0106
		(3)		(Income/Growth/Death-Joint)

 ARTICLE II CONTINUED 

Minimum Remaining Withdrawal Amount Adjustments 
 Gross
partial withdrawals up to the maximum annual withdrawal amount will reduce the minimum remaining withdrawal amount by the same amount (dollar for dollar). Gross partial withdrawals in excess of the maximum annual withdrawal amount will reduce the
minimum remaining withdrawal amount by the greater of: 
  

	1)	the excess gross partial withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess gross partial withdrawal (the amount in excess of the maximum annual withdrawal amount remaining prior to the withdrawal); 

 

	 	B)	is the policy value after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C)	is the minimum remaining withdrawal amount after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount. 

Total Withdrawal Base 
 The total withdrawal base on the
rider date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). 
 The total withdrawal base during
the growth period (as described in “Growth Benefit and Growth Period” above) is equal to: 
  

	 	A)	the total withdrawal base on the rider date; plus 

  

	 	B)	any premiums added during the growth period, 

  

	 	C)	all of which are accumulated daily to the end of the growth period at an annual effective rate equal to the growth rate percentage shown on page 1. 

The total withdrawal base after the growth period is equal to: 
  

	 	A)	the total withdrawal base at the end of the growth period, plus 

  

	 	B)	any premiums added after the growth period; less 

  

	 	C)	any adjustments for withdrawals (as described under “Total Withdrawal Base Adjustments” below) including the withdrawal at the end of the growth period, if any. 

The growth period stops upon or at the earlier of the first withdrawal of any amount from the policy value or the [10th] rider anniversary. 

Total Withdrawal Base Adjustments 
 Gross partial
withdrawals up to the maximum annual withdrawal amount will not reduce the total withdrawal base. Gross partial withdrawals in excess of the maximum annual withdrawal amount will reduce the total withdrawal base by the greater of 1 and 2, where:

  

	1)	is the excess gross partial withdrawal amount; and 

  

	2)	is the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess gross partial withdrawal (the amount in excess of the maximum annual withdrawal amount remaining prior to the withdrawal); 

 

	 	B)	is the policy value after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C)	is the total withdrawal base prior to the withdrawal of the excess amount. 

 Death Benefit 

Upon the later of the annuitant or the annuitant’s spouse’s death, we will pay an additional death benefit amount equal to the excess, if any, of the
minimum remaining withdrawal amount over the base policy death benefit and this rider will then terminate. 

  

					
	 RGMB 18 0106
		(4)		(Income/Growth/Death-Joint)

 ARTICLE III 

CONTINUATION 
 In the case of spousal joint owners where
one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. No additional death benefit will be paid under this rider at
this time. 
 RIDER UPGRADE 
 You may elect, in writing,
to upgrade the total withdrawal base to the policy value within [30 days] after the [first] rider anniversary and [30 days] after each rider anniversary thereafter, subject to the age restrictions on the new rider. If an upgrade is elected, this
rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own Growth Rate Percentage which may be lower than this rider’s Growth Rate Percentage. The new rider will have its
own Rider Fee Percentage which may be higher than this rider’s Rider Fee Percentage. 
 At the time of upgrade, the minimum remaining withdrawal amount
will also be upgraded to the policy value and the maximum annual withdrawal amount will be recalculated based on the new total withdrawal base. 
 The new
rider effective date will be the date the Company receives all information necessary, in a written form acceptable to the Company, to process the upgrade. 

Signed for us at our home office. 
  

																	
			 		

		 				 		

		 		
					SECRETARY								PRESIDENT				

  

					
	 RGMB 18 0106
		(5)		(Income/Growth/Death-Joint)

							
	

				Home Office:		
		 		 4333 Edgewood Road N.E.
 Cedar
Rapids, Iowa 52499
 (319)398-8511
		 
	 A Stock Company (Hereafter called the Company, we, our or us)
						

 GUARANTEED MINIMUM WITHDRAWAL BENEFIT PLUS GROWTH 

AND DEATH BENEFIT RIDER 
 This rider is
issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the rider is attached to a group annuity. 

Rider Data Specification 
  

									
	 Policy Number:  

Rider Date:  
 Growth Rate
Percentage:  
 Rider Fee Percentage:  

Annuitant:  
		 		 12345
 01/03/2006

5.00%
 1.55%

John Doe
		 		
		 		 	
	 Annuitant’s Issue Age/Sex:  

Annuitant’s Spouse:  

Annuitant’s Spouse’s Issue Age/Sex:   
		 		 35 / Male
 Jane Doe

35 / Female
		 		

 ARTICLE I 
 This
rider is not available for an existing qualified policy which has been continued by a surviving spouse or beneficiary as the new owner. This rider will terminate upon the later of the annuitant’s or annuitant’s spouse’s (as of the
rider date) death, if you surrender your policy, elect to upgrade (as described in Article III of this rider), or elect to receive annuity payments under your policy. This rider will also terminate if the policy to which this rider is attached is
assigned or if the owner is changed without our approval. You can terminate this rider within [30 days] after the [first] rider anniversary and [30 days] after each rider anniversary thereafter. Termination of the rider will result in the loss of
all benefits provided by the rider. 
 If you elect this rider, [100%] of your policy value must be in one or more of the designated funds. You can
generally transfer between the designated funds as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated fund while this rider is in force. If you wish to make a transfer to a
non-designated fund, this rider must be terminated, as described above, prior to making the transfer. 
 The annuitant’s spouse as of the rider date is
hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse can not be changed. The annuitant’s spouse must be the sole primary beneficiary and/or a joint owner. The only
living owners allowed on the contract to which this rider is attached are the annuitant and the annuitant’s spouse. 
 A rider fee will be deducted on
each rider anniversary and upon rider termination as described below. 

  

					
	 RGMB 20 0106
		(1)		(Income/Growth/Death-Joint-Enh)

 ARTICLE I CONTINUED 

DEFINITIONS: 
 Terms used that are not defined in this
rider shall have the same meaning as those in your policy. 
 Gross Partial Withdrawal 

The amount which will be deducted from your policy value as a result of each partial withdrawal. 

Rider Anniversary 
 The anniversary of the rider date.

 Rider Fee 
 The rider fee is the rider fee percentage
referenced above, multiplied by the total withdrawal base at the time the fee is deducted. This fee will be deducted from each investment option in proportion to the amount of policy value in that investment option on each rider anniversary. A
portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since it was last deducted. 
 Rider
Year 
 Each twelve-month period following the rider date. 

ARTICLE II 
 GROWTH BENEFIT AND GROWTH PERIOD

 The total withdrawal base will accumulate using the growth rate percentage as described in this Article. The growth period is the period of time from
the rider date until the earlier of the first withdrawal of any amount from the policy value or the [10th] rider anniversary. The growth rate percentage applies only to the total withdrawal base. 

FOR LIFE GUARANTEED MINIMUM WITHDRAWAL BENEFIT 
 Under
this rider, we guarantee that you can withdraw up to the maximum annual withdrawal amount each year, regardless of the policy value, until the annuitant’s or the annuitant’s spouse’s death, whichever is later. 

The “For Life” Withdrawal Percentage is determined by the attained age of the younger of the living spouses at the time of the first withdrawal of
any amount from the policy value taken on or after January 1st following the younger of the living spouse’s [59th] birthday: 
  

													
	 Attained Age atFirst Withdrawal
	  	 	  	 For Life”

Withdrawal
 Percentage

		 		 		  		  		  		 	
	 	 	59 - 64	 	 	  		  	 	  	4.5%	 	 
	 	 	65 - 69	 	 	  		  		  	5.0%	 	 
	 	 	70 - 74	 	 	  		  		  	5.5%	 	 
	 	 	75 - 79	 	 	  		  		  	6.0%	 	 
	 	 	80 - 84	 	 	  		  		  	6.5%	 	 
	 	 	85 - 89	 	 	  		  		  	7.0%	 	 
	 	 	90 - 94	 	 	  		  		  	7.5%	 	 
	 	 	95 +	 	 	  		  	 	  	8.0%	 	 

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, then this percentage will
be zero until the January 1st following the younger of the living spouse’s [59th] birthday. 
 Withdrawals will reduce the policy value of the
policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Withdrawals guaranteed by this rider can be
continued by selecting an amount and frequency of payment in a manner acceptable to us. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be paid. 

Maximum Annual Withdrawal Amount 
 On the rider date the
maximum annual withdrawal amount will be equal to the greater of 1 and 2, where: 
  

	1)	is A multiplied by B multiplied by C where: 

  

	 	A)	is the total withdrawal base on the rider date, 

  

	 	B)	is the “For Life” Withdrawal Percentage as determined and shown above. If the younger of the annuitant or the annuitant’s spouse is not yet [59] on the rider date, this percentage will be equal to 0%, and

  

	 	C)	is equal to the number of days between the rider date and January 1st of the next calendar year, divided by the number of days in the current calendar year. 

  

					
	 RGMB 20 0106
	 	(2)	 	(Income/Growth/Death-Joint-Enh)

 ARTICLE II CONTINUED 
  

	2)	is an amount equal to the minimum required distribution amount (based on the premium paid to the policy to which this rider is attached) for the current calendar year using the annuitant’s age only if all of the
following are true: 

  

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required distributions can not be based on the age of someone who is
deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

  

	 	F)	the minimum required distributions are only for the current calendar year. Amounts carried over from past calendar years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a maximum annual withdrawal amount. An amount in addition
to the amount described in 2 above, may need to be taken to satisfy minimum required distributions, in certain situations. Such additional withdrawal amount will be considered an excess gross partial withdrawal (as described under “Total
Withdrawal Base Adjustments” below). 
 On January 1st of each subsequent calendar year following the rider date, the maximum annual withdrawal
amount will be reset equal to the greater of 1 and 2 where: 
  

	1)	is A multiplied by B where: 

  

	 	A)	is the total withdrawal base as of this date, and 

  

	 	B)	is the “For Life” Withdrawal Percentage as determined and shown above. If the younger of the annuitant or the annuitant’s spouse is not yet [59] on January 1st of the current calendar year, this
percentage will be equal to 0%. 

  

	2)	is an amount equal to the minimum required distribution amount for this policy for the current calendar year using the annuitant’s age only if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required distributions can not be based on the age of someone who is
deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

  

	 	F)	the minimum required distributions are only for the current calendar year. Amounts carried over from past calendar years are not considered. 

If any of the above are not true, then 2) is equal to zero and the minimum required distribution is not available as a maximum annual
withdrawal amount. An amount in addition to the amount described in 2 above, may need to be taken to satisfy minimum required distributions. Such additional withdrawal amount will be considered an excess gross partial withdrawal (as described under
“Total Withdrawal Base Adjustments” below). 
 Minimum Remaining Withdrawal Amount 

The minimum remaining withdrawal amount is the total minimum dollar amount of guaranteed withdrawals you have remaining, provided withdrawals do not exceed the
maximum annual withdrawal amount each rider year. The minimum remaining withdrawal amount on the rider date is equal to the policy value (less premium enhancements, if the rider is added in the first policy year). The minimum remaining withdrawal
amount after the rider date is equal to the minimum remaining withdrawal amount on the rider date plus any premiums added after the rider date (not including premium enhancements, if any) less any adjustments for withdrawals (as described under
“Minimum Withdrawal Amount Adjustments” below). 

  

					
	 RGMB 20 0106
		(3)		(Income/Growth/Death-Joint-Enh)

 ARTICLE II CONTINUED 

Minimum Remaining Withdrawal Amount Adjustments 
 Gross
partial withdrawals up to the maximum annual withdrawal amount will reduce the minimum remaining withdrawal amount by the same amount (dollar for dollar). Gross partial withdrawals in excess of the maximum annual withdrawal amount will reduce the
minimum remaining withdrawal amount by the greater of: 
  

	1)	the excess gross partial withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess gross partial withdrawal (the amount in excess of the maximum annual withdrawal amount remaining prior to the withdrawal); 

 

	 	B)	is the policy value after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C)	is the minimum remaining withdrawal amount after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount. 

Total Withdrawal Base 
 The total withdrawal base on the
rider date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). 
 The total withdrawal base during
the growth period (as described in “Growth Benefit and Growth Period” above) is equal to: 
  

	 	A)	the total withdrawal base on the rider date; plus 

  

	 	B)	any premiums added during the growth period, 

  

	 	C)	all of which are accumulated daily to the end of the growth period at an annual effective rate equal to the growth rate percentage shown on page 1. 

The total withdrawal base after the growth period is equal to: 
  

	 	A)	the total withdrawal base at the end of the growth period, plus 

  

	 	B)	any premiums added after the growth period; less 

  

	 	C)	any adjustments for withdrawals (as described under “Total Withdrawal Base Adjustments” below) including the withdrawal at the end of the growth period, if any. 

The growth period stops upon or at the earlier of the first withdrawal of any amount from the policy value or the [10th] rider anniversary. 

Total Withdrawal Base Adjustments 
 Gross partial
withdrawals up to the maximum annual withdrawal amount will not reduce the total withdrawal base. Gross partial withdrawals in excess of the maximum annual withdrawal amount will reduce the total withdrawal base by the greater of 1 and 2, where:

  

	1)	is the excess gross partial withdrawal amount; and 

  

	2)	is the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess gross partial withdrawal (the amount in excess of the maximum annual withdrawal amount remaining prior to the withdrawal); 

 

	 	B)	is the policy value after the maximum annual withdrawal amount has been withdrawn, but prior to the withdrawal of the excess amount; and 

 

	 	C)	is the total withdrawal base prior to the withdrawal of the excess amount. 

 Death Benefit 

Upon the later of the annuitant or the annuitant’s spouse’s death, we will pay an additional death benefit amount equal to the excess, if any, of the
minimum remaining withdrawal amount over the base policy death benefit and this rider will then terminate. 

  

					
	 RGMB 20 0106
		(4)		(Income/Growth/Death-Joint-Enh)

 ARTICLE II CONTINUED 

NURSING CARE OPTION 
 Definitions applicable to this
option: 
 Elimination Period – [180 days] within the last [365 days.] 

Hospital - An institution which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) operates primarily
for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by a staff of one or more licensed physicians,
and 5) has medical, surgical and diagnostic facilities or access to such facilities. 
 Medical Necessity - Confinement prescribed by
a physician based on the individual’s inability to sustain themselves outside of a hospital or nursing facility due to physical ailments. 

Nursing Facility - A facility which 1) is operated pursuant to the laws and regulations of the state in which it is located, 2) provides
care prescribed by a physician and performed or supervised by a registered graduate nurse on a 24-hour basis, and 3) is not primarily a hospital, a home for the aged, a retirement home, a rest home, a community or assisted living center or a place
mainly for the treatment of alcoholism, mental illness, or drug abuse. 
 Physician - A Doctor of Medicine or Doctor of Osteopathy who
is licensed as such and operating within the scope of the license. 
 Waiting Period – [12 months] from the rider date. 

If either the annuitant or the annuitant’s spouse is confined, due to a medical necessity, in a hospital or nursing facility and has been so confined for
the elimination period, benefits from this option are available provided that the waiting period requirement has been satisfied. The elimination period and waiting period do not need to occur consecutively. The Nursing Care Option provides an
increase to the “For Life” Withdrawal Percentage (as described in the For Life Guaranteed Minimum Withdrawal Benefit provision of this Article), until the qualifying person or persons are no longer confined as described above. The increase
in the “For Life” Withdrawal Percentage provided by this option will be as follows: 
  

			
	 Attained Age at

First Withdrawal
	  	Nursing Care Option
Increase Percentage
	       [59+]
	  	[100%]

 As an example of the Nursing Care Option benefit, assume that the first withdrawal under the rider was taken at attained age
72 and the applicable “For Life” Withdrawal Percentage is 5.5%. If the qualification conditions for this option are met at any later date, then the “For Life” Withdrawal Percentage will be increased by the Nursing Care Option
Increase Percentage applicable for attained age 72. The applicable attained age is based on the first withdrawal of any amount from the policy value under the rider itself, and is not based on any withdrawal under the Nursing Care Option, unless
that withdrawal is also the first withdrawal of any policy value under the rider itself. 
 If the Nursing Care Option Increase Percentage for attained age
72 is 100%, then the Nursing Care Option benefit provides an additional 5.5% to the “For Life” Withdrawal Percentage resulting in a total “For Life” Withdrawal Percentage of 11.0% while the Nursing Care Option benefit continues
to be available. 

  

					
	 RGMB 20 0106
	 	(5)	 	(Income/Growth/Death-Joint-Enh)

 ARTICLE II CONTINUED 

For the remainder of the calendar year in which qualifications are met, the additional benefit provided by this option will be prorated based on the number of
days remaining until January 1st of the next calendar year. In the example above, if the qualifications are met with 90 days remaining in the calendar year, then the additional 5.5% will be prorated to be an additional 1.356% determined by
multiplying 5.5% by 90/365. For any calendar year in which qualifications have been met at the beginning of the year, the full increase as provided by this option, 5.5% in the example, will be awarded while qualifications continue to be satisfied.

 We will require confirmation of confinement while benefits are being received. Confirmation of confinement must be deemed satisfactory to us. Confirmation
of confinement may be a statement from a physician or a hospital or nursing facility administrator and any other information deemed necessary by us to confirm confinement. When confinement has ceased, the “For Life” Withdrawal Percentage
will be as indicated in the For Life Guaranteed Minimum Withdrawal Benefit provision previously described in this Article. If confinement ceases and the rider remains active, you may re-qualify by satisfying the elimination period requirement and
the benefits under this option will be available. 
 ARTICLE III 

CONTINUATION 
 In the case of spousal joint owners where
one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. No additional death benefit will be paid under this rider at
this time. 
 RIDER UPGRADE 
 You may elect, in writing,
to upgrade the total withdrawal base to the policy value within [30 days] after the [first] rider anniversary and [30 days] after each rider anniversary thereafter, subject to the age restrictions on the new rider. If an upgrade is elected, this
rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own Growth Rate Percentage which may be lower than this rider’s Growth Rate Percentage. The new rider will have its
own Rider Fee Percentage which may be higher than this rider’s Rider Fee Percentage. 
 At the time of upgrade, the minimum remaining withdrawal amount
will also be upgraded to the policy value and the maximum annual withdrawal amount will be recalculated based on the new total withdrawal base. 
 The new
rider effective date will be the date the Company receives all information necessary, in a written form acceptable to the Company, to process the upgrade. 

Signed for us at our home office. 
  

																	
			 		

		 				 		

		 		
					SECRETARY								PRESIDENT				

  

					
	 RGMB 20 0106
		(6)		(Income/Growth/Death-Joint-Enh)

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