HomeMy WebLinkAboutAgreement_General_11/10/2016 (15) GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY
A Stock Company
.8515 East Orchard Road Greenwood Village, CO 80111
For service,. ca0 1'-800 -701 -8255
Group Fixed Deferred Annuity Contract
Non- Participating
PLAN SPONSOR Village of Tequesta
CONTRACTHOLDER Village of Tequesta and the Trustee /s of the Village of Tequesta Deferred
Compensation Plan as identified on the Group Annuity Contract
Application.
PLAN Village of Tequesta Deferred Compensation Plan
CONTRACT NUMBER 98781 -01
CONTRACT DATE September 9, 2016 or the later of the dates signed by all parties. or the
later of the dates signed by all parties.
Great -West Life & Annuity Insurance Company ( "Great- West") agrees to pay annuity benefits on behalf
of Participants who - choose an annuity payment option under this Group Fixed Deferred Annuity
Contract ( "Contract'). The provisions on the following pages, together with the Application for this
Contract, and other documents referenced in Section 10.2, are part of this Contract.
Signed for Great -West Life & Annuity Insurance Company and effective on the Contract Date.
Secretary President
This Contract is a legal contract between Contractholder, Plan Sponsor and Great -West Life & Annuity
Insurance Company. PLEASE READ THIS CONTRACT CAREFULLY.
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TABLE OF CONTENTS
SECTION1. DEFINITIONS .................................................................................... ............................... 4
SECTION 2. OWNERSHIP PROVISIONS ............................................................... ..............................6
2 .1 Ownership of the Contract ................................................:.............................................................. 6
2 .2 Transfer and Assignment .................................................................................. ............................... 6
2.3 Trust ................................................................................................................. ............................... 6
SECTION 3. PARTICIPANT ACCOUNT VALUE ................................................... ............................... 7
3.1 Fixed Account Value ......................................................................................... ............................... 7
3.2 Transaction Date ............................................................................................... ............................... 7
SECTION 4. CONTRIBUTIONS AND DEPOSITS TO PARTICIPANT ACCOUNTS ............................. 8
4 .1 Contributions ...................................................................................................... ..............................8
4.2`Limitations on Salary Reduction Contributions .................................................. ............................... 8
4:3 Deposits to Participant Accounts ....................................................................... ............................... 8
4.4 Allocation of Contributions and Deposits ........................................................... ............................... 8
SECTION 5. CONTRACT CHARGES AND FEES ................................................. ............................... 9
5.1 Contract Maintenance Charge ..............................:.................................:......... .....I......................... 9
5.2 Contract Termination Charge ............................................................................ ............................... 9
5.3 Fees Imposed by Investment Option Provider ................................................... ............................... 9
5.4 Service Charges and Fees ................................................................................ ............................... 9
5.5 Payment of Charges and Fees .......................................................................... ............................... 9
SECTION 6. PARTICIPANT -, ALTERNATE PAYEE -,.AND BENEFICIARY - DIRECTED TRANSFERS
AMONG INVESTMENT OPTIONS OFFERED BY THE PLAN ............................. ............................... 10
SECTION 7. DISTRIBUTIONS FROM PARTICIPANT ACCOUNTS ...................... .............................11
7.1. Distribution Requirements ............ .................................................... . .............. I ....... ..................... .. 11
72 Rollovers ......................................................................................................... ............................... 11
7.3 Establishment of Alternate Payee Account ...................................................... ............................... 11
7.4 Required Minimum Distributions during the Participant's Lifetime ................... ............................... 11
7.5, Distributions after the Participant's Death ....................................................... ............................... 11
7.6 Plan- to-Plan Transfers ...... ...................................................:..............:........... .......... ............. ........ 11
7.7 Transfers from a Governmental Plan for the Purchase of Permissive Service Credits ................... 12
SECTIONS. PAYMENT OPTIONS ....................................................................... ............................... 13
8.1 Requests for Distributions to a Participant, Beneficiary or Alternate Payee ..... ............................... 13
8.2 Conditions of Payment ............ :.: ............. : ... : ............. : ..................... :.............................................. 13
8.3 Total or Partial Lump Sum Payment Option .................................................... ............................... 13
8.4 Periodic Payment Options ............................................................................... ............................... 13
8,5 Annuity Payment Options ................................................................................ ............................... 13
8.6 Election of Annuity Options ............................................................................... .............................14
8.7 Misstatement of Age or Death ............................................................................ .............................14
SECTION 9. CONTRACT TERMINATION ............................................................. .............................15
9.1 Notice of Contract Termination and Selection of Termination Option(s) .......... ............................... 15
9.2 Contract Termination Provisions ..................................................................... ............................... 15
9.3 Contract Termination due to Plan Termination ................................................ ............................... 15
SECTION 10. GENERAL PROVISIONS ................................................................. .............................16
10 .1 Contract .......................................................................................................... .............................16
10.2 Entire Contract .............................................................................................. ............................... 16
10'.3 Contract Modification ..................................... :............................................................................. 16
10.4 Modification of Fixed Account Options .......................................................... ............................... 16
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10:5 Restorations ..............................................................................'.................... ............I.................. 16
10.6 Plan Provisions ............................................................................................. ............................... 17
10.7 Non - Participating .......................................................................................... ............................... 17
10.8 Currency and Contributions and Deposits ..................................................... ............................... 17
10.9 Notices .......................................................................................................... ............................... 17
10.10 Disclaimer ................................................................................................... ............................... 17
10. 11 Representations ............................................................................................ .............................17
10.12 Non - Waiver ................................................................................................. ............................... 17
10.13 Information ...:.............................................................................................. ............................... 17
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SECTION 1. DEFINITIONS
Administrative Offices -8515 East Orchard Road, Greenwood Village, CO 80111.
Alternate Payee — any spouse, former spouse, child or other dependent of a Participant or any other
person recognized under applicable law who is recognized by a Qualified Domestic Relations Order as
having a right to receive all or a portion of the benefit payable under a Plan with respect to such
Participant.
Annuitant —the person upon whose life the payment of an annuity is based.
Annuity Commencement Date — the date annuity payments begin to an Annuitant.
Applicable Tax — the amount of tax, if any, charged by a state or other governmental authority.
Beneficiary— a person or entity named by the Participant to receive all or a portion of the Participant's
account at his or her death.
Business Day— any day and during the hours on which the New York Stock Exchange is open for
trading.
Code —the Internal Revenue Code of 1986, as amended from time to time, or any future United States
Internal Revenue law that replaces it, including corresponding Treasury Regulations and Internal
Revenue Service guidance.
Contributions — salary reduction contributions, Participant after -tax contributions, employer
contributions, or other contributions made to the Plan by or on behalf of a Participant under the Code.
Deposits — rollovers, plan to plan transfers, Transfers, or other amounts, other than Contributions, paid
into the Participant Account under the Plan.
Distributions - amounts paid to a Participant, Beneficiary or Alternate Payee, pursuant to the terms of
the Plan and the Code.
Fixed Account— an investment option, the assets of which are part of the General Account of Great-
West.
Fixed Account Value —the sum of the Fixed Accounts.
GeneralAccount— Great- West's assets other than those held in any segregated investment account.
Great -West— Great -West Life & Annuity Insurance Company, located at the Administrative Offices.
Guaranteed Interest Rate — the minimum interest rate on an annual effective basis, if any, described on
a Fixed Account rider(s).
Participant— an individual eligible to participate in the Plan with assets in a Participant Account.
Participant Account.— a separate record in the name of each Participant, Beneficiary or Alternate
Payee, which reflects his or her share in the Fixed Account(s).
Participant Account Value — the sum of the Fixed Account Value credited to the Participant Account.
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Participant Effective Date — the date on which the first Contribution or Deposit is credited to a
Participant Account.
Payee — a person entitled to receive all or a portion of the value of the Participant Account.
Plan — The name of the plan as noted on the first page of the Contract.
Plan Sponsor— an entity maintaining the Plan on behalf of Participants, Alternate Payees and
Beneficiaries. In a multiple employer plan, the Plan Sponsor shall be considered the entity maintaining
the multiple employer plan on behalf of participating employers and the participating employers
Participants, Alternate Payees and Beneficiaries.
Qualified Domestic Relations Order— a domestic relations order that creates or recognizes the
existence of an Alternate Payee's right to, or assigns to an Alternate Payee the right to receive all or a
portion of the benefits payable with respect to a Participant and that complies with the requirements of
the Code and ERISA, if applicable, and is approved by the Plan.
Request— an inquiry or instruction in a form satisfactory to Great -West. A valid Request must be: (1)
received by Great -West at its Administrative Offices in good order; and (2) submitted in accordance
with the provisions of this Contract, or as required by Great -West. The Request is subject to any action
taken by Great -West before the Request was processed.
Staff -Up Costs — the amounts incurred by Great -West in acquiring and implementing the plan, which
may include but are not limited to restorations, commissions or other costs.
Transfer— the reinvestment or exchange of all or a portion of the Participant Account balance from one
investment option or,provider under the Plan to another.
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SECTION 2. OWNERSHIP PROVISIONS
2.1 Ownership of the Contract
Contractholder is the owner of the Contract and is identified on the first page of the Contract. Plan
Sponsor and Contractholder have certain rights and privileges as set forth under this Contract.
2.2 Transfer and Assignment
The interests of the Contractholder and Plan Sponsor in this Contract may not be transferred, sold,
assigned, pledged, charged, encumbered, or in anyway alienated; however, if the Plan is consolidated
or merged with another plan or if the assets and liabilities of the Plan are transferred to another plan,
the Contract may be assigned to the new Plan Sponsor and /or trustee.
2.3 Trust
The Contract may be used in lieu of a trust agreement for purposes of satisfying Code sections 401(a),
401(f) and 457(g) and no portion of the amount contributed to the Contract, plus earnings thereon, may
be used for or diverted to any purpose other than the exclusive benefit of Participants and their
Beneficiaries prior to the satisfaction of all liabilities to them.
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SECTION 3. PARTICIPANT ACCOUNT VALUE
3.1 Fixed Account Value
The. Fixed Account Value in the Participant Account is calculated as follows:
(a) all Contributions and Deposits to a Fixed Account option made by or on behalf of the
Participant, Alternate Payee and Beneficiary; plus
(b) all interest credited to the Contractholder's assets in the Fixed Account on an annual effective
basis pursuant to the Guaranteed Interest Rate applicable to the Fixed Account; less
(c) any amounts transferred or distributed from the Fixed Account; less
(d) any applicable charges, fees and Applicable Tax, if any.
3.2 Transaction Date
All Requests, Contributions and Deposits received in good order with all required documentation at
Great- West's Administrative Offices prior to the close of business of the New York Stock Exchange will
be processed as of the date received, and if received after the close of business of the New York Stock
Exchange will be processed on the next Business Day. However, Great -West shall not be liable for the
results of any delay or interruption due to causes or conditions beyond its control including, without
limitation, labor disputes, riots, war and war -like operations including acts of terrorism, epidemics,
explosions,. sabotage, acts of God, failure of power, fire or other casualty,, natural disasters or
disruptions in orderly trading on any relevant exchange or market, including disruptions due to
extraordinary market volume that result in substantial delay in receipt of correct data.
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SECTION 4. CONTRIBUTIONS AND DEPOSITS TO PARTICIPANT ACCOUNTS
4.1 Contributions
Prior to the termination of the contract and unless otherwise described in a Fixed Account rider(s),
Contributions may be made at any time, pursuant to the terms of the Plan.
Great -West shall not be responsible for determining the amount of Contributions to be made for any
Participant. The Contribution amounts will be allocated to Participant Accounts pursuant to the
accompanying Contribution report. The Contribution report must be submitted in a manner acceptable
to Great -West and shall be conclusive and binding on the Plan and on any person oe entity claiming an
interest under the Contract. When the Contribution report does not coincide with the Contribution
received and the inconsistency is not resolved within a period of time required under the law, Great -
West may return the Contribution.
Great - West's prior approval may be required before a Contribution may be made that causes a
Participant Account .Value to exceed $1,000,000.
4.2 Limitations on Salary Reduction Contributions
Each Participant's salary reduction Contributions, if any, must satisfy any limitations imposed by the
Plen or the Code.
4.3 Deposits to Participant Accounts
Deposits will be accepted insofar as they are permitted under the terms of the Plan and. applicable
Code requirements.
4.4 Allocation of Contributions and Deposits
Contributions and Deposits, less Applicable Tax, if any, will be allocated in the Participant Account
when received by Great -West at its Administrative Offices, subject to Section 3.2 of this Contract.
Contributions and Deposits will be allocated as directed by the Participant among any number of
currently offered Fixed Account options available under the Contract. If the offered Fixed Account
options are changed, Contributions and Deposits may be. redirected and the account balance may be
reallocated `subject to the terms of the accounts selected.
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SECTION 5. CONTRACT CHARGES AND FEES
5.1 Contract Maintenance Charge
An annual contract maintenance charge may apply. However, if the Participant Effective Date is after
January 1, the initial contract maintenance charge for that Participant Account will apply during the
calendar quarter after the Participant's one -year anniversary (calculated from the Participant Effective
Date) and will be pro -rated for the remainder of the year.
The deduction of the contract maintenance charge will be pro -rated among the applicable Fixed
Account Value on the date of deduction. Whenever a deduction for a contract maintenance charge is
made from a Fixed Account, Great -West will reduce the Participant Account Value in an amount equal
to the deduction:
5.2 Contract Termination Charge
Upon termination of the Contract by Plan Sponsor, a contract termination charge based upon a
percentage of the original Start-Up Costs may apply.
5.3 Fees Imposed by Investment Option Provider
Any.and all fees imposed by the provider of any investment option offered by the Plan and invested in
by the Participant, Alternate Payee and Beneficiary, including but not limited to redemption fees, shall
be deducted from the Participant Account Value.
5.4 Service Charges and Fees
Great -West and Plan Sponsor may enter into an agreement for services to the Plan not otherwise
provided under this Contract. Charges and fees for these services will be described in the agreement.
5.5 Payment of Charges and Fees
Any fees imposed by the providers of any investment option, all charges and fees may be billed directly
to Plan Sponsor. If Plan Sponsor does not elect to have such charges and fees billed to Plan Sponsor,
such charges and fees shall be deducted from the Participant Account Value.
In all instances where Plan Sponsor has elected to be billed for any fees and charges and any of the
fees or charges are unpaid after the date billed, as disclosed in and pursuant to the procedures in the
fee disclosure and/or service agreement for the Plan, Plan Sponsor and Contractholder hereby
instructs Great-West to debit Participant Accounts. Great -West may continue to deduct.charges and
fees quarterly from Participant Accounts unless and until Plan Sponsor provides Great -West with
written instructions-to reinitiate billing.
Great -West may change any charges and fees upon not fewer than 30 days advance written notice to
Plan Sponsor.
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SECTION 6. PARTICIPANT -, ALTERNATE PAYEE -, AND BENEFICIARY- DIRECTED.
TRANSFERS AMONG INVESTMENT OPTIONS OFFERED BY THE PLAN
Upon receipt of a satisfactory Request meeting all of the requirements of this section, Great -West will
process a single =sum Transfer of all or a portion of a Participant Account in the Plan. Transfers must:
(a) satisfy the terms of the Plan in accordance with the appropriate provisions of the Code; and
(b) satisfy any restrictions in the attached Fixed Account rider(s), and any trading restrictions imposed
by the investment option provider, including but not limited to mutual.fund restrictions on market timing or
excessive trading.
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SECTION 7. DISTRIBUTIONS FROM. PARTICIPANT ACCOUNTS
7.1 Distribution Requirements
Notwithstanding any provision herein to the contrary, Distributions to a Payee may only be made in
accordance with the terms of the Plan and applicable Code sections and any terms of the Fixed
Account rider(s), and will be tax reported under the applicable rules in effect on the date of Distribution.
Great -West will rely on information provided by Plan Sponsor or its designee with respect to the timing
and amount of any benefit payable to a Payee under this Contract. Great -West will not process any
Distributions to a Payee without Plan Sponsor or its designee instructions.
7,2 Rollovers
If the Payee of an eligible rollover Distribution elects to have the Distribution paid directly to a specified
eligible retirement plan, as defined in Code section 402(c)(8)(B), then the Distribution will be paid to that
eligible retirement plan in a direct rollover. If the Plan provides for mandatory Distributions under
Section 401(a)(31)(B) of the Code, such Distributions shall be sent to the IRA provider.selected by Plan
Sponsor pursuant to the Plan Sponsors or its designee's instructions.
7.3 Establishment of Alternate Payee Account
A Request in connection with a Qualified Domestic Relations Order (QDRO) must be approved by Plan
Sponsor, except as otherwise agreed. Great -West will make payment to the Alternate Payee and /or
establish a Participant Account on behalf of the Alternate Payee named in such order. The Alternate
Payee shall be treated as a surviving spouse for purposes of Code section 401(a)(9) and shall be
responsible for submitting a Request to begin Distributions in accordance with the Code.
7.4 Required Minimum Distributions during the Participant's Lifetime
Participants are required by the Code to begin receiving required minimum Distributions as of their
required beginning date; which is April 1 of the calendar year following the later of: (a) attainment of age
70 %; or "(b) retirement, or such other date as may be prescribed in the Code. Required minimum
Distributions made under this Contract will only be made in a manner consistent with Code section
401(a)(9). It is the Participant's or Plan Sponsor's responsibility to Request payments in accordance
with the minimum distribution requirements. Great -West is not responsible for any penalties resulting
from a failure to Request timely payments in the proper amount.
7.5 Distributions after the Participant's Death
If the Participant dies, the amount payable on death will be the Participant Account Value net of any
outstanding loan balance. Distributions to Beneficiaries must begin on or before the designated
Beneficiary's required beginning date in a manner and amount consistent with Code section 401(a)(9)
as it is in effect at the time of the Distribution.
It is the Beneficiary's responsibility to Request payments and to pay any penalties resulting from a
failure to Request timely payments in the proper amount. A Beneficiary may not receive more than the
Participant Account Value.
7.6 Plan -to -Plan Transfers
A Participant or Beneficiary may direct that all or a portion of the Participant Account Value be
transferred in a single sum to a contract under another Plan Sponsors plan. Such transfers will be
permitted provided:
(a) Both the transferor and transferee plan provide for such transfers, and the transfer satisfies the
terms of the Plan and applicable provisions of the Code;
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(b) In the case of a transfer for a Participant, the Participant is an employee or former employee of
the Plan Sponsor (or the business of the Plan Sponsor) for the receiving plan;
(c) In the case of a transfer for a Beneficiary, the Participant was an employee or former employee of
the Plan Sponsor (or the business of the Plan Sponsor) for the receiving plan;
(d) Great -West receives a satisfactory Request for such transfer; and
(e) The restrictions, if any, contained in the attached Fixed Account rider(s), if any, allow such
transfer.
7.7 Transfers from a Governmental Plan for the Purchase of Permissive Service Credits
If the Plan so provides, a Participant may direct that all or a portion of the Participant Account Value be
transferred in a single sum to a qualified defined benefit plan that is a governmental plan (as defined in
Code section 414(d)). Such transfers Will be permitted provided:
(a) The transfer satisfies'the terms of. the Plan in accordance with the appropriate provisions of the
Code;
(b) Great -West receives a satisfactory Request for such transfer; and
(c) The restrictions, if any, contained in the attached Fixed Account riders) allow such transfer.
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SECTION 8. PAYMENT OPTIONS
8.1 Requests for Distributions to a Participant. Beneficiary or Alternate Payee
As long as the Participant Account Value is greater than zero and as allowed by the Plan and Code, a
Request may be made to:
(a) Elect an annuity payment option, provided such Request is made at least 30 days before the
Annuity Commencement Date;
(b) Elect a non - annuity payment option and designate the date payment shall commence; or
(c) Change from one payment option to a different payment option, if allowed under the terms of the
payment option selected.
8.2 Conditions of Payment
Approved Distributions shall be effective on the later of: (a) the date elected subject to any restrictions
of the Plan and Code and any Fixed Account rider(s); or (b) the date of the Request_
8.3 Total or Partial Lump Sum Payment Option
If, based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the
applicable terms and provisions of the Plan and the Code sections governing the Plan, ail or a portion
of a Participant Account may be applied to a lump sum payment option selected by the Payee.
Subject to the provisions. of any attached Fixed Account rider(s), the amount to be distributed is: (I) the
amount requested as a lump sum; less (ii) the Applicable Tax, if any, as of the date of the amount
distributed, and (iii) any applicable fees and charges.
8.4'Pedodic Payment Options
If, based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the
applicable terms and provisions of the Plan and the Code sections governing the Plan, all or a portion
of a Participant Account may be applied to a periodic payment option selected by the Payee, subject to
any restrictions in a Fixed Account rider(s). Charges and fees will continue to apply. An Applicable
Tax, if any, may apply. Periodic payment elections are subject to the administrative procedures of
Great -West in effect at the time of the election and the periodic payment options Great -West makes
available at the time of Distribution.
If a Participant is receiving periodic payments, such payments will cease as of receipt by Great -West of
notice of the Participant's death. The deceased Participant's Beneficiary may then elect a payment
option under this Section 9 meeting all the requirements of Code section 401(a)(9).
8.5 Annuity Payment Options
If, based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the
applicable terms and provisions of the Plan and the Code sections governing the Plan, all or a portion
of a Participant Account may be applied to an annuity payment option selected by the Payee, so long
as the requirements of Code section 401(a)(9) are met. Thereafter, this Contract shall no longer be
applicable with respect to amounts in the annuity payment option.
The amount to be applied to an annuity payment option is: (i) the portion of the Participant Account
Value elected by Payee subject to any restrictions in a Fixed Account rider(s), less (ii) Applicable Tax, if
any, less (iii) any. fees and charges described in the Contract.
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The minimum amount that may be applied under the elected annuity option is $5,000. If any payments
to be made under the elected annuity payment option will be less than $50, Great -West may make the
payments in the most frequent interval that produces a payment of at least $50.
Great -West will issue a certificate to each Annuitant describing the benefits payable under the elected
annuity payment option.
8.6 Election of Annuity Options
An Annuitant is required to elect an annuity payment option. The Annuitant must Request an annuity
payment option or change an annuity payment option no later than 30 days prior to the Annuity
Commencement Date.
To the extent available under the Plan, the available annuity payment options are:
Income for Single Life Only
Income for Single Life with Guaranteed Period
Income for Joint Life Only
Income for Joint Life with Guaranteed Period
Income for a Specific Period
Any other form of annuity payment permitted under the Plan, if acceptable to Great -West.
The annuity option that will always be available is the Income for Single Life Only Annuity. If this
annuity option is elected, Great -West will make payments to the Annuitant at a frequency specified in
the annuity certificate for the duration of the Annuitant's lifetime. Payments will cease pursuant to the
.terms of the certificate.
Minimum Monthly Payment for Each $1,000 of Participant Account Value
Applied to Purchase a Lifetime Monthly Annuity
Age of Lifetime Monthly
Payee Payment
50 $4.00
55 4.28
60 4.66
65 5.20
70 5.98
75 7.16
8.7 Misstatement of Age or Death
Great -West may require adequate proof of the age and death of any Payee before processing a
Request for or making any payment. If the age of the Payee has been misstated, the payments
established for him/her under the applicable payment option will be made on the basis or his/her correct
age.
If payments made pursuant to an annuity payment option were too large because of a misstatement of
age, Great -West may deduct the difference from the next payment or payments with interest. If
payments were too small, Great -West may add the difference to the next payment with interest. Any
interest payable will be made at the rate required by law.
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SECTION 9. CONTRACT TERMINATION
9.1 Notice of Contract Termination and Selection of Termination Option(s)
Either Great -West or Plan Sponsor may terminate this Contract with advance written notice to the other
party or parties. The contract termination date shall be the seventy -fifth (75 day after the date written
notice is received in the Administrative Offices in good order. If the seventy-fifth (75 day is not a
Business Day, the contract termination date shall be the Business Day immediately following the
seventy-fifth (75t day. Prior to the contract termination date, Great -West and Plan Sponsor may agree
to an alternate contract termination date. Contract termination may not occur on the date selected by
Plan Sponsor unless Great -West has received all required information. In such event, Great -West shall
maintain Participant Account Values until Great -West receives all required information in good order.
9.2 Contract Termination Provisions
Plan Sponsor shall direct Great -West to pay the Participant Account Values as described below.
Fixed Account(s): Great -West will remit the Fixed Account Value pursuant to the Fixed Account rider(s)
contract termination option selected.
Plan Sponsor and Contractholder hereby instructs Great -West to deduct any outstanding charges and
fees, including the contract termination charge, if applicable, due to Great -West from the amount remitted
from any of the Fixed Accounts.
9.3 Contract Termination due to Plan Termination
If Plan Sponsor terminates the Plan, it shall notify Great -West of such Plan Termination and that final
Contributions have been remitted to Great -West. Upon notice of Contract Termination Due to Plan
Termination, Plan Sponsor agrees to provide any and all - information and instructions GreatMest requires
to properly comply with Plan Sponsor's notification of Plan Termination and subject to the provisions of
the Fixed Account rider(s).
Plan Sponsor acknowledges that the amount distributed from the Contract upon Plan Termination shall
be equal to the balance of each Participant Account as reflected in the records of Great -West on the date
of Distribution subject to the provisions in the Fixed Account rider(s), less all outstanding charges or fees,
including an applicable contract termination charge, and reduced by any required income tax withholding
or other applicable fees due upon Distribution.
Plan Sponsor shall file any and all required Forms 5500.
If the Plan is abandoned, orphaned or if Plan Sponsor cannot be located or Plan Sponsor fails to provide
appropriate representations and instructions to Great -West in connection with termination of the Plan,
Great -West is authorized to accept notices, representations and instructions from, the Plan administrator
or trustee, the bankruptcy trustee for Plan Sponsor, the U.S. Department of Labor, if applicable, or an
authorized and appropriate representative of Plan Sponsor. Great -West may also utilize any procedures
promulgated by the U.S. Department of Labor, if applicable, or other applicable regulatory agencies for
abandoned or orphaned plans including the facilitation of Distributions to Payees performed by a
Qualified Termination Administrator, as that term is defined under Federal law and regulations
promulgated thereunder, or comparable person as allowed by applicable law.
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SECTION 10. GENERAL PROVISIONS
10.1 Contract
Great -West has issued this Contract to Plan Sponsor and Contractholder in consideration of the
Application and payment of the initial Contribution or Deposit.
10.2 Entire Contract
This Contract, including the Application, amendments, endorsements, letter agreements, specification
page, if any, and Fixed Account or other rider(s), if any, constitute the entire contract between Plan
Sponsor and Great -West.
All statements in the Application, in the absence of fraud, have been accepted as representations and
not warranties. Only the President, Vice - President, or the Secretary of Great -West, or their authorized
designees, can agree on behalf of Great -West to modify any provisions of this Contract.
One or more provisions of this Contract may be clarified by letter agreement, amendment, or other
writing executed by both Great -West and Plan Sponsor.
10.3 Contract Modification
Great -West may modify this Contract from time to time to conform it to changes in tax or other law,
including applicable regulations and rulings, without consent of Plan Sponsor or any other person.
Great -West will provide notice and a copy of any such modification to Plan Sponsor as soon as
reasonably practicable.
Plan Sponsor and Great -West may, by written agreement, make other modifications to this Contract,
subject to the approval of the appropriate state department of insurance, if applicable. No such
modification will, without the written consent of Plan Sponsor, affect the terms, provisions, or conditions
of this Contract, which are or may be applicable to Contributions or Deposits made prior to the date of
such modification.
10.4 Modification of Fixed Account Options
Great -West may offer new or cease offering existing Fixed Account options, or make other changes to
the Fixed Account options as Great -West deems necessary, and subject to the approval of the state
insurance department, if applicable. If Great -West changes material provisions of its Fixed Account
options, Great -West will provide at least sixty (60) calendar days written notice to the Plan Sponsor.
This notice shall explain any Fixed Account change(s), communicate the timeline and effective date of
any Fixed Account change and explain Plan Sponsor's right to opt out of any Fixed Account change.
Plan Sponsors absence of an objection to such notice will be considered consent to the change(s).
If Great -West replaces Fixed Account options and does not receive an objection from the Plan
Sponsor, Transfers between account options as disclosed in the notice will be completed by Great-
' West as of the effective date of the change. Such allocation will be in effect until such time as Great -
West receives a written Request for a different allocation.
If Plan Sponsor provides written objection to Great -West within the sixty (60) calendar day notice
period, Great -West will not make the Fixed Account change at issue. If Plan Sponsor objects to the
Fixed Account change, Great -West may terminate this Contract by providing written notice pursuant to
Section 9.1 of this Contract.
10.5 Restorations
Great -West may agree to restore any back -end load charges, market value adjustments, or other
investment charges deducted from plan assets under a prior investment option.
GFAC 10 FFII Page 16
Revisan l: Sep 9. 26t6 4:52P.1 98 -01 Villageol Tepuew
10.6 Plan Provisions
In all cases, the plan document shall determine (subject to the Code) the speck features of the Plan,
which may include the availability of certain types of investment options, Distributions, loans, and other
features allowed but not mandated by the Code. Any provision of this Contract which deals with a
feature not included in the Plan shall not apply.
10.7 Non - Participating
This Contract is Non - Participating, meaning that it is not eligible to share in Great- West's divisible
surplus.
10.8 Currency and Contributions and Deposits
All amounts to be paid to or by Great -West must be in currency of the United States of America. All
Contributions and Deposits to this Contract must be made payable to Great -West or to a designee
acceptable to Great - West_.
10.9 Notices
Any notice or demand by Great -West to or upon Plan Sponsor or any Payee may be given by mailing it
to that person's last known address as stated in .Great - West's file via the United States Postal Service
or last known email address or facsimile number on file.
An application, report, Request, election, direction, notice or demand by Plan Sponsor or a Payee will
be made in a form satisfactory to Great -West. When Great -West requires it, Plan Sponsor will obtain
the signature of the Payee on forms provided by Great -West. Great -West must first approve any
written materials developed by any other person describing this Contract.
10.10 Disclaimer
Nothing contained in this Contract shall be construed to be tax or legal advice, and Great -West
assumes no responsibility or liability for any costs, including but not limited to taxes, penalties or
interest incurred by the Plan, Plan Sponsor or any other Payee arising out of a determination of liability.
Great -West shall not be held liable for the negligence, willful misconduct, or.failure to. perform of any
third party.
10.11 Representations
Great-West shall be entitled to rely and act solely on the reports, directions, proofs, notices, elections,
and other information furnished to it by Contractholder, Plan Sponsor, Participant, Alternate Payees,
Beneficiaries or their respective agent, and such acts shall be conclusive and binding as to all persons
or corporations claiming an interest hereunder,
10.12 Non- Waiver
The waiver by Great -West of any breach of any term or condition in this Contract will not be deemed a
waiver of any prior or subsequent breach.
10.13 Information
Plan Sponsor shall furnish all information that Great -West may reasonably require for the administration
of this Contract. Great -West shall not be responsible for any obligation under this Contract until it
receives all requested information in a form acceptable to Great -West,
GFAC 10 FFII Page 17
Revision 1: Sep 9, 2016 4:52 PM 95781 -01 Wage of Tequesta
GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY
A Stock Company
8515 East Orchard Road Greenwood Village, CO 80111
Forinquiries, information orresolution of complaints, cal/ 1. 800 -701 -8255
Fixed Account
This Guaranteed Interest Fund ( "GIF ") Fixed Account rider ( "Rider") is part of the Great -West Life 8
Annuity Insurance Company ( "Great - West") Contract to which it Is attached.
Guaranteed Interest Fund
The GIF is a Fixed Account that is part of the General Account of Great -West. All or a portion of
Contributions and Deposits may be allocated to the GIF.
Definitions
Competing Fund- any of the following types of funds offered by the Plan Sponsor:
(a) any stable value fund; or
(b) any fund with a known or periodically declared rate of interest; or
(c) any money market fund; or
(d) any bond fund with a duration of 3 years or less
Plan Sponsor Initiated Event — an action that materially impacts assets in the GIF as it relates to
the Plan, including but not limited to a: spin -off; sale; merger; full or partial plan termination,
including Distribution of assets performed by a Qualified Termination Administrator, as that term is
defined under Federal law and regulations promulgated thereunder, or comparable person as
allowed by applicable law; terminating union in a multi - employer . plan; terminating participating
employer in a multiple employer plan; termination by a political subdivision of a governmental
457(b) plan or a layoff of at least 20% of work force in any twelve month period.
General
For.the purposes of the references in the Rider, Great -West shall use a comparable source if
applicable information is unavailable on the United States Federal Reserve Website.
Credited Interest Rate
Interest earned on the GIF value is compounded daily to the effective annual interest rate. Unless
otherwise described in the Rider,, the interest rate to be credited to the Contractholder's assets in
the GIF during the calendar quarter will be determined by Great -West prior to the last day of the
previous calendar quarter and shall be reset at least quarterly, Great -West shall notify Plan
Sponsor, Participants, Alternate Payees and Beneficiaries invested in the GIF at least thirty (30)
calendar days in advance at the address on file with Great -West should the credited interest rate
be reset more frequently than quarterly. All reset credited interest rates shall be declared in
advance.
Guaranteed Interest Rate
The effective annual interest rate will never be less than 0 %.
Guaranteed Interest Fund Value
The value of the Contractholder's assets in the GIF in respect of the Participant Account will be
determined as the value of (a) minus (b) where:
GIF 10 FFII R Page 1
Redso 1: Sep 9, 20164M R1 9878"1 Oaged`rEquesla
(a) is the sum of Contributions and Deposits by and on behalf of Participants, Alternate Payees
and Beneficiaries allocated to the GIF plus interest credited to the Contractholder's assets
in the GIF; and
(b) is the sum of any amounts distributed plus any amounts transferred from the GIF, as well
as charges and fees and Applicable Tax, if any.
Limitations
Great -West shall defer processing Distribution or Transfer Requests if transactions cannot be
executed or settled due to the closing or disruption of financial markets or exchanges. Great -West
shall resume the processing Distributions and Transfers once the disruption is resolved.
Plan Sponsor shall not offer Competing Funds, as defined above, unless mutually agreed upon by
Great -West and Plan Sponsor.
Should the Plan Sponsor offer a Competing Fund without Great - West's agreement, or should an
existing Plan- investment option become a Competing Fund and remain available to the Plan
without Great - West's prior agreement, and Great -West learns of such Competing Fund, Great -
West shall suspend all Transfers out of the GIF upon at least thirty (30) calendar days advance
written notice to the Participants, Alternate Payees and Beneficiaries invested in the GIF at the
address on file with Great -West. This Transfer restriction shall remain in effect until the Competing
Fund is removed as an eligible Plan investment option, or as otherwise mutually agreed.
Excessive Trading
Based on Great - West's excessive trading policy, Great -West shall restrict a Participant, Alternate
Payee or Beneficiary from making a Transfer into the GIF for up to thirty (30) calendar days from
the date of the most recent Transfer from the GIF. Contributions and Deposits, other. than
Transfers, will be allowed into the GIF during the thirty (30) day period.
Plan Sponsor Initiated Events
Plan Sponsor shall provide notification to Great -West at least thirty (30) calendar days in advance
of a Plan Sponsor Initiated Event.
Unless a Plan Sponsor Initiated Event causes Great -West to: require Plan Sponsor to make an
election of a Contract Termination Option in this Rider with respect to the GIF assets affected by
the Plan Sponsor Initiated Event or when Great -West and Plan Sponsor otherwise agree, Great -
West shall remit the lesser of the Participant Account Value invested in the GIF or the Participant
Account Value invested in the GIF as reduced by the Market Value Adjustment Factor formula as
described in Contract Termination Option 1 in this Rider upon any Participant, Alternate Payee or
Beneficiary Distribution, including a plan to plan Transfer or transfer from a governmental plan to
purchase service credits, that occurs Within 12 months after the date Great -West recognizes the
Plan Sponsor Initiated Event ( "Event Date "). The Event Date shall be the Calculation Date for
purposes of calculating the Market Value Adjustment Factor. If the average of the 3 year and 5
year Treasury Constant Maturity rates, as of the Event Date, is 300 basis points or more above the
lowest weekly average of the 3 and 5 year Constant Maturity Treasuries over the previous 104
weeks from the Event Date, the Market Value Adjustment period above shall apply thirty -six
months after the Event Date.
If the Market Value Adjustment Factor is positive, a Market Value Adjustment shall not be
assessed.
Any Plan Sponsor choosing to remove the GIF as an eligible Plan investment option but not
declare a contract termination date, may Transfer the Group Contractholder's GIF value upon
election of Contract Termination Options 1 or 2 as identified in this Rider below, based on mutually
agreed upon dates. References to contract termination date shall not apply.
GIF 10 FFII FL Page 2
Revism 1: Sep 9, 2016 4S2 PM 96761 -01 ViUage of TeUUesta
Contract Termination
At least sixty (60) calendar days before the contract termination date, Plan Sponsor must notify
Great -West, in writing, of its selection from among the Contract Termination Options described
below. Great -West shall remit all GIF amounts pursuant to the Plan Sponsor elections.
Contract Termination Options
1. Lump Sum Payment with Market Value Adjustment — The Market Value Adjustment
Mill be calculated as of the date Great -West receives notice of contract termination
in good order, or another date as mutually agreed ( "Calculation Date'. Within
seven (7) Business Days after the contract termination date, Great -West will remit
the lesser of the total Participant Account Values of the Contractholder's assets in
the GIF ( "book value ") or the book value of the GIF adjusted by the Market Value
Adjustment Factor described below. If Great -West receives the difference between
any reduced MVA and book value from Plan Sponsor prior to the contract
termination date, Great -West will remit the book value.
Market Value Adjustment (MVA) = MVAF x (book value)
The Market Value Adjustment Factor (MVAF) is:
MVAF = (1 +i) -1
(1 +j+ 1.003
Where:
i is the Three (3) Year Treasury Constant Maturity rate as published in United States
Federal Reserve Website on the later of the Contract Date and the last Business
Day of the week two (2) years prior to the Calculation Date.
j is the Three (3) Year Treasury Constant Maturity rate as published in United States
Federal Reserve Website on the last Business Day of the week prior to the
Calculation Date.
2. Payment at Book Value — Great -West shall remit the total Participant Account
Values of the Contractholder's assets in the GIF ( "book value ") pursuant to a) or b)
below. Great -West shall not reset the credited interest rate on the Contractholder's
assets in the GIF after the contract termination date.
(a) Great -West will remit the book value no later than twelve (12) months after
the contract termination date.
Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan
loans shall be made from the GIF assets and Contributions and Deposits will
not be accepted into the GIF after the contract termination date. A
percentage of Transfers, including plan to plan transfers or transfers from a
governmental plan to purchase service credits from the Participant Account
shall be restricted as of the contract termination date. Great -West shall
notify Participants, Alternate Payees and Beneficiaries invested in the GIF of
this restriction at least thirty (30) calendar days in advance, at the address
on file with Great -West. In the event such notice is provided to a
Participant, Alternate Payee or Beneficiary fewer than thirty (30) days before
the contract termination date, the restriction shall not take effect for such
GIF 10 FRI FL Page 3
Reruiw 1: Sep 9.2016 3:52 PM 58781 -01 Vaage of Tegwsa
Participant, Alternate Payee or Beneficiary sooner than thirty (30) days from
the date of such notice.
Distributions may be made from the GIF at any time.
No Plan Sponsor Transfers shall be allowed after the contract termination
date.
Option a) shall apply only if, on the date Great -West receives notice of
contract termination in good order, the average of the 3 year and 5 year
Treasury Constant Maturity rates is less than 300 basis points above the
lowest weekly average of the 3 and 5 year Constant Maturity Treasuries
over the previous 104 weeks from notice. Great -West shall use published
rates from the United States Federal Reserve website. Otherwise, option (b)
shall apply.
Numerical Example: On the date notice of contract termination is
received by Great -West in good order, the average of the 3 year and 5
year Treasury Constant Maturity rates is 4.00 %. Over the previous 104
weeks from notice, the lowest average of the 3 year and 5 year Treasury
Constant Maturity rates from the United States Federal Reserve website
was 2.25 %. Since 4.00% is less than 300 basis points above 225 %,
option a) applies.
(b) Great -West will remit the book value no later than thirty -six (36) months after
contract termination date.
Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan
loans shall be made from the GIF assets and Contributions and Deposits will
not be accepted into the GIF after the contract'termination date. Participant,
Alternate Payee and Beneficiary Transfers, including plan to plan transfers
or transfers from a governmental plan to purchase service credits, shall be
restricted to a percentage of Participant Account assets in the GIF pursuant
to the following schedule:
Months from % of
contract termination date Transfers Allowed
0 -12 0%
13 -24 a total of 25% of Participant GIF
assets as of January 1 in the
year of the 1 e month.
25 -36 a total of 33% of Participant GIF
assets as of January 1 81 in the
year of the 25 month.
Great -West shall notify Participants, Alternate Payees and Beneficiaries
invested in the GIF of this restriction at least thirty (30) calendar days in
advance, at the address on file with Great -West. In the event notice is
provided to a Participant, Alternate Payee or Beneficiary fewer than thirty
(30) days before the contract termination date, the restriction shall not take
effect for such Participant, Alternate Payee or Beneficiary sooner than thirty
(30) days from the date of such notice.
Distributions may be made from the GIF at any time.
GIF 10 FFII FL Page 4
Rer6ron 1: Sep 9.2016 4:52 PM 98791 -01 Wage of TMuesta
No Plan Sponsor Transfers shall be allowed
Option b) shall apply only if, on the date Great -West receives contract
termination notification in good order, the average 3 year and 5 year
Treasury Constant Maturity rates is 300 basis points or more above the
lowest weekly average of the 3 and 5 year Constant Maturity Treasuries
over the previous 104 weeks from notice. Great -West shall use published
rates from the United States Federal Reserve website.
Numerical Example: On the date notice of contract termination is received by
Great -West in good order, the average of the 3 year and 5 year Treasury
Constant Maturity rates is 6. oo %. Over the previous 104 weeks from notice, the
lowest average of the 3 year and 5 year Treasury Constant Maturity rates from
the United States Federal Reserve website was 2.50 %. Since 6.00% is more
than 300 basis points above 2.50 %, option b) applies.
3. Payment in 20 Quarterly Installments — Great -West will remit the total Participant
Account Values of the Contractholder's assets in the GIF ( "book value ") in twenty
quarterly installments with the first installment comprising 1 /20'' of the book value on
the date remitted, that payment being made no later than ninety (90) calendar days
after contract termination date. The remaining payments shall be incrementally
remitted in fractional amounts of remaining book value each quarter over the
succeeding nineteen quarters (e.g. 1/19, 1/18...1/1) until the total book value is
remitted.
Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan loans
shall be made from the GIF assets and Contributions and Deposits will not be
accepted into the GIF after the contract termination date. No Plan Sponsor or
Participant, Alternate Payee or Beneficiary Transfers including plan to plan transfers
or transfers from a governmental plan to purchase service credits shall be allowed.
Distributions may be made from the GIF at any time.
4. Any other termination option allowable under applicable law as mutually agreed
upon in writing by Great -West and Plan Sponsor.
Signed for Great -West Life & Annuity Insurance Company on the Effective Date of the Group
Annuity Contract.
President
GIF 10 FFII FL Page 5
Revisor 1: Sep 9, 2016 4:52 PM 98781 -01 YLBege of Teaues i
GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY
A Stock Company
8515 East Orchard Road Greenwood Village, Co 60111
Forservice, call 1-800-701-8255
Letter Agreement
This Letter Agreement is attached to and made part of the Great -West Life & Annuity
Insurance Company Contract (GFAC 10 FFII), pursuant to Section 10.02 "Entire Contract ".
This Letter Agreement supersedes and replaces any other previous Letter Agreements or
representations.
Great -West Life & Annuity Insurance Company ( "Great- West ") and Village of Tequesta ( "Plan
Sponsor") agree to the following clarifications and modifications of the Great - West's Group Fixed
Deferred Annuity Contract ( "Contract "), Contract Number 98781 -01.
1. Contract Maintenance Charge — The Contract Maintenance Charge as described in the
Contract is $
2. Contract Termination Charge — The Contract Termination Charge described in the Contract
is %.
This Letter Agreement shall become effective on the Contract Date. This Letter Agreement may
be modified at anytime upon mutual consent of both parties.
FFI110 Ur Agrmt Revisrom l: Sep 9,20164:52 PM 98781 -01 WlageofTequesla Pagel
GREAT -WEST LIFE & ANNUITY INSURANCE CC?MPANY
A Stock Company €
8515 East Orchard Road Greenwood Villag CO 80 }
L vor selv7ce. co 1- 800.701 -8255
APPLICATION FOR lGROUP ANNUITY CONTRACT
. ........
SECTION A PLAN SPONSO
NAW OF PLAN SPONSOR FEDERAL TALC 10 4 :
Village of Tm 59-6044081
ADDRESS SITUS €
j 345 Tequesta Or Teguesta FL 33459 FL
CITY fi1AT z v-
TELEPHONE 0 1 FAX 0 TYPE OF ENTITY
9 GovefRlment
FULL LEGAL NAME OF PLAN
Vfflaqe of Tm. iosta 4011 a ) P lan
SECTION B. CONTRAC TMOLDER
_. .....m g
i NAM: Of TRUSTEE iF DIFFERENT THAN THE PLAN SPONSOR FEDERAL TAX 10 if appilitatile 1
ADDRESSSITUS, if wplocaNe
CITY 5tA 1
TELEPHONE � FAX #€ � �T � ' YPE O F ENTITY a
s 1
R& ION C. PRODUCT INF O RMATION
F ixed Armin ity
SECTIO D, PLAN INFORMATION
._,
0 401(a) Plan � C l 401(k) Plan � C I 457(b) Governmental Plan
[ ERISA] Nor, -ERISA � ERISA [,L Non I*RISA
SECTION E DEFAULT INVEST OPT
Guaranteed Interest Fund (] No Default Investment Option (Money returned to payee as required by law)
Other Inve stment Option
SECTION F FIXED ACCOUNTS
Guaranteed Interest Fund
SECTION G. SERIES ACCOUNTS SECTION H SEPARATE ACCOUNTS
l _ .,, _
r None None
.
SEC I I AGREEMENT AND SI „�
AGREEMENT
By signing this Application Plan Sponsor and Contractholder, d ether than Plan Sponsor, understand, accept
and otherwise agree to the provisions of the attached Group Annuity Contract. certify and otherwise, represent
that the information contained on this appi €cation is true and correct to the lest of their knowledge, and agree to
notify Great " " -test of any charges to the information provided above
�+II•
Ilrrr �� .... ...... rrio=w 16
Signahue of Plan SPcarasar gate ai nfAwe of TiW C� ,t�
if different than rli n rsta'tsta
Village Manager
s”
GAC A 10 FFII rl, Fie an €; S a'z..2Ut z:t7 spa 98 OZ, VOW 01r Sta Page 1 of 2
FRAUD NOTICE
NOTICE: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement
of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the
third degree.
REPLACEMENT INFORMATION:
By Employer Will this group annuity contract replace any existing contract? Yes: ❑ No: ❑
By Agent To the best of your knowledge, will this group annuity contract replace any existing contract? Yes: ❑ No: ❑
FLORIDA license agent:
Licensed Agent Signature Agent Name (printed. typed or stamped)
Agent's.Florida license identification number Date
GAC A 10 FFII FL Page 2 of 2
Revision l: Sep 9, 20764:55 PM 90787 -0t Wage of Tequesw
