Registration Statement for a Separate Account (Unit Investment Trust) — Form N-4
Filing Table of Contents
Document/Exhibit Description Pages Size
1: N-4 Initial Filing of Pacific Life Value for Ny HTML 1.42M
2: EX-99.1(A) Minutes of Action of Board of Directors 2 15K
21: EX-99.10 Independent Auditor's Consent 1 10K
22: EX-99.13(A) Pacific Value-Performance Calculations 12± 61K
23: EX-99.13(B) Pacific Value-Performance Calculations 11± 62K
24: EX-99.15 Powers of Attorney 7 19K
3: EX-99.3(A) Distribution Agreement 8 38K
4: EX-99.3(B) Form of Selling Agreement 16 52K
5: EX-99.4(A) Pacific Value-Form of Individual Flexible Premium 32 136K
6: EX-99.4(B) Form of Qualified Pension Plan Rider 10 48K
7: EX-99.4(C) Form of 403(B) Tax-Sheltered Annuity Rider 10 47K
8: EX-99.4(D) Individual Retirement Annuity Rider 8 37K
9: EX-99.4(E) Roth Individual Retirement Annuity Rider 7 37K
10: EX-99.4(F) Simple Individual Retirement Annuity Rider 8 37K
11: EX-99.4(G) Stepped-Up Death Benefit Rider 2 12K
12: EX-99.4(H) Form of Guaranteed Protection Advantage Rider 3 17K
13: EX-99.5(A) Pacific Value Variable Annuity Application 7± 38K
14: EX-99.5(B) Form of Guaranteed Protection Advantage Rider 2 20K
15: EX-99.6(A) Articles of Incorporation of Pm Group Life 7 25K
16: EX-99.6(B) Amended and Restated Articles of Incorporation 1 10K
17: EX-99.6(C) By-Laws of Pacific Life & Annuity Co. 13 45K
18: EX-99.8(A) Fund Participation Agreement 40 89K
19: EX-99.8(B) Administrative Agreement 5 22K
20: EX-99.9 Opinion and Consent of Legal Officer of Pac Life 2± 12K
EX-99.4(E) — Roth Individual Retirement Annuity Rider
Exhibit Table of Contents
EXHIBIT 4(e)
[LOGO OF PACIFIC LIFE &
ANNUITY COMPANY]
Pacific Life & Annuity Company
700 Newport Center Drive
Newport Beach, CA 92660
ROTH INDIVIDUAL RETIREMENT ANNUITY RIDER
This rider is a part of the Contract to which it is attached (the Contract) by
Pacific Life & Annuity Company (PL&A).
The Contract is hereby modified as specified below in order to qualify as a Roth
Individual Retirement Annuity (Roth IRA) under Code Section 408A.
The provisions of this rider shall control if they are in conflict with those of
the Contract.
A. Definitions
Annuitant - The individual named as a measuring life for periodic annuity
payments under the Contract.
Annuity Start Date - The date shown in the Contract Specifications, or the date
the Owner has most recently elected under the Contract, if any, for the start of
annuity payments if the Annuitant is still living and the Contract is in force;
or if earlier, the date that annuity payments actually begin.
Applicable Designation Date - September 30 of the calendar year next following
the Owner's Year of Death.
Applicable Distribution Period - The period used to determine the amount
required to be distributed as an RMD during a Distribution Year.
Code - The Internal Revenue Code of 1986, as amended.
Compensation - Wages, salaries, professional fees, or other amounts derived from
or received for personal services actually rendered (including, but not limited
to, commissions paid salesmen, compensation for services on the basis of a
percentage of profits, commissions on insurance premiums, tips, and bonuses) and
includes earned income, as defined in Code Section 401(c)(2) (reduced by the
deduction the self-employed individual takes for contributions made to a
self-employed retirement plan). For purposes of this definition, Code Section
401(c)(2) shall be applied as if the term trade or business for purposes of Code
Section 1402 included the service described Code Section 1402 (c)(6).
Compensation does not include amounts derived from or received as earnings and
profits from property (including, but not limited to, interest and dividends) or
amounts not includible in gross income. Compensation also does not include any
amount received as a pension or annuity or as deferred compensation.
Compensation shall include any amount includible in the individual's gross
income under Code Section 71 with respect to a divorce or separation instrument
described in Code Section 71(b)(2)(A). In the case of a married individual
filing a joint return, the greater compensation of his or her spouse is treated
as his or her own compensation, but only to the extent that such spouse's
compensation is not being used for purposes of the spouse making a contribution
to a Roth IRA or a Non Roth IRA.
Contract - This annuity contract issued by PL&A as a Roth IRA.
Contributions - The Purchase Payments, premiums, rollovers or other
contributions received by PL&A under the Contract.
Designated Beneficiary - An individual designated or treated as a beneficiary
under the Contract for RMD purposes in accordance with the Regulations under
Code Section 401(a)(9)(E) and related provisions, e.g., Reg. (S) 1.401(a)(9)-4.
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DB Election Date - The date that is 30 days prior to the DB Required Beginning
Date.
DB Required Beginning Date - December 31 of the calendar year next following the
Owner's Year of Death.
Distribution Year - A calendar year for which an RMD is required. The first
Distribution Year is the calendar year that contains the DB Required Beginning
Date or the Spouse Required Beginning Date, whichever is applicable. Each
subsequent calendar year is also a Distribution Year.
IRA - An individual retirement account or individual retirement annuity under
Code Section 408.
IRS - Internal Revenue Service.
Life Expectancy - The life expectancy of one or more individuals as determined
by using the appropriate table in Reg. (S) 1.401(a)(9)-9.
Measuring Designated Beneficiary - The Designated Beneficiary as of the DB
Required Beginning Date whose Life Expectancy is used under Regs. (S)
1.401(a)(9)-4 and (S) 1.401(a)(9)-5, Q&A-7 to determine any Applicable
Distribution Period as of such date. If as of the Applicable Designation Date
any trust, estate or other entity is treated under Reg. (S) 1.401(a)(9)-4, Q&A-3
as a beneficiary under the Contract (taking into account any Separate Shares),
the Contract shall be deemed to have no Measuring Designated Beneficiary. If as
of the Applicable Designation Date the Contract (taking into account any
Separate Shares) has more than one Designated Beneficiary (and no entity
beneficiary), the Measuring Designated Beneficiary is the Designated Beneficiary
with the shortest Life Expectancy as of such date.
Non Roth IRA - An IRA that is not a Roth IRA.
Notice Date - The day on which PL&A receives, in a form satisfactory to PL&A,
proof of death and instructions satisfactory to PL&A regarding payment of death
benefit proceeds.
Owner or You - The Owner of the Contract.
Owner's Year of Death - The calendar year in which the Owner dies.
PL&A - Pacific Life & Annuity Company.
Plan - A tax-qualified retirement plan or arrangement, including an IRA.
QDRO - A qualified domestic relations order under Code Section 414(p).
Regulation or Reg. - A regulation issued or proposed pursuant to the Code.
RMD - Required minimum distribution under Code Section 401(a)(9) or related Code
provision.
Roth IRA - An IRA under Code Section 408A.
Separate Share - A separate portion or segregated share of the benefits under
the Contract that is determined by an acceptable separate accounting under Reg.
(S) 1.401(a)(9)-8, Q&A-3, or that qualifies as a segregated share for an
alternate payee under a QDRO under Reg. (S) 1.401(a)(9)-8, Q&A-6(b)(1). A
Separate Share shall be treated as a separate Contract for RMD purposes and
Section 6 below.
SEP - A Simplified Employee Pension form of IRA under Code Section 408(k).
SIMPLE IRA - A SIMPLE IRA under Code Section 408(p).
Spouse - The Owner's spouse, including a former spouse covered by a QDRO who is
treated as the Owner's spouse pursuant to Reg. (S) 1.401(a)(9)-8, Q&A-6.
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Spouse's Continuation Election Date - The date that is 30 days prior to the
earlier of the Spouse's Required Beginning Date or December 31 of the fifth
calendar year after the Owner's Year of Death, in accordance with Reg. (S)
1.401(a)(9)-3, Q&A-4(c).
Spouse's Required Beginning Date - The later of December 31 of the calendar year
next following the Owner's Year of Death or December 31 of the calendar year in
which the deceased Owner would have attained age 70 1/2.
Spouse's Year of Death - The calendar year in which the Surviving Spouse dies.
Surviving Spouse - The surviving Spouse of a deceased Owner.
B. Roth IRA Provisions
1. The Annuitant shall at all times be the Owner of the Contract (or its
beneficial Owner where a fiduciary is its legal Owner). Such individual
Owner's rights under the Contract shall be nonforfeitable, and the Contract
shall be for the exclusive benefit of such Owner and his or her
beneficiaries.
2. No benefits under the Contract may be transferred, sold, assigned, or
pledged as collateral for a loan, or as security for the performance of an
obligation, or for any other purpose, to any person; except that the
Contract may be transferred to a former or separated spouse of the Owner
under a divorce or separation instrument described in Code Section
408(d)(6). In the event of such a transfer, the transferee shall be treated
for all purposes as the Owner under the Contract.
3. (a) Maximum permissible amount. Except in the case of a "qualified rollover
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contribution" or a recharacterization (as defined in paragraph 3(e)
below), no Contribution will be allowed into the Contract unless it is
in cash and the total of such Contributions to all the individual
Owner's Roth IRAs for a taxable year does not exceed the lesser of the
Owner's Compensation for such year or the following applicable dollar
limit:
Year Limit
---- -----
2002-2004 $ 3,000
2005-2007 $ 4,000
2008 & later $ 5,000
In addition, for years after 2008 the $5000 limit will be indexed for
cost-of-living adjustments under Code Section 219(b)(5)(C) at $500
increments.
For an Owner age 50 or older the above dollar limits are increased as
follows:
Year Limit
---- -----
2002-2005 $ 500
2006 & later $ 1,000
Such a Contribution is referred to herein as a "regular contribution."
A "qualified rollover contribution" is a rollover contribution that
meets the requirements of Code Sections 408(d)(3) and 408A(c)(3)(B),
except that the one-rollover-per-year rule of Code Section 408(d)(3)(B)
does not apply if the rollover contribution is from a Non Roth IRA.
Contributions may be limited under paragraphs 3(b) through (d) below.
(b) Regular contribution limit. If subparagraph 3(b) (i) or (ii) below
---------------------------
apply, the maximum regular contributions that can be made to all of the
Owner's Roth IRAs for a taxable year is the smaller of the amounts
determined under subparagraph 3(b) (i) or (ii) below.
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(i) The maximum regular contribution is phased out ratably between
certain levels of modified adjusted gross income ("modified AGI,"
defined in paragraph 3(f) below) in accordance with the following
table:
[Enlarge/Download Table]
Filing Status Full Contribution Phase-out Range No Contribution
Modified AGI
-------------------------------------------------------------------
Single or Head of Household $95,000 or less Between $95,000 and $110,000 or more
$110,000
Joint Return $150,000 or less Between $150,000 and $160,000 or more
$160,000
Married-Separate Return $0 Between $0 and $10,000 $10,000 or more
For purposes of this table, a husband and wife are not treated as married for a
taxable year if they have lived apart at all times during such year and file
separate returns for such year. If the Owner's modified AGI for a taxable year
is in the phase-out range, the maximum regular contribution determined under
this table for that taxable year is rounded up to the next multiple of $10 and
is not reduced below $200.
(ii) If the Owner makes regular contributions to both Roth and Non
Roth IRAs for a taxable year, the maximum regular contribution
that can be made to all the Owner's Roth IRAs for that taxable
year is reduced by the regular contributions made to the Owner's
Non Roth IRAs for the taxable year (ignoring SIMPLE IRA or SEP
contributions).
(c) Qualified rollover contribution limit. A rollover from a Non Roth IRA
--------------------------------------
cannot be made to this Roth IRA Contract if, for the year the amount is
distributed from the Non Roth IRA, (i) the Owner is married and files a
separate return, (ii) the Owner is not married and has modified AGI in
excess of $100,000 or (iii) the Owner is married and together the Owner
and the Owner's spouse have modified AGI in excess of $100,000. For
purposes of the preceding sentence, a husband and wife are not treated
as married for a taxable year if they have lived apart at all times
during such year and file separate returns for such year.
(d) SIMPLE IRA and SEP limits. No Contribution shall be allowed into the
--------------------------
Contract under a SIMPLE IRA or SEP Plan. Also, no transfer or rollover
of funds attributable to contributions made by a particular employer
under its SIMPLE IRA Plan shall be allowed into the Contract from a
SIMPLE IRA prior to the expiration of the 2-year period beginning on
the date the individual Owner first participated in that employer's
SIMPLE IRA Plan.
(e) Recharacterization. A regular contribution to a Non Roth IRA may be
-------------------
recharacterized pursuant to Reg. (S) 1.408A-5 as a regular contribution
to this Roth IRA Contract, subject to the limits in paragraph 3(b)
above.
(f) Modified AGI. For purposes of paragraphs 3(b) and (c) above, an Owner's
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modified AGI for a taxable year is defined in Code Section
408A(c)(3)(C)(i) and does not include (i) any amount included in
adjusted gross income as a result of a rollover from a Non Roth IRA (a
"conversion") or (ii) for purposes of the rollover rules in paragraph
3(c) above during the years 2005-2010, any RMD from an IRA under Code
Section 401(a)(9) or a related Code provision.
4. Any Purchase Payment (or premium payment) under the Contract is not fixed,
but may not be less than any minimum amount stated in the Purchase Payment
(or Premiums) provisions of the Contract.
5. Any Purchase Payment (or premium) refund declared by PL&A under the
Contract, other than a refund attributable to an excess Contribution, shall
be applied toward the purchase of additional benefits before the close of
the calendar year following the calendar year of the refund.
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6. Upon the Owner's death, the Contract and all distributions under it shall
comply with the RMD rules in Code Sections 401(a)(9), 408(a)(6) and
408(b)(3), as modified by Code Section 408A(c)(5), and in the Regulations
thereunder, and such rules shall override any distribution options in the
Contract that are inconsistent with such rules. Consequently, distributions
shall be made in accordance with this Section 6 and the Regulations under
those Code Sections. Selection of any annuity or other distribution option
described in the Contract that does not satisfy the requirements of this
Section 6 shall not be permitted.
(a) Upon the Owner's death, the entire interest shall be distributed by
December 31 of the fifth calendar year that follows the Owner's Year
of Death, except to the extent that paragraph 6(b) or (c) below
applies.
(b) If the Surviving Spouse is the sole Designated Beneficiary under the
Contract (taking Separate Shares into account) as of the Applicable
Designation Date, then -
(i) If no irrevocable written election to the contrary has been filed
with PL&A by the deceased Owner or the Surviving Spouse prior to
the Spouse's Continuation Election Date, the Contract shall
continue in the name of the deceased Owner, and RMDs must begin
by the Spouse's Required Beginning Date and be distributed over
the Surviving Spouse's remaining Life Expectancy (by December 31
of each subsequent Distribution Year). The RMD amount that must
be distributed each Distribution Year with respect to the
Contract shall be equal to the quotient obtained by dividing the
account balance for the Contract (as determined under Reg. (S)
1.408-8, Q&A-6) by the Applicable Distribution Period. For these
purposes, the Applicable Distribution Period for each
Distribution Year after the Owner's Year of Death -
(1) Is measured by the Surviving Spouse's remaining Life
Expectancy, recalculated annually through the Spouse's Year
of Death, and
(2) For a Distribution Year after the Spouse's Year of Death, is
measured by the Surviving Spouse's remaining Life Expectancy
as of the Surviving Spouse's birthday in the Spouse's Year
of Death, reduced by one year for each calendar year that
has elapsed since the calendar year next following the
Spouse's Year of Death.
If the Surviving Spouse dies before the Spouse's Required
Beginning Date for such a continued Contract, then the Surviving
Spouse shall be treated as the deceased Owner for purposes of
this Section 6 (except that any surviving spouse of such a
deceased Surviving Spouse cannot continue the Contract further
under this subparagraph (i) as a Surviving Spouse). Any Surviving
Spouse may arrange to have any portion (or all) of any RMD that
is distributable with respect to such Surviving Spouse's interest
in the Contract distributed from another Roth IRA formerly owned
by such deceased Owner for which such Surviving Spouse is also a
designated beneficiary (rather than from the Contract) in
accordance with Reg. (S) 1.408-8, Q&A-9.
(ii) The Surviving Spouse may elect at any time to treat the entire
remaining interest in the Contract as a Roth IRA of such
Surviving Spouse, if such Surviving Spouse has an unlimited right
to withdraw amounts from the Contract and is the sole beneficiary
of the Contract, within the meaning of Reg. (S) 1.408-8,
Q&A-5(a). Such an eligible Surviving Spouse shall make such an
election by a written request to PL&A to redesignate such
Surviving Spouse as the Owner and Annuitant of the Contract. Such
an eligible Surviving Spouse shall be deemed to have made such an
election if either -
(1) Such Surviving Spouse makes any transfer, rollover or other
contribution of any amount for the benefit of such Surviving
Spouse into the Contract, or
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(2) Such Surviving Spouse directs PL&A in writing to transfer or
rollover any part or all of the assets to which such
Surviving Spouse is entitled under the Contract to another
IRA owned by such Surviving Spouse, or
(3) Any RMD that is required to be distributed from the Contract
under this Section 6 or under Code Section 401(a)(9) (e.g.,
in the case of any amount rolled over or transferred into
the Contract from a Plan) is not distributed within the
appropriate time.
(iii) The Surviving Spouse may make an irrevocable election in writing
with PL&A by the Spouse's Continuation Election Date to have such
Surviving Spouse's entire interest under the Contract distributed
under another method offered by PL&A that qualifies under Code
Section 401(a)(9). In addition to any optional method that
qualifies under the 5-year rule in paragraph 6(a) above, such
optional methods include the following:
(1) Any annuity option that satisfies Reg. (S) 1.401(a)(9)-5,
Q&A-1(e) and provides for periodic distributions that begin
no later than the Spouse's Required Beginning Date, or
(2) Any other method that provides for periodic distributions
that begin no later than the Spouse's Required Beginning
Date and do not extend beyond the remaining Life Expectancy
of such Surviving Spouse.
(c) If as of the Applicable Designation Date the Contract (taking any
Separate Shares into account) has at least one Designated Beneficiary
and no entity (e.g., a trust or estate) is treated under Reg. (S)
1.401(a)(9)-4, Q&A-3 as a beneficiary under the Contract, then -
(i) To the extent that no irrevocable election to the contrary
has been filed with PL&A by the deceased Owner or any such
Designated Beneficiary by the DB Election Date (and no
Surviving Spouse is the sole Designated Beneficiary), then
annual distributions of the remaining interest in the
Contract must be made over the Applicable Distribution
Period starting with the DB Required Beginning Date. In that
case, the RMD amount that must be distributed each
Distribution Year with respect to the Contract shall be
equal to the quotient obtained by dividing the account
balance for the Contract (as determined in accordance with
subparagraph 6(b)(i) above) by the Applicable Distribution
Period. For these purposes -
(1) The Applicable Distribution Period for the Distribution
Year next following the Owner's Year of Death is
determined by the Measuring Designated Beneficiary's
remaining Life Expectancy, using such beneficiary's age
as of such beneficiary's birthday in such Distribution
Year; and
(2) For a subsequent Distribution Year the Applicable
Distribution Period is reduced by one year for each
calendar year that has elapsed since the calendar year
next following the Owner's Year of Death.
Such RMD amount must be distributed no later than the DB
Required Beginning Date, and for each subsequent
Distribution Year by December 31 thereof. However, any
Designated Beneficiary may arrange to have any portion (or
all) of such RMD (that is distributable with respect to such
beneficiary's interest in the Contract) distributed from
another Roth IRA formerly owned by such deceased Owner for
which such beneficiary is also a designated beneficiary
(rather than from the Contract) in accordance with Reg. (S)
1.408-8, Q&A-9.
(ii) Any such Designated Beneficiary may make an irrevocable
election in writing with PL&A by the DB Election Date to
have such Designated Beneficiary's entire interest under the
Contract distributed under another method offered by PL&A
that qualifies under Code Section 401(a)(9). In addition to
any optional method that qualifies under the 5-year rule in
paragraph 6(a) above, such optional methods include the
following:
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(1) Any annuity option that satisfies Reg. (S) 1.401(a)(9)-5,
Q&A-1(e) and provides for periodic distributions that begin no
later than the DB Required Beginning Date, or
(2) Any other method that provides for periodic distributions that
begin no later than the DB Required Beginning Date and do not
extend beyond the remaining Life Expectancy of the Measuring
Designated Beneficiary.
(d) Any amount payable to a minor child of the Owner shall be treated as
if it is payable to the Surviving Spouse if the remainder of the
interest becomes payable to such spouse when such child reaches the
age of majority.
(e) Unless the Owner provides to the contrary in writing to PL&A, any
beneficiary of any interest under the Contract shall have an unlimited
right after the Notice Date, upon 30 days written notice to PL&A, to
withdraw any portion or all of such interest or to apply any such
amount to an annuity option that qualifies under Reg. (S)
1.401(a)(9)-5, Q&A-1(e).
(f) If the Owner dies before the entire interest under the Contract has
been distributed, no additional cash Contributions or rollover
Contributions shall be allowed into the Contract, except where the
Surviving Spouse elects (or is deemed to elect) to convert the
Contract to be his or her own Roth IRA, as specified above in this
Section 6.
7. PL&A shall furnish annual calendar year reports concerning the status of
the Contract and such information concerning RMDs as is prescribed by the
IRS.
C. Tax Qualification Provisions
The Contract as amended by this rider is intended to qualify as a Roth IRA
contract that meets the requirements of Code Section 408A and any
applicable Regulations relating thereto. To that end, the provisions of
this rider and the Contract (including any other rider or endorsement) are
to be interpreted to ensure or maintain such tax qualification, despite any
other provision to the contrary. PL&A reserves the right to amend this
rider to comply with any future changes in the Code or any Regulations,
rulings or other published guidance under the Code, or to reflect any
clarifications that may be needed or are appropriate to maintain such tax
qualification, without consent (except for the states of Michigan,
Pennsylvania, South Carolina and Washington, where affirmative consent is
required). PL&A shall provide the Owner with a copy of any such amendment.
All other terms and conditions of your Contract remain unchanged.
PACIFIC LIFE & ANNUITY COMPANY
/s/ Thomas C. Sutton /s/ Audrey L. Milfs
Chairman and Chief Executive Officer Secretary
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