Survey of Nonparticipating Single-Premium Group Annuity Rates

OMB 1212-0030
Expiration date: [TBD]
NONPARTICIPATING NET SINGLE PREMIUM
GROUP ANNUITY RATE ILLUSTRATION
FOR
PLAN TERMINATION OR ASC 715 SETTLEMENT

Date of Illustration
Company Identification Code _________________________
Paperwork Reduction Act Notice
The PBGC has asked the ACLI to conduct this survey so that it can ensure that its actuarial assumptions are
in line with those underlying private sector annuity prices. The PBGC uses this information to determine the
actuarial present value of benefits under single-employer plans that terminate and under multi-employer plans that
undergo a mass withdrawal of contributing employers. Your response is voluntary. The ACLI will not disclose to
the PBGC the identity of the insurance company responding to this survey. The PBGC regards the information
gathered through the survey as confidential under 5 U.S.C. § 552(b) and 29 CFR Part 4901.
Under the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number. This collection of
information has been approved by the Office of Management and Budget (OMB) under control number 1212-0030.
The PBGC estimates that the average burden of responding to this survey is 30 minutes. Comments concerning the
accuracy of this estimate or suggestions for reducing this burden may be sent to the Pension Benefit Guaranty
Corporation, Office of the General Counsel, 1200 K Street, NW, Washington, DC 20005-4026.

Instructions
/ /

If you are temporarily withdrawn from the immediate annuity market at the Date of
Illustration, please check this box.
(If you checked the above box, skip Part I below.)

/ /

If you are temporarily withdrawn from the deferred annuity market at the Date of
Illustration, please check this box.
(If you checked the above box, skip Part II below.)
(If you checked both of the above boxes, go directly to Part IV, Question 1.)

1.

Display the net rate plan factors that reflect or are consistent with mortality and interest rate
assumptions that underlie your company's quotation basis on actual bids on the above date.
If you prefer, you may display these assumptions explicitly. If you provide actuarial
assumptions, please make sure that there is enough information for the PBGC to be able to
fill out the tables in Parts I and II. In either event, the assumptions or the factors based on
them should contain no specific expense loading or provisions for disabled lives.

2.

Assume an annuity contract for a plan termination or ASC 715 settlement on the date of
illustration specified above. (See the enclosure for more details and background.)

PART I
Exact Age
of Annuitant

IMMEDIATE ANNUITY RATES
$10 Monthly Life Annuity Due (120 ä(12) x )
Male

Female

50

________

55

________

60

________

65

________

70

________

75

________

80

________

PART II

DEFERRED ANNUITY RATES
$10 Monthly Deferred Life Annuity (120 n ä(12) x)
(without death benefit or surrender value)

Exact Age
of Annuitant

Deferred to Exact Age 65
Male

30
35
40
45
50
55
60

Female

PART III
1.
Please indicate the MINIMUM plan termination or ASC 715settlement consideration per
case that you are currently willing to accept on the basis illustrated.
a.
/ / Over $25 million
b.
/ / Over $10 million but not more than $25 million
c.
/ / Over $5 million but not more than $10 million
d.
/ / Over $1 million but not more than $5 million
e.
/ / Over $500 thousand but not more than $1 million
f.
/ / Not more than $500 thousand
2.

a.
b.
c.
d.
e.
f.

Assuming the investment climate remains unchanged, please indicate the MAXIMUM
amount of plan termination or ASC 715settlement business (not necessarily in one
transaction) that you would be willing to accept during the next quarter on the basis
illustrated.
/ / Over $250 million
/ / Over $100 million but not more than $250 million
/ / Over $50 million but not more than $100 million
/ / Over $20 million but not more than $50 million
/ / Over $5 million but not more than $20 million
/ / Not more than $5 million

PART IV
1.
Please indicate the TOTAL VOLUME of plan termination and ASC 715settlement
business that your company wrote during the quarter ending on the Date of Illustration.
a.
/ / Over $250 million
b.
/ / Over $100 million but not more than $250 million
c.
/ / Over $50 million but not more than $100 million
d.
/ / Over $20 million but not more than $50 million
e.
/ / Over $5 million but not more than $20 million
f.
/ / Not more than $5 million
g.
/ / None
2.
Have you changed any assumptions underlying the prices in the past quarter? (Circle Yes
or No)
Mortality
Expenses
Other

Yes / No
Yes / No
Yes / No

3.

Did you participate in the PBGC survey in the previous year?
/ / Yes
/ / No

4.

Is the current value of your company’s annuity portfolio greater than $5 billion?
/ / Yes
/ / No