The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete. | |||||||||||||||||
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM D Notice of Exempt Offering of Securities |
|
1. Issuer's Identity
CIK (Filer ID Number) | Previous Names |
| Entity Type | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
0001780188 |
Insurance Company Separate Account | ||||||||||||||
Name of Issuer | |||||||||||||||
Group Variable Annuity Series I Separate Account | |||||||||||||||
Jurisdiction of Incorporation/Organization | |||||||||||||||
ILLINOIS | |||||||||||||||
Year of Incorporation/Organization | |||||||||||||||
|
2. Principal Place of Business and Contact Information
Name of Issuer | |||
---|---|---|---|
Group Variable Annuity Series I Separate Account | |||
Street Address 1 | Street Address 2 | ||
1299 ZURICH WAY | |||
City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer |
SCHAUMBURG | ILLINOIS | 60196 | 425-577-5100 |
1. Issuer's Identity
CIK (Filer ID Number) | Previous Names |
| Entity Type | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
0000351754 |
|
| ||||||||||||||
Name of Issuer | ||||||||||||||||
Zurich American Life Insurance Co | ||||||||||||||||
Jurisdiction of Incorporation/Organization | ||||||||||||||||
ILLINOIS | ||||||||||||||||
Year of Incorporation/Organization | ||||||||||||||||
|
2. Principal Place of Business and Contact Information
Name of Issuer | |||
---|---|---|---|
Zurich American Life Insurance Co | |||
Street Address 1 | Street Address 2 | ||
1299 Zurich Way | |||
City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer |
SCHAUMBURG | ILLINOIS | 60196 | 425-577-5100 |
3. Related Persons
Last Name | First Name | Middle Name |
---|---|---|
Fike | David | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
President & Chief Executive Officer of Zurich American Life Insurance Company (ZALICO)Last Name | First Name | Middle Name |
---|---|---|
Tengtio | Oscar | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President, Treasurer and Chief Financial Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Lazarczyk | Laura | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | X | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director, Vice President, General Counsel and Corporate Secretary of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Hauser | Richard | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director and Assistant Secretary of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Ehrlich | Cathy | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Illustration Actuary of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Rohwetter | Michael | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President and Chief Investment Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Knipfer | Mark | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Dampman | Dave | |
Street Address 1 | Street Address 2 | |
7045 College Boulevard | ||
City | State/Province/Country | ZIP/PostalCode |
Overland Park | KANSAS | 66211 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President, Operations of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Thomas | Juanita | |
Street Address 1 | Street Address 2 | |
5962 Cross Pointe Drive | ||
City | State/Province/Country | ZIP/PostalCode |
Oldsmar | FLORIDA | 34677 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President and 38a-1 Chief Compliance Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Kleinman | Ira | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Broek | Debra | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Fike | David | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Executive Vice President of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Rehman | Farah | |
Street Address 1 | Street Address 2 | |
200 Sam Houston Parkway | ||
City | State/Province/Country | ZIP/PostalCode |
Houston | TEXAS | 77042 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President and Responsible Officer, Illustrations of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Pietroluongo | Louis | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Director of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Page | Adam | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Chief Information Security Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Hirs | Peter | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | Executive Officer | X | Director | Promoter |
---|
Clarification of Response (if Necessary):
Chairman of the Board of Directors of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Daniel | Bob | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Controller of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Dunajewski | Stefan | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President and Chief Actuary of ZALICOLast Name | First Name | Middle Name |
---|---|---|
McNamara | Eoin | |
Street Address 1 | Street Address 2 | |
4 World Trade Center | ||
City | State/Province/Country | ZIP/PostalCode |
New York | NEW YORK | 10007 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Vice President and Chief Risk Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Larson | Jane | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Chief Compliance Officer of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Junus | Novian | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Appointed Actuary of ZALICOLast Name | First Name | Middle Name |
---|---|---|
Falco | Rita | |
Street Address 1 | Street Address 2 | |
1299 Zurich Way | ||
City | State/Province/Country | ZIP/PostalCode |
Schaumburg | ILLINOIS | 60196 |
Relationship: | X | Executive Officer | Director | Promoter |
---|
Clarification of Response (if Necessary):
Secretary of ZALICO4. Industry Group
|
|
|
5. Issuer Size
Revenue Range | OR | Aggregate Net Asset Value Range | ||
---|---|---|---|---|
No Revenues | No Aggregate Net Asset Value | |||
$1 - $1,000,000 | $1 - $5,000,000 | |||
$1,000,001 - $5,000,000 | $5,000,001 - $25,000,000 | |||
$5,000,001 - $25,000,000 | $25,000,001 - $50,000,000 | |||
$25,000,001 - $100,000,000 | $50,000,001 - $100,000,000 | |||
Over $100,000,000 | Over $100,000,000 | |||
X | Decline to Disclose | Decline to Disclose | ||
Not Applicable | Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
|
|
7. Type of Filing
New Notice | Date of First Sale | 2019-08-29 | First Sale Yet to Occur | ||||||
X | Amendment |
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? |
|
9. Type(s) of Securities Offered (select all that apply)
Equity | Pooled Investment Fund Interests | ||
Debt | Tenant-in-Common Securities | ||
Option, Warrant or Other Right to Acquire Another Security | Mineral Property Securities | ||
Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security | X | Other (describe) | |
Interests in ZALICO's Group Variable Annuity Series I Separate Account issued pursuant to group variable annuities. |
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? |
|
Clarification of Response (if Necessary):
11. Minimum Investment
Minimum investment accepted from any outside investor | $3,000,000 | USD |
12. Sales Compensation
Recipient |
| ||||||
Meyer-Chatfield | None | ||||||
|
| ||||||
J. Alden Associates, Inc. | 40002 | ||||||
Street Address 1 | Street Address 2 | ||||||
---|---|---|---|---|---|---|---|
261 Old York Road | |||||||
City | State/Province/Country | ZIP/Postal Code | |||||
Jenkintown | PENNSYLVANIA | 19046 | |||||
|
| ||||||
13. Offering and Sales Amounts
Total Offering Amount | USD |
| ||||
Total Amount Sold | $128,000,000 | USD | ||||
Total Remaining to be Sold | USD |
|
Clarification of Response (if Necessary):
14. Investors
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering. | |||
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: |
|
15. Sales Commissions & Finder's Fees Expenses
Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions | $1,280,000 | USD |
| ||
Finders' Fees | $0 | USD |
|
Clarification of Response (if Necessary):
16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
$0 | USD |
|
Clarification of Response (if Necessary):
Zurich American Life Insurance Company deducts charges from premium and contract values per terms of applicable annuity contract.Signature and Submission
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission
In submitting this notice, each issuer named above is: |
|
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
X | I also am a duly authorized representative of the other issuer(s) identified in Item 1 above and authorized to sign on their behalf. |
Issuer | Signature | Name of Signer | Title | Date |
---|---|---|---|---|
Group Variable Annuity Series I Separate Account | Dave Dampman | Dave Dampman | Vice President | 2021-08-09 |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.