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efta-efta01109106DOJ Data Set 9Other

Summary of Coverage

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DOJ Data Set 9
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efta-efta01109106
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
Summary of Coverage Individual Life Insurance Coverage on Leon Black Split-Dollar Entity: AIF IV Management, Inc. Policy owner: Norman Brownstein, Trustee under the Leon D. Black Insurance Trust #1 dated September 13, 1999. These policies' registe dates are September 1999. Carrier Policy Number Amount of Coverage Normal Annual Premium Account Value 03-06-14 Net Cash Surrender Value 03-06-14 Split-Dollar Advance 03-06-14 Prudential VI 016 844 $30,000,000 $502,335 $5,507,071.88 $5,507,071.88 / $6,108,212 4X4 Equitable 49 232 126 $15,000,000 $264,894 $2,618,782.03 $2,608,605.48" $3,172,980 Security Life of Denver 610014742 $ 5.000.000 $ 96.380 $ 653,770.81 1!,553370.81 $1.180,138 Total—IndividualLifeInsurance Coverage _ $50,000,000 $863,609 $8,779,624.72 $8,769,448.17 $10,461,330 Second-to-Die, Wealth Transfer Life Insurance Coverage on Leon & Debra Black Split-Dollar Entity: AIF IV Management, Inc. Policy owner: Norman Brownstein, Trustee under the Leon D. Black Insurance Trust #2 dated September 13, 1999. These policies, other than the Prudential policy, have a register date of April 28, 1999 in order to save Debra's insurance age. (Prudential utilizes "current age" vs. "closest age", therefore backdating was not necessary and the register date for the Prudential policy is 9/13/99.) Carrier Policy Number Amount of Coverage Normal Annual Premium Account Value 03-06-14 Net Cash Surrender Value 03-06-14 Split-Dollar Advance 03-06-14 Prudential VO 001 958 $20,000,000 $179,595 $3,595,406.25 $3,595,406.25 $2,304,955 New York Life 75 500 858 $20,000,000 $196,080 S3,911,560.61 $3,907,639.01 $2,514,929 Pacific Lill VP 6089 7390 $ 5,010,000 $ 33,218 $ 609,880.70 $ 609,880.70 $424,480 John Hancock 20 039 301 $30,000,000 $359,022 $7,152,693.91 $7,152,693.91 54,622,974 AXA Equitable 49 232 123 $25.000.000 $205,246 $3,637,964.07 $3,636,204.99 $2,627,947 Total Second-to-Die Life Insurance Coverage $100,010,000 5973,161 518,907,505.54 518,901,824.86 512,495,285 This information has been taken from sources which we believe to be reliable, but there is no guarantee as to its accuracy. it is not a replacement for any account statement or transaction confirmation issued by the provider. Please compare this document to your custodial statement for accuracy, as applicable. Please refer to the prospectus and most recent annual report for further information. Transcription errors do not affect actual policy values. ••%Ara Dos SnseiM w Feb& laragenitADOINIork Ca•Vostieesar, 014SI. act EFTA01109106

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