reliant life share case...

Reliant Life Shares Case Summary™

Confidential Investor Policy

Ameritas Life Ins. Corp.

Policy #: U00003278A

THIS IS A CONFIDENTIAL DOCUMENT FOR EXPRESS USE BY RELIANT LIFE SHARES CLIENTS AND AGENTS ONLY.

THIS DOCUMENT CONTAINS CONFIDENTIAL MEDICAL INFORMATION. ANY DISSEMINATION OR USE OF THE

INFORMATION CONTAINED HEREIN IS EXPRESSLY PROHIBITED UNDER CALIFORNIA LAW WITH THE EXECPTION

OF DISSEMINATION OF WHICH IS NECESSARY TO EFFECT THE SALE OF THIS POLICY.

Carrier’s Information

Carrier: Ameritas Life Ins. Corp. Policy #: U00003278A

Carrier Rating: Std. & Poor’s - A+(Superior) Policy Issue Date: 08-05-2009

Policy Type: Universal Life Death Benefit: $4,950,000

Annual Premiums: $216,000 Date Premiums Due: Annually on 08-05

Insured’s Information

Age: 77 (Age Nearest) Gender: Female

DOB: 11/22/1936 Life Expectancy 5 Years (60 months)

Summary of Medical Condition

The insured is a 76 year-old female. Her medical history is significant for Gastroesophageal Reflux Disease and Barrett Esophagus. She had abdominal surgery in June 2012 with Cholecystectomy, repair of Hiatal Hernia and Nissan Fundoplication. She has a history of Migraine Headaches and Fibromyalgia. She has a history of Atherosclerosis, Valvular Heart Disease and Thoracic Aortic Aneurysm. Her Cardiovascular-Cerebrovascular Comorbidities include Age, Postmenopausal Female, Dyslipidemia, Hypertension, Dyspnea, and Inflammatory Processes. She has a history of Degenerative Disease in her knees, back and shoulders with failed knee replacements and Osteopororsis. She is being treated for chronic bronchitis and asthma. Her Family History is significant for Cancer and Heart Disease. Medications include Zolpidem Tartrate (Ambien), Albuterol Sulfate, Nebulizer Devi, Protonix (Pantoprazole Sodium), Simvastatin, Proair HFA, Zestril (Lisinopril), Digoxin, Zantac, Zithromax (Azithromycin), Promethazine Codeine and Vitamins and Supplements.

Premium Payments and Investor’s Fixed Return

Total Premiums Due:

Reliant Life Shares will escrow the amount of $800,000 based upon a Life Expectancy of 5 years (60 months) plus a 12 month reserve for a total of 6 years (72 months). All funds will be deposited in the Premium Reserve Account controlled by Christiana Trust.

Total Fixed Return:

Based on an initial investment of $100,000, the Total Fixed Return is 100% or $200,000. Based upon a projected Life Expectancy of 5 years plus a 1 year reserve for a total of 6 years, the Annual Return is 16.66% if the insured passes at the end of the 72nd month.

Scott Grady

Highlight

Andersen Consulting, LLC Life Expectancy Certificate

DATE: 5/29/2013 PATIENT: SS#: D.O.B.: 11/22/1936 AGE: 77 SEX: Female PRIMARY DIAGNOSIS: Atherosclerosis, Valvular Heart Disease, Syncope, Thoracic Aortic Aneurysm, Dyslipidemia, Hypertension, Dyspnea, Palpitations, Gastroesophageal Reflux Disease, Peptic Ulcer Disease, Colon Polyps, Cholecystitis, Diverticulosis, Asthma, Allergic Rhinitis, Migraine Syndrome, Degenerative Joint Disease, Degenerative Disc Disease, Osteoarthritis, Osteoporosis, Fibromyalgia, Basal Cell Carcinoma, and Cataracts

SUMMARY OF DIAGNOSES & RISK STRATIFICATION

Subject is a 77 year old 5'5" 158 lbs Caucasian female found to have ongoing medical diagnoses, which currently do not indicate a life threatening scenario. Her medical history is significant for Atherosclerosis including Valvular Heart Disease. An Echocardiogram (05/12) showed ejection fraction of 67% with moderate aortic regurgitation, mild mitral regurgitation, and trace tricuspid regurgitation. She has calcification of tri leaflet aortic valve as well as mitral valve annulus calcification. She has a thoracic aortic aneurysm as well as mild calcification of aorta. Her EKG (06/12) showed a sinus rhythm at 60. She has a history of vasovagal syncope (07/12) secondary to stress. A CT showed chronic small vessel ischemic changes of brain (07/12). She has a history of palpitations. Her Cardiovascular-Cerebrovascular Comorbidities include Age, Postmenopausal Female, Dyslipidemia, Hypertension, Dyspnea, and Inflammatory Processes. She has a history of migraine syndrome. She has asthma and allergic rhinitis, medically managed. She has a long standing history of Gastroesophageal Reflux Disease with a Barrett’s Esophagus. She has been managed for Peptic Ulcer Disease, Diverticulosis, and gastric ulcer. She has a history of Hiatal Hernia. She has a history of a benign colon polyp (06/10). She has a history of Cholecystitis/Cholelithiasis s/p Cholecystectomy (06/12). She is managed for Fibromyalgia. She has multilevel Osteoarthritic Degenerative Joint Disease s/p failed knee replacement. She has Degenerative Disc Disease and Osteoporosis of lumbar spine with resultant chronic low back pain. She has Scoliosis. She has a history of Basal Cell Carcinoma as well as precancerous dermatologic lesions. She is s/p Cataract extraction and repair of a retinal tear of left eye. Her Mammogram (10/09) was benign. Surgical History: Right Total Knee Replacement with revision x 3; Colonoscopy s/p Polypectomy (06/10); Mohs Procedure for Skin Cancer; Cataract Extraction; Left Retinal Tear Repair; Bladder Suspension; Appendectomy; Breast Surgery with Benign Findings; Hysterectomy with Bilateral Salpingo Oophorectomy; Cholecystectomy (06/12)

Laboratory Data: • 02/13: Blood Urea Nitrogen 21 mg/dL

• 07/11: Glomerular Filtration Rate 51.6 mL/min/1.73 m²

Lipid Studies

• 02/13: Cholesterol 289 mg/dL, Triglycerides 310 mg/dL, HDL-Cholesterol 56 mg/dL, LDL-Cholesterol 171 mg/dL, Cholesterol/HDL-Cholesterol Risk Ratio 5.2



Social History: Widow; children; quit tobacco ’59; negative for alcohol and exercise Family History: Significant for Heart Disease and Cancer Medications Listed: Aspirin, Antibiotics, Albuterol, Carafate, Digoxin, Lyrica, Cymbalta, Lisinopril/HCTZ, Procar, Pulmicort, Percocet, Prilosec, Simvastatin, Reclast, Prednisone, Vicodin, Voltaren, Ultracet, Zantac, Zocor, Zestoretic, Zofran, and Vitamins and Supplements Given the age of the subject and her medical management with compliance her projected LE would be 60 months on available information. This does not mean that Ms. will not die sooner, nor live longer than the time frame indicated. Clearly the risk factors summarized above have mortality implications. This review was compiled solely for and may not be used by any other company.

Signed: ARDEN B. ANDERSEN, D.O., PhD, M.S.P.H., DIRECTOR OF MEDICAL REVIEWS Please note: A Life Expectancy cannot be precisely determined for any specific patient, but rather is the average life expectancy of a large group of patients with similar clinical and individual profiles. No one can guarantee or warrant the accuracy of any patient’s precise life expectancy. The information contained in this facsimile is privileged and confidential information for the use of the individual or entity named.

Scott Grady

Rectangle

15260 Ventura Blvd., Suite 1420, Sherman Oaks, CA 91403 • 818-788-1904 •www.ReliantLifeShares.com

SOCIAL SECURITY ADMINISTRATION’S LIFE EXPECTANCY CALCULATOR

As part of our commitment to transparency, we have attached the following life expectancy estimate for the insured using the Social Security Administration’s Life Expectancy Calculator (http://www.ssa.gov/OACT/population/longevity.html). Please note that the Social Security Administration’s calculation is based strictly on gender and date of birth and shows the average age of death for a male or female. It does not take into account health and social information such as a person’s medical condition, medical history, family medical history, lifestyle choices such as drinking smoking, etc., or any other factor that may affect the actual life expectancy of the insured.

http://www.ssa.gov/OACT/population/longevity.html

Skip to content

Social Security Online Retirement & Survivors BenefitsOffice of the Chief Actuary

Change Gender/Date of BirthLife Expectancy Home PageRetirement PlannerRetirement EstimatorSurvivors PlannerOther Things to ConsiderApply for Benefits Online

Life Expectancy Calculator

The following table lists the average number of additional years a female born on November 22, 1936, can expect to live when she reaches a specific age.

At Age

Additional Life Expectancy

(in years)Estimated Total

Years

76 and 8 monthsa

12.3 89.0

a Your current age.

Note: The estimates of additional life expectancy:

• do not take into account a wide number of factors such as current health, lifestyle, and family history that could increase or decrease life expectancy.

• are based on◦ the gender and date of birth you entered (your cohort) and◦ information from our cohort life expectancy tables.

(Some of the information can be found in the 2013 Trustees Report.)

Page 1 of 1Retirement & Survivors Benefits: Life Expectancy Calculator

http://www.ssa.gov/cgi-bin/longevity.cgi

Reliant Life Shares - Life Settlement Disclosure Form

RELIANT LIFE SHARES, LLC

LIFE SETTLEMENT DISCLOSURE FORM – Policy # U00003278A

SET FORTH BELOW IS INFORMATION REQUIRED BY CALIFORNIA LAW TO BE DISCLOSED TO PURCHASERS OF

LIFE SETTLEMENT INTERESTS. ADDITIONAL REQUIRED DISCLOSURES ARE CONTAINED IN THE PURCHASE

AGREEMENT THAT YOU HAVE EXECUTED.

1. INFORMATION ABOUT THE INSURED

The insured is currently a 77 year-old (Age Nearest) Female (DOB: 11/22/1936).

2. INFORMATION ABOUT THE INSURANCE COMPANY ISSUING THE POLICY

The insurance company that issued the policy that is described below is as follows:

Ameritas Life Insurance Corp.

1876 Waycross Road

Cincinnati, OH 45240

Tel: (800) 319-6901

3. INFORMATION ABOUT THE REGULATOR OF THE INSURANCE COMPANY

The State or foreign country regulator of the insurance company that issued the policy is:

The Ohio Department of Insurance

50 W. Town Street

Third Floor - Suite 300

Columbus, Ohio 43215

(614) 644-2658

4. GENERAL INSURANCE POLICY INFORMATION

The insurance policy number is: U00003278A

This policy was originally issued on 08-05-2009

This policy is a Universal Life policy.

5. INSURANCE FACE VALUE, POLICY OWNERSHIP & PURCHASE INFORMATION

The total face value of this policy is $4,950,000.

You are purchasing ____% of the death benefit payable under this policy.

You are purchasing ____% of ownership of this policy.


6. INFORMATION APPLICABLE IF THIS IS A GROUP POLICY

X This policy is not a group policy

_ This policy is a group policy. The name, address and telephone number of the group is as

follows:

Name: ____________________________________________

Address: ____________________________________________

____________________________________________

Telephone: ____________________________________________

You should be aware that material terms and conditions govern the conversion of this group

policy to an individual policy. This information is as follows:

Should premiums on this policy increase upon such conversion, the premiums due on this policy

would increase from $________________ on a(n) _______________________ basis to

$________________ on a(n) _______________________ basis upon any such conversion. This

information is based on current conversion rates that apply to this policy, which may be different at the

time of any such conversion.

Material terms and conditions of which you should be aware are as follows:

______________________________________________________________________________

_____________________________________________________________________________________

_______________________________________________________________________

7. INFORMATION APPLICABLE IF THIS IS A TERM POLICY

X This Policy is not a term policy.

_ This policy is a term policy. The term of this policy is: ____________________________

and the person responsible for renewing this policy, if necessary, is as follows:

____________________________________________________________________________

_____________________________________________________________________________________

_______________________________________________________________________

8. INFORMATION APPLICABLE IF THIS IS A ‘SECOND TO DIE’ POLICY

X This is not a “second to die” policy.

The total fixed return on this purchase is 100%. Based upon your investment of

_____________ you will receive _____________ upon maturity.

_ This policy is a “second to die” policy that will not reach maturity until both insured have died.


9. PAYMENT OF POLICY PREMIUMS

Funds will be escrowed in the amount of $800,000 to pay the premiums due on this policy as required

by the insurance company to keep the policy in-force for 6.0 years, and will be paid by the Trustee,

Christiana Trust, in accordance with the terms set forth in the Life Settlement Purchase Agreement.

In the event the premium reserves described in the Life Settlement Purchase Agreement are exhausted,

only then will Purchaser be responsible for a payment of their pro-rata share of any unpaid premiums

that become due to keep this policy in force.

10. INFORMATION ABOUT THE CONTESTIBILITY OF THIS POLICY

This policy is beyond the state statute for contestability because the required amount of time has

elapsed since the original date of issue of this policy or the insurance company that issued this policy has

waived the contestability provision in writing.

11. POLICY OWNER

This policy will be owned by:

Reliant Life Shares Series Trust, 2013-5

Trustee: Christiana Trust, a division of WSFS Bank

500 Delaware Avenue 11th Floor

Post Office Box 957 | Wilmington, DE 19801

P: 302-573-3239 F: 302-421-9137

www.christianatrust.com

http://www.christianatrust.com/


I have reviewed this Life Settlement Disclosure Form and wish to purchase the Interest described herein.

LIFE SETTLEMENT PURCHASER(S)

_______________________________

Signature

________________________________

Printed Name Printed Name

________________________________

Social Security or Tax ID#

________________________________

Address

________________________________

City, State, Zip

________________________________

Telephone Number

________________________________

Facsimile Number

LIFE SETTLEMENT PURCHASER(S)

_______________________________

Signature

________________________________

Printed Name Printed Name

________________________________

Social Security or Tax ID#

________________________________

Address

________________________________

City, State, Zip

________________________________

Telephone Number

________________________________

Facsimile Number

Bill Carberry

Sign Here

PROJECTIONS FOR POLICY U00003278A

Death BenefitInvestment

AmountOwnership Percentage

Death Benefit Owned

Life Expectancy (in years)

Escrowed Premiums

per this investor

Gain on Investment

@ Life Expectancy

Total Return Percentage

Premiums Reserved starting 8/1/13

$4,950,000 $100,000 4.040% $200,000 5.00000 $32,324 $100,000 100.000% $800,000

Insured age (nearest) 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93

COI - Premiums

Year 1

COI - Premiums

Year 2

COI - Premiums

Year 3

COI - Premiums

Year 4

COI - Premiums

Year 5

COI - Premiums

Year 6

COI - Premiums

Year 7

COI - Premiums

Year 8

COI - Premiums

Year 9

COI - Premiums Year 10








$290,578 $92,156 $106,855 $124,145 $144,486 $92,447 $154,913 $216,000 $216,000 $216,000 $216,000 $216,000 $216,000 $216,000 $216,000 $216,000 $216,000

RETURN ON INVESTMENT

Date Year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Start Date: 8/1/2013

Initial Investment ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000) ($100,000)

$200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $200,000

$0 $0 $0 $0 $0 $0 ($6,196) ($14,836) ($23,476) ($32,116) ($40,756) ($49,396) ($58,036) ($66,676) ($75,316) ($83,956) ($92,596)Cash Inflow to Investor

$200,000 $200,000 $200,000 $200,000 $200,000 $200,000 $193,804 $185,164 $176,524 $167,884 $159,244 $150,604 $141,964 $133,324 $124,684 $116,044 $107,404

$100,000 $100,000 $100,000 $100,000 $100,000 $100,000 $93,804 $85,164 $76,524 $67,884 $59,244 $50,604 $41,964 $33,324 $24,684 $16,044 $7,404

100.00% 50.00% 33.33% 25.00% 20.00% 16.67% 13.40% 10.65% 8.50% 6.79% 5.39% 4.22% 3.23% 2.38% 1.65% 1.00% 0.44%

The estimated premium calculations noted above are based on policy illustrations provided by the insurance carrier as of August 1, 2013. Since both the illustrated premiums and future cost of insurance (COI) are not guaranteed by the insurance carrier, they cannot be relied on to be 100% accurate. Reliant Life Shares LLC believes the illustrated premiums and MAPS generated figures to be reliable and calculated based on current industry standards; however, it cannot guarantee them because they are based on specific carrier & policy performance over future years.

Premium reserves for 6 years (life expectancy + 1 year) start on 8/1/13. There is no premium refund on this policy if the insured passes away early. Pro Rata premium calls shown in any particular year are cumulative, hence the amount due in each year is likely substantially lower than the cumulative number shown.

This sample sheet assumes an estimated $100,000 investment. Please note that each investor's actual investment amount will be reflected in the investor documents.

Investor Death Benefit

MINUS Premium Call (if applicable)

Gain on Investment

Return on investment (ROI)

15260 Ventura Blvd., Ste. 1420, Sherman Oaks, CA 91403 • 818-788-1904 • www.ReliantLifeShares.com

reliant life share case...

Documents