The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete.
The reader should not assume that the information is accurate and complete. |
| UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM D
Notice of Exempt Offering of Securities
| | OMB APPROVAL | | OMB Number: | 3235-0076 | | Estimated average burden | | hours per response: | 4.00 | | |
1. Issuer's Identity
| CIK (Filer ID Number) | Previous Names | | Entity Type |
| 0001170473 | | HARTFORD LIFE INSURANCE CO ICMG SERIES IV |
| | | Corporation | | | Limited Partnership | | | Limited Liability Company | | | General Partnership | | | Business Trust | | X | Other (Specify) |
Series IV, IVA, IVB, IVC, IVD, IVE, IVF, IVG, IVH, IVJ, IVK, IVL, IVV |
| Name of Issuer |
|---|
| TALCOTT RESOLUTION LIFE INSURANCE CO ICMG SERIES IV |
| Jurisdiction of Incorporation/Organization |
|---|
| CONNECTICUT |
| Year of Incorporation/Organization |
|---|
| X | Over Five Years Ago | | | Within Last Five Years (Specify Year) | | | | Yet to Be Formed | |
2. Principal Place of Business and Contact Information
| Name of Issuer |
|---|
| TALCOTT RESOLUTION LIFE INSURANCE CO ICMG SERIES IV |
| Street Address 1 | Street Address 2 |
| TALCOTT RESOLUTION LIFE INSURANCE CO | ONE GRIFFIN ROAD |
| City | State/Province/Country | ZIP/PostalCode | Phone Number of Issuer |
| WINDSOR | CONNECTICUT | 06095 | 800-862-6688 |
3. Related Persons
| Last Name | First Name | Middle Name |
| TALCOTT RESOLUTION LIFE INSURANCE CO | - |
| Street Address 1 | Street Address 2 |
| ONE GRIFFIN ROAD NORTH |
| City | State/Province/Country | ZIP/PostalCode |
| WINDSOR | CONNECTICUT | 06095 |
| Relationship: | | Executive Officer | | Director | X | Promoter |
Clarification of Response (if Necessary):
4. Industry Group
| | Agriculture | | Banking & Financial Services | | | | Commercial Banking | | | Insurance | | | Investing | | | Investment Banking | | X | Pooled Investment Fund | | | | Hedge Fund | | | Private Equity Fund | | | Venture Capital Fund | | X | Other Investment Fund | | | Is the issuer registered as
an investment company under
the Investment Company
Act of 1940? | | | | | Other Banking & Financial Services | | | | Business Services | | Energy | | | | | | | | | | | | | | | Health Care | | | | | | | | | | | | | Manufacturing | | Real Estate | | | | | | | | | | | | | Retailing | | Restaurants | | Technology | | | | | | | | Travel | | | | | | | | Tourism & Travel Services |
| | | | Other | |
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 |
| | Decline to Disclose | X | Decline to Disclose |
| | Not Applicable | | Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
| | | Rule 504(b)(1) (not (i), (ii) or (iii)) | | | | Rule 504 (b)(1)(i) | | | | Rule 504 (b)(1)(ii) | | | | Rule 504 (b)(1)(iii) | | | X | Rule 506(b) | | | | Rule 506(c) | | | | Securities Act Section 4(a)(5) | | | | Investment Company Act Section 3(c) |
| | | Section 3(c)(1) | | Section 3(c)(9) |
| | | Section 3(c)(2) | | Section 3(c)(10) |
| | | Section 3(c)(3) | | Section 3(c)(11) |
| | | Section 3(c)(4) | | Section 3(c)(12) |
| | | Section 3(c)(5) | | Section 3(c)(13) |
| | | Section 3(c)(6) | | Section 3(c)(14) |
| | |
7. Type of Filing
| | New Notice | | Date of First Sale | 2005-09-30 | | | 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 | X | 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) |
| VARIABLE LIFE INSURANCE CONTRACT |
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 | $0 | USD |
12. Sales Compensation
| Recipient | | Recipient CRD Number | | None |
|
| AXA Advisors LLC | 6627 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| HENRY THOMAS | 1186107 |
| Street Address 1 | Street Address 2 |
| 4521 CRUMS MILL RD |
| City | State/Province/Country | ZIP/Postal Code |
| HARRISBURG | PENNSYLVANIA | 17112 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| BB&T INVESTMENT SERVICES | 33856 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JAMES FARMER | 204568 |
| Street Address 1 | Street Address 2 |
| 200 SOUTH COLLEGE ST. | 8TH FLOOR |
| City | State/Province/Country | ZIP/Postal Code |
| CHARLOTTE | NORTH CAROLINA | 28202 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| BUCK KWASHA SECURITIES LLC | 135474 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| WILLIAM J BOWDEN | 1923641 |
| Street Address 1 | Street Address 2 |
| 200 GALLERIA PARKWAY | SUITE 1900 |
| City | State/Province/Country | ZIP/Postal Code |
| ATLANTA | GEORGIA | 30339 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| CLARK SECURITIES INC. | 43803 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| CHRISTOPHER PARKER | 2739646 |
| Street Address 1 | Street Address 2 |
| 2100 ROSS AVE | SUITE 2200 |
| City | State/Province/Country | ZIP/Postal Code |
| DALLAS | TEXAS | 75201 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| EXECUTIVE SERVICES SECURITIES, INC | 25299 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| ANDREW MCGINNIS | 3126380 |
| Street Address 1 | Street Address 2 |
| 3445 PEACHTREE RD., NE | SUITE 200 |
| City | State/Province/Country | ZIP/Postal Code |
| ATLANTA | GEORGIA | 30326 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| FAS CORP | 43536 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JIM MCKEONE | 2921833 |
| Street Address 1 | Street Address 2 |
| 4747 WEST 135TH ST | SUITE 100 |
| City | State/Province/Country | ZIP/Postal Code |
| LEAWOOD | KANSAS | 66224 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| FPCM SECURITIES, LLC | 38283 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JIM VAN EPPS | 844958 |
| Street Address 1 | Street Address 2 |
| 140 BROADWAY | 21ST FLOOR |
| City | State/Province/Country | ZIP/Postal Code |
| NEW YORK | NEW YORK | 10005 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| ALABAMA | | CALIFORNIA | | CONNECTICUT | | DELAWARE | | FLORIDA | | GEORGIA | | ILLINOIS | | INDIANA | | MINNESOTA | | PENNSYLVANIA | | RHODE ISLAND | | VIRGINIA | |
| Recipient | | Recipient CRD Number | | None |
|
| J. ALDEN ASSOCIATES | 40002 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| BENNETT MEYER | 1495939 |
| Street Address 1 | Street Address 2 |
| 261 OLD YORK RD | SUITE 837 |
| City | State/Province/Country | ZIP/Postal Code |
| JENKINTOWN | PENNSYLVANIA | 19046 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CONNECTICUT | | DELAWARE | | INDIANA | | MISSOURI | | NEW JERSEY | |
| Recipient | | Recipient CRD Number | | None |
|
| J. ALDEN ASSOCIATES | 40002 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JOHN ANTOLIK | 4290393 |
| Street Address 1 | Street Address 2 |
| 261 OLD YORK RD | SUITE 837 |
| City | State/Province/Country | ZIP/Postal Code |
| JENKINTOWN | PENNSYLVANIA | 19406 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CONNECTICUT | | DELAWARE | | INDIANA | | MISSOURI | | NEW JERSEY | |
| Recipient | | Recipient CRD Number | | None |
|
| J. ALDEN ASSOCIATES | 40002 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| STEVEN GOLDBERG | 2890212 |
| Street Address 1 | Street Address 2 |
| 261 OLD YORK RD | SUITE 837 |
| City | State/Province/Country | ZIP/Postal Code |
| JENKINTOWN | PENNSYLVANIA | 19406 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CONNECTICUT | | DELAWARE | | INDIANA | | MISSOURI | | NEW JERSEY | |
| Recipient | | Recipient CRD Number | | None |
|
| J. ALDEN ASSOCIATES | 40002 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| WILLIAM CHATFIELD | 1053051 |
| Street Address 1 | Street Address 2 |
| 261 OLD YORK RD | SUITE 837 |
| City | State/Province/Country | ZIP/Postal Code |
| JENKINTOWN | PENNSYLVANIA | 19406 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CONNECTICUT | | DELAWARE | | INDIANA | | MISSOURI | | NEW JERSEY | |
| Recipient | | Recipient CRD Number | | None |
|
| M HOLDINGS SECURITIES, INC | 43285 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| CHARLES HOVORKA | 1563256 |
| Street Address 1 | Street Address 2 |
| 1125 N.W.COUCH ST | SUITE 900 |
| City | State/Province/Country | ZIP/Postal Code |
| PORTLAND | OREGON | 97209 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| M HOLDINGS SECURITIES | 43285 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JAMES M CLARY | 2081542 |
| Street Address 1 | Street Address 2 |
| 1125 N.W.COUCH ST | SUITE 900 |
| City | State/Province/Country | ZIP/Postal Code |
| PORTLAND | OREGON | 97209 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| NEWPORT GROUP SECURITIES, INC | 29722 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| BRYANT KIRK | 1049653 |
| Street Address 1 | Street Address 2 |
| 300 INTERNATIONAL PARKWAY | SUITE 270 |
| City | State/Province/Country | ZIP/Postal Code |
| HEATHROW | FLORIDA | 32746 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| DELAWARE | | NORTH CAROLINA | | OHIO | |
| Recipient | | Recipient CRD Number | | None |
|
| NFP ADVISORS, LLC | 42046 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| ROBERT LEEPER | 1635925 |
| Street Address 1 | Street Address 2 |
| 1250 CAPITOL OF TEXAS | HIGHWAY S.#2-125 |
| City | State/Province/Country | ZIP/Postal Code |
| AUSTIN | TEXAS | 78748 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| FLORIDA | | ILLINOIS | | VIRGINIA | |
| Recipient | | Recipient CRD Number | | None |
|
| PARK AVENUE SECURITIES | 46173 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| ROBERT SAUERTIG | 2113238 |
| Street Address 1 | Street Address 2 |
| 7 HANOVER SQUARE |
| City | State/Province/Country | ZIP/Postal Code |
| NEW YORK | NEW YORK | 10004 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| PRIVATE PLACEMENT INSURANCE PRODUCTS, LLC | 140139 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| MATT SCHOEN | 1279191 |
| Street Address 1 | Street Address 2 |
| 2754 BRANDT DRIVE SOUTH | SUITE 200 |
| City | State/Province/Country | ZIP/Postal Code |
| FARGO | NORTH DAKOTA | 58104 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| DELAWARE | | GEORGIA | | WASHINGTON | |
| Recipient | | Recipient CRD Number | | None |
|
| WJ LYNCH INVESTOR SERVICES, LLC | 140762 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| WILLIAM J LYNCH | 1060714 |
| Street Address 1 | Street Address 2 |
| 535 BOYLSTON ST | SUITE T2 |
| City | State/Province/Country | ZIP/Postal Code |
| BOSTON | MASSACHUSETTS | 02116 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CALIFORNIA | | DELAWARE | | GEORGIA | | MASSACHUSETTS | | SOUTH CAROLINA | |
| Recipient | | Recipient CRD Number | | None |
|
| UBS FINANCIAL SERVICES | 8174 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JAMES MADDEN | 2074516 |
| Street Address 1 | Street Address 2 |
| 1200 HARBOR BLVD |
| City | State/Province/Country | ZIP/Postal Code |
| WEEHAWKEN | NEW JERSEY | 07086 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| STERN CAPITAL, LLC | 131226 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| DEAN HAMILTON | 234908 |
| Street Address 1 | Street Address 2 |
| 708 THIRD AVE. | SUITE 1610 |
| City | State/Province/Country | ZIP/Postal Code |
| NEW YORK | NEW YORK | 10017 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| NORTHWESTERN MUTUAL INVESTMENT SERVICES, LLC | 2881 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JIM FOYT | 3152720 |
| Street Address 1 | Street Address 2 |
| 611 EAST WISCONSIN AVE. |
| City | State/Province/Country | ZIP/Postal Code |
| MILWAUKEE | WISCONSIN | 53202 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CALIFORNIA | | DELAWARE | | MAINE | |
| Recipient | | Recipient CRD Number | | None |
|
| NORTHWESTERN MUTUAL INVESTMENT SERVICES, LLC | 2881 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JOHN MILNE | 2393982 |
| Street Address 1 | Street Address 2 |
| 611 EAST WISCONSIN AVE. |
| City | State/Province/Country | ZIP/Postal Code |
| MILWAUKEE | WISCONSIN | 53202 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| NORTHWESTERN MUTUAL INVESTMENT SERVICES, LLC | 2881 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| WILLIAM BORCHERT | 1057817 |
| Street Address 1 | Street Address 2 |
| 611 EAST WISCONSIN AVE. |
| City | State/Province/Country | ZIP/Postal Code |
| MILWAUKEE | WISCONSIN | 53202 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| CALIFORNIA | | DELAWARE | | MAINE | |
| Recipient | | Recipient CRD Number | | None |
|
| INNOVATION PARTNERS, LLC | 146344 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JIM VAN EPPS | 844958 |
| Street Address 1 | Street Address 2 |
| 10930 CRABAPPLE ROAD | SUITE 206 |
| City | State/Province/Country | ZIP/Postal Code |
| ROSWELL | GEORGIA | 30075 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| ALABAMA | | CALIFORNIA | | CONNECTICUT | | DELAWARE | | FLORIDA | | GEORGIA | | ILLINOIS | | INDIANA | | MINNESOTA | | PENNSYLVANIA | | RHODE ISLAND | | VIRGINIA | |
| Recipient | | Recipient CRD Number | | None |
|
| CONDUENT SECURITIES, LLC | 135474 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| KRISTEN DAIEGLE | 2607706 |
| Street Address 1 | Street Address 2 |
| 9040 ROSWELL ROAD | SUITE 700 |
| City | State/Province/Country | ZIP/Postal Code |
| ATLANTA | GEORGIA | 30350 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| CAPACUITY SECURITIES, INC. | 15384 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| BRYANT KIRK | 1049653 |
| Street Address 1 | Street Address 2 |
| 300 INTERNATIONAL PARKWAY | #350 |
| City | State/Province/Country | ZIP/Postal Code |
| LAKE MARY | FLORIDA | 32746 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
| Recipient | | Recipient CRD Number | | None |
|
| KESTRA INVESTMENT SERVICES, LLC | 42046 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| JOSEPH TODD CARPENTER | 1096644 |
| Street Address 1 | Street Address 2 |
| 5707 SOUTHWEST PARKWAY | BUILDING 2, SUITE 400 |
| City | State/Province/Country | ZIP/Postal Code |
| AUSTIN | TEXAS | 78735 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
| FLORIDA | | ILLINOIS | | MINNESOTA | |
| Recipient | | Recipient CRD Number | | None |
|
| Buck HR Securities, Inc | 299842 |
| (Associated) Broker or Dealer | | None |
| | (Associated) Broker or Dealer CRD Number | | None |
|
| Kristin Daigle | 2607706 |
| Street Address 1 | Street Address 2 |
| 420 LEXINGTON AVENUE | SUITE 2220 |
| City | State/Province/Country | ZIP/Postal Code |
| NEW YORK | NEW YORK | 10170-2220 |
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States | | All States |
| |
|
13. Offering and Sales Amounts
| Total Offering Amount | | USD | |
| Total Amount Sold | $11,721,668,460 | 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 | $15,251,440 | USD | |
| Finders' Fees | $0 | USD | |
Clarification of Response (if Necessary):
Issuer pays Sales Commissions which are equal to a percentage of premium received by the Issuer.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.
Clarification of Response (if Necessary):
Sum of DAC and applicable premium taxSignature 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: |
- Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, in the accordance with applicable law, the information furnished to offerees.*
- Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against the issuer in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
- Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).
|
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.
| Issuer | Signature | Name of Signer | Title | Date |
| TALCOTT RESOLUTION LIFE INSURANCE CO ICMG SERIES IV | /s/ ANDREW MENSCH | ANDREW MENSCH | VP, LOMBARD INTERNATIONAL ADMINISTRATIVE SERVICES CO | 2022-02-24 |
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* 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.
