0001387847-16-000004.txt : 20160609 0001387847-16-000004.hdr.sgml : 20160609 20160609163323 ACCESSION NUMBER: 0001387847-16-000004 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b ITEM INFORMATION: Investment Company Act Section 3(c) ITEM INFORMATION: Section 3(c)(1) FILED AS OF DATE: 20160609 DATE AS OF CHANGE: 20160609 EFFECTIVENESS DATE: 20160609 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Lombard International Life Assurance Co Separate Account GVA 12 CENTRAL INDEX KEY: 0001387847 IRS NUMBER: 520795747 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-99315 FILM NUMBER: 161706371 BUSINESS ADDRESS: STREET 1: ONE LIBERTY PLACE STREET 2: 1650 MARKET STREET, 54TH FLOOR CITY: PHILADELPHIA STATE: PA ZIP: 19103 BUSINESS PHONE: 484-530-4800 MAIL ADDRESS: STREET 1: ONE LIBERTY PLACE STREET 2: 1650 MARKET STREET, 54TH FLOOR CITY: PHILADELPHIA STATE: PA ZIP: 19103 FORMER COMPANY: FORMER CONFORMED NAME: AGL LIFE ASSURANCE CO SEPARATE ACCOUNT GVA 12 DATE OF NAME CHANGE: 20070125 D/A 1 primary_doc.xml X0707 D/A LIVE 0001387847 Lombard International Life Assurance Co Separate Account GVA 12 ONE LIBERTY PLACE 1650 MARKET STREET, 54TH FLOOR PHILADELPHIA PA PENNSYLVANIA 19103 484-530-4800 PENNSYLVANIA AGL LIFE ASSURANCE CO SEPARATE ACCOUNT GVA 12 Other insurance company separate account true LILAC Lombard International Life Assurance Company One Liberty Place 1650 Market St., 54th Floor Philadelphia PA PENNSYLVANIA 19103 Promoter Issuer is an insurance company separate account formed under Pennsylvania insurance law. Pooled Investment Fund Other Investment Fund false Decline to Disclose 06b 3C 3C.1 true 9999999997-07-004233 2007-01-16 true true true group variable annuity contracts false 1000000 Innovation Partners, LLC 146344 Gerald R. Nowotny 1761926 5950 Fairview Rd. Suite 806 Charlotte NC NORTH CAROLINA 28210 DE DELAWARE false Royal Alliance Associates, Inc. 23131 Gerald R. Nowotny 1761926 One World Financial Center 15th Floor New York NY NEW YORK 10281 DE DELAWARE false United Securities Alliance, Inc. 36487 Gerald R. Nowotny 1761926 7720 E. Belleview Ave. Suite B103 Greenwood Village CO COLORADO 80111 DE DELAWARE false Indefinite 80263933 Indefinite false 3 47097 0 Issuer pays no sales commissions or finders' fees. LILAC pays all sales commissions from its corporate resources. 0 false Lombard International Life Assurance Co Separate Account GVA 12 /s/ John F Reilly John F Reilly Senior Vice President and Deputy General Counsel 2016-06-09