0001568166-13-000001.txt : 20131015 0001568166-13-000001.hdr.sgml : 20131014 20131015093524 ACCESSION NUMBER: 0001568166-13-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b ITEM INFORMATION: Investment Company Act Section 3(c) ITEM INFORMATION: Section 3(c)(7) FILED AS OF DATE: 20131015 DATE AS OF CHANGE: 20131015 EFFECTIVENESS DATE: 20131015 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Philadelphia Financial Life Assurance Co Separate Account VA104 CENTRAL INDEX KEY: 0001568166 IRS NUMBER: 520795747 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-204495 FILM NUMBER: 131150561 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 D 1 primary_doc.xml X0707 D LIVE 0001568166 Philadelphia Financial Life Assurance Co Separate Account VA104 ONE LIBERTY PLACE 1650 MARKET STREET - 54TH FLOOR PHILADELPHIA PA PENNSYLVANIA 19103 484-530-4800 PENNSYLVANIA None None Other Insurance company separate account true 2013 PFLAC Philadelphia Financial Life Assurance Company One Liberty Place 1650 Market Street - 54th Floor Philadelphia PA PENNSYLVANIA 19103 Promoter Issuer is insurance company separate account authorized by PA insurance statute. Pooled Investment Fund Other Investment Fund false Decline to Disclose 06b 3C 3C.7 false 2013-10-09 true true true variable annuity contract false 0 M Holdings Securities, Inc. 43285 Ted Houghton 735581 M Financial Plaza 1125 NW Couch St., Suite 900 Portland OR OREGON 97209 TX TEXAS false Summit Equities, Inc. 11039 Don Gross 1913749 4 Campus Drive Parsippany NJ NEW JERSEY 07054 TX TEXAS false Indefinite 1232971 Indefinite false 1 4315 0 Issuer pays sales commissions which are equal to a percentage of premium received by the issuer. PFLAC pays additional compensation from its corporate resources. 0 false Philadelphia Financial Life Assurance Co Separate Account VA104 /s/ John F. Reilly John F. Reilly Vice President and Senior Counsel 2013-10-15