Form D Lombard International Life Assurance Co Separate Account Vl 246

Notice of Exempt Offering of Securities, items 06b, 3C, and 3C.7

Published: 2019-10-04 17:26:43
Submitted: 2019-10-04
Period Ending In: 2019-10-04
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SEC FORM D

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
X None
Entity Type
0001790374
   Corporation
   Limited Partnership
   Limited Liability Company
   General Partnership
   Business Trust
X Other (Specify)

insurance company separate account
Name of Issuer
Lombard International Life Assurance Co Separate Account VL 246
Jurisdiction of Incorporation/Organization
PENNSYLVANIA
Year of Incorporation/Organization
   Over Five Years Ago
X Within Last Five Years (Specify Year) 2019
   Yet to Be Formed

2. Principal Place of Business and Contact Information

Name of Issuer
Lombard International Life Assurance Co Separate Account VL 246
Street Address 1 Street Address 2
ONE LIBERTY PLACE 1650 MARKET ST., 54TH FLOOR
City State/Province/Country ZIP/PostalCode Phone Number of Issuer
PHILADELPHIA PENNSYLVANIA 19103 (484) 530-4800

3. Related Persons

Last Name First Name Middle Name
Lombard International Life Assurance Company LILAC
Street Address 1 Street Address 2
One Liberty Place 1650 Market St., 54th Floor
City State/Province/Country ZIP/PostalCode
Philadelphia PENNSYLVANIA 19103
Relationship:    Executive Officer    Director X Promoter

Clarification of Response (if Necessary):

Issuer is an insurance company separate account formed under Pennsylvania insurance law.

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?
   Yes X No
   Other Banking & Financial Services
   Business Services
Energy
   Coal Mining
   Electric Utilities
   Energy Conservation
   Environmental Services
   Oil & Gas
   Other Energy
Banking & Financial Services
   Biotechnology
   Health Insurance
   Hospitals & Physicians
   Pharmaceuticals
   Other Health Care
   Manufacturing
Banking & Financial Services
   Commercial
   Construction
   REITS & Finance
   Residential
   Other Real Estate
Retailing
Restaurants
Banking & Financial Services
   Computers
   Telecommunications
   Other Technology
Banking & Financial Services
   Airlines & Airports
   Lodging & Conventions
   Tourism & Travel Services
   Other Travel
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)
X 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)
X Section 3(c)(7)

7. Type of Filing

X New Notice Date of First Sale 2019-09-30    First Sale Yet to Occur
   Amendment

8. Duration of Offering

Does the Issuer intend this offering to last more than one year?
X Yes    No

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 contracts

10. Business Combination Transaction

Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer?
   Yes X No

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
Northwestern Mutual Investment Services, Inc. 2881
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Justin Charise 5175745
Street Address 1 Street Address 2
720 E. 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
   Foreign/non-US
ALASKA

13. Offering and Sales Amounts

Total Offering Amount USD
or X Indefinite
Total Amount Sold $500,000 USD
Total Remaining to be Sold USD
or X Indefinite

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:
1

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 $5,750 USD
   Estimate
Finders' Fees $0 USD
   Estimate

Clarification of Response (if Necessary):

Issuer pays sales commissions which are equal to a percentage of the premium received by the Issuer. LILAC will also pay sales commissions from its corporate resources.

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.

$10,020 USD
   Estimate

Clarification of Response (if Necessary):

Amount shown represents the total of all DAC tax, state premium tax, and underwriting charges.

Signature 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
Lombard International Life Assurance Co Separate Account VL 246 /s/ Paul Ryan Henry Paul Ryan Henry Senior Director & Counsel 2019-10-04

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.

* 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.


primary_doc.xml
Schema Version:
X0708
Submission Type:
D
Test Or Live:
LIVE

Primary Issuer

Cik
0001790374
Entity Name
Lombard International Life Assurance Co Separate Account VL 246

Issuer Address

Street1
ONE LIBERTY PLACE
Street2
1650 MARKET ST., 54TH FLOOR
City
PHILADELPHIA
State Or Country
PA
State Or Country Description
PENNSYLVANIA
Zip Code
19103
Issuer Phone Number
(484) 530-4800
Jurisdiction Of Inc
PENNSYLVANIA
Issuer Previous Name List
None
Edgar Previous Name List
None
Entity Type
Other
Entity Type Other Desc
insurance company separate account

Year Of Inc

Within Five Years
true
Value
2019

Related Person Info

Related Person Name

First Name
LILAC
Last Name
Lombard International Life Assurance Company

Related Person Address

Street1
One Liberty Place
Street2
1650 Market St., 54th Floor
City
Philadelphia
State Or Country
PA
State Or Country Description
PENNSYLVANIA
Zip Code
19103
Related Person Relationship List Relationship
Promoter
Relationship Clarification
Issuer is an insurance company separate account formed under Pennsylvania insurance law.

Offering Data

Industry Group

Industry Group Type
Pooled Investment Fund

Investment Fund Info

Investment Fund Type
Other Investment Fund
Is40 Act
false
Issuer Size Aggregate Net Asset Value Range
Decline to Disclose

Item

0
06b
1
3C
2
3C.7

Type Of Filing

New Or Amendment Is Amendment
false
Date Of First Sale
2019-09-30
Duration Of Offering More Than One Year
true

Types Of Securities Offered

Is Pooled Investment Fund Type
true
Is Other Type
true
Description Of Other Type
variable life insurance contracts

Business Combination Transaction

Is Business Combination Transaction
false
Minimum Investment Accepted
0

Recipient

Recipient Name
Northwestern Mutual Investment Services, Inc.
Recipient C R D Number
2881
Associated B D Name
Justin Charise
Associated B D C R D Number
5175745

Recipient Address

Street1
720 E. Wisconsin Ave.
City
Milwaukee
State Or Country
WI
State Or Country Description
WISCONSIN
Zip Code
53202

States Of Solicitation List

State
AK
Description
ALASKA
Foreign Solicitation
false

Offering Sales Amounts

Total Offering Amount
Indefinite
Total Amount Sold
500000
Total Remaining
Indefinite

Investors

Has Non Accredited Investors
false
Total Number Already Invested
1

Sales Commissions Finders Fees

Sales Commissions Dollar Amount
5750
Finders Fees Dollar Amount
0
Clarification Of Response
Issuer pays sales commissions which are equal to a percentage of the premium received by the Issuer. LILAC will also pay sales commissions from its corporate resources.

Use Of Proceeds

Gross Proceeds Used Dollar Amount
10020
Clarification Of Response
Amount shown represents the total of all DAC tax, state premium tax, and underwriting charges.

Signature Block

Authorized Representative
false

Signature

Issuer Name
Lombard International Life Assurance Co Separate Account VL 246
Signature Name
/s/ Paul Ryan Henry
Name Of Signer
Paul Ryan Henry
Signature Title
Senior Director & Counsel
Signature Date
2019-10-04
Additional Files
FileSequenceDescriptionTypeSize
0001790374-19-000001.txt   Complete submission text file   7999

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SEC CFR Title 17 of the Code of Federal Regulations.