Form 5500 Annual Return Report — Schedule D Supplement

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Form 5500 Series Schedule D is an attachment to Form 5500 that is required if a plan participated in a Pooled Separate Account (PSA).

To complete Part I of Schedule D for RecordkeeperDirect-Multifund^® plans, you will need this information:

• Part 1a, Name of MTIA, CCT, PSA, or 103-12 IE: Variable Annuity Account 5
• Part 1b, Name of sponsor entity listed in (a): Great-West Life and Annuity Insurance Company of New York
• Part 1c, EIN-PN: GWLANY 93-1225432-004
• Part 1d, Entity Code: “P” for “Pooled Separate Account”
• Part 1e, Dollar value of interest in MTIA, CCT, PSA or 103-12 IE at end of year: enter the value from Part II, line 5 found on the “Form 5500 Annual Return Report — Schedule A” in the “Reports and Analysis” section of the Plan Sponsor Website.