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EXHIBIT 10 (c)
XXXXXX XXXXXXX DEFERRED COMPENSATION PLAN AGREEMENT
THIS AGREEMENT, made and entered into this 12th day of June, 1995, by
and between BLUE BALL NATIONAL BANK, a national banking association with
principal offices and place of business at 0000 Xxxx Xxxxxx, Post Xxxxxx Xxx
000, Xxxx Xxxx, Xxxxxxxxxxxx, 00000 (hereinafter referred to as the "Bank"), and
XXXXXX XXXXXXX, an adult individual residing at 00 Xxxxxxx Xxxxxx, Xxx Xxxxxxx,
Xxxxxxxxxxxx (hereinafter referred to as "Xxxxxxx"),
WITNESSETH:
WHEREAS, Xxxxxxx is employed by the Bank; and
WHEREAS, the Bank recognizes the valuable services heretofore performed
for it by Xxxxxxx and wishes to encourage his continued employment; and
WHEREAS, Xxxxxxx wishes to defer a certain portion of compensation
payable to him; and
WHEREAS, the parties hereto wish to provide the terms and conditions
upon which the Bank shall pay such deferred compensation to Xxxxxxx or his
designated beneficiary; and
WHEREAS, the parties intend that this Agreement be considered an
unfunded arrangement, maintained primarily to provide deferred compensation
benefits for Xxxxxxx, a member of select group of management or highly
compensated employees of the Bank, for purposes of Employee Retirement Income
Act of 1974, as amended;
NOW, THEREFORE, in consideration of the premises and of the mutual
promises herein contained, the parties hereto agree as follows:
1. DEFINITION OF TERMS. Certain words and phrases are defined when
first used in this Agreement. In addition, the following words and phrases when
used herein, unless the context clearly requires otherwise, shall have the
following respective meanings:
(a) Accrued Benefit. The sum of all Deferred Amounts
credited to Xxxxxxx'x Retirement Account and due and owing to Xxxxxxx or
his beneficiaries pursuant to this Agreement, together with Additions
thereto calculated as set forth in paragraph 3 hereof, minus any
distributions hereunder.
(b) Affiliate. Any corporation, partnership, joint venture,
association, or similar organization or entity, the employees of which
would be treated as employed by the Bank under Section 414(b) and 414(c)
of the Code.
(c) Agreement. This Agreement, together with any and all
amendments or supplements thereto.
(d) Code. The Internal Revenue Code of 1986, 26 U.S.C. 101
et seq., as amended or as it may be amended from time to time.
(e) Compensation. Total salary and commissions of
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Xxxxxxx paid or accrued by the Bank, exclusive of Accrued Benefits,
stock options, stock appreciation rights, and any employer contributions
or payments to any other trust, fund, agreement or plan providing
retirement, pension, profit sharing, health, welfare, death, insurance
or similar benefits.
(f) Deferred Amount. A portion of the Compensation otherwise
payable to Xxxxxxx, receipt of which Xxxxxxx has elected to defer under
the provisions of paragraphs 2 and 4 hereof.
(g) Effective Date. The date of the execution of this
Agreement.
(h) Election of Deferral. A written notice filed by Xxxxxxx
with the Payroll Department of the Bank in substantially the form
attached hereto as Exhibit "A," specifying the amount of Compensation to
be deferred.
(i) Fiscal Year. The taxable year of the Bank.
(j) Normal Retirement Date. The date Xxxxxxx attains
sixty-five (65) years of age.
(k) Notice of Discontinuance. A written notice filed by
Xxxxxxx with the Payroll Department of the Bank in substantially the
form attached hereto as Exhibit "B," requesting discontinuance of the
deferral of Xxxxxxx'x Compensation.
(l) Retirement Account. Book entries maintained by the Bank
reflecting Deferred Amounts and Additions thereon; provided, however,
that the existence of such book entries and the Retirement Account shall
not create and shall not be deemed to create a trust of any kind, or a
fiduciary relationship between the Bank and Xxxxxxx, his designated
beneficiary, or other beneficiaries under this Agreement.
2. DEFERRED COMPENSATION. Commencing on the Effective Date, and
continuing through the date on which Xxxxxxx'x employment terminates because of
his death, normal retirement, disability, or any other cause, Xxxxxxx and the
Bank agree that Xxxxxxx shall be entitled to elect to defer into his Retirement
Account up to the following maximum amounts of the Compensation that Xxxxxxx
would otherwise be entitled to receive from the Bank in each of the following
Fiscal Year of the Bank:
Amount Deferred
1995 $10,000.00
1996 $11,000.00
1997 $12,100.00
1998 $13,310.00
1999 $14,641.00
2000 $16,105.00
2001 $17,716.00
2002 $19,487.00
2003 $21,436.00
2004 $23,579.00
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The contemplated Annual Deferral Sum shall be deferred in substantially equal
bi-weekly amounts during each Fiscal Year or portion thereof during which this
Agreement is in effect. The amount of Compensation actually deferred in any
Fiscal Year, taking into account discontinuance of deferral pursuant to a Notice
of Discontinuance, termination of Xxxxxxx'x employment, the death of Xxxxxxx, or
otherwise is hereinafter referred to as the "Annual Deferred Amount." The
portions of Xxxxxxx'x Annual Deferred Amount deferred bi-weekly shall be
credited to Xxxxxxx'x Retirement Account bi-weekly, as Deferrals are accrued.
3. ADDITIONS TO DEFERRED AMOUNTS. The Bank hereby agrees that it
will credit Deferred Amounts in Xxxxxxx'x Retirement Account with additions
thereon ("Additions") from and after the dates Deferred Amounts are credited to
the Retirement Account, subject to the limitations herein set forth. Additions
to Deferred Amounts, calculated at the rate of eight percent (8%) per annum,
compounded annually at the end of each Fiscal Year, shall accrue commencing on
the date the Retirement Account first has a positive balance and shall continue
until the first of the following events to occur:
(a) The date that Death Benefits as described in
paragraph 7(b) hereof, Retirement Benefits, or Disability Benefits,
whichever applies, end hereunder; or
(b) The date on which Death Benefits as described in
paragraph 7(a) hereof commence; or
(c) The date on which a Termination Benefit or an
Acquisition Termination Benefit, as herein defined, is paid.
4. ELECTION TO DEFER COMPENSATION. Xxxxxxx may elect an Annual
Deferral Sum hereunder by filing an Election of Deferral. The initial Election
of Deferral must be filed within thirty (30) days of the Effective Date of this
Agreement. Such initial Election of Deferral, if any, shall be effective
commencing with the first day of the first month after it is filed. Thereafter,
an Election of Deferral must be filed at least thirty (30) days prior to the
beginning of the Fiscal Year to which it pertains and shall be effective on the
first day of the Fiscal Year following the filing thereof.
5. TERMINATION OF ELECTION. Xxxxxxx'x initial Election of Deferral
shall continue in effect, pursuant to the terms of the Election of Deferral,
unless and until Xxxxxxx files with the Bank a Notice of Discontinuance or a
subsequent Election of Deferral specifying a different amount of deferral. Each
Election of Deferral filed subsequent to the initial Election of Deferral shall
similarly continue in effect until Xxxxxxx files a Notice of Discontinuance or a
new Election of Deferral. Any new Election of Deferral, to be effective, must be
filed at least thirty (30) days prior to the beginning of the Fiscal Year in
which deferral is sought. A Notice of Discontinuance shall be effective if filed
at least twenty (20) days prior to any January 1st, April 1st, July 1st or
October 1st. Such Notice of Discontinuance shall be effective commencing with
the January 1st, April 1st, July 1st or October 1st following its filing,
whichever applies, and shall apply only with respect to Xxxxxxx'x Compensation
and bonuses attributable to services not yet performed.
6. RETIREMENT BENEFITS.
(a) Retirement Benefit. The Bank agrees that, from
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and after the retirement of Xxxxxxx from the service of the Bank upon
reaching his Normal Retirement Date, the Bank shall thereafter pay as a
retirement benefit (herein referred to as the "Retirement Benefit") to
Xxxxxxx Xxxxxxx'x entire Accrued Benefit, payable in equal annual
installments, due on the 31st day of January of each year commencing on
the first such date following the Normal Retirement Date, for a period
of fifteen (15) years. The amount of each annual installment shall be an
amount which, if paid annually over the remainder of the fifteen (15)
year payment term, would result in payment of the entire Accrued
Benefit, together with interest accrued at the rate of eight (8%)
percent per annum, in equal annual installments.
(b) Election of Benefits Upon Normal Retirement Date.
Xxxxxxx shall have the option, upon attaining his Normal Retirement
Date, to elect to receive his Retirement Benefit, notwithstanding his
continued employment with the Bank after he has attained his Normal
Retirement Date. Xxxxxxx'x election to receive his Retirement Benefit
notwithstanding his continued employment must be made in writing at
least ninety (90) days prior to his Normal Retirement Date. The
Retirement Benefit payable upon election pursuant to this paragraph 6.b
shall be the amount that would have been payable had Xxxxxxx retired
from service with the Bank as of his Normal Retirement Date. Any such
election shall be irrevocable and shall result in the termination of
Xxxxxxx'x right to any further deferrals hereunder.
7. DEATH BENEFITS.
(a) Death Benefit Prior to Commencement of Retirement or
Disability Benefits. In the event of Xxxxxxx'x death while in the
employment of Bank and prior to commencement of Retirement Benefits or
Disability Benefits, Bank shall pay to Xxxxxxx'x designated beneficiary,
in accordance with the last such designation received by the Bank from
Xxxxxxx prior to his death, a benefit in fifteen (15) annual
installments, each in the amount of Forty-Four Thousand Five Hundred
Sixty and 00/100 ($44,560.00). If no such designation has been received
by Bank from Xxxxxxx prior to his death, or if said payments are
otherwise to be made as provided herein, said payments shall be made to
Xxxxxxx'x then-living spouse, so long as she shall live, and thereafter
to such person or persons, including her estate, as she may appoint
under her Will, making specific reference hereto; if Xxxxxxx is not
survived by a spouse, or if said spouse shall be then deceased, having
failed to so appoint, then said payments shall be made to the
then-living children of Xxxxxxx, if any, in equal shares, for their
joint and survivor lives; and if none, or after their respective joint
and survivor lives, any balance thereof in one lump sum to the estate of
Xxxxxxx. Payments shall be due on January 31 of each year, commencing on
the first such date occurring after the death of Xxxxxxx. To the extent
that the Accrued Benefit in Xxxxxxx'x Retirement Account exceeds the
total of payments required under this section, such excess sums shall be
forfeited.
(b) Death Benefit After Commencement of Benefits. In the
event of Xxxxxxx'x death after the commencement of Normal Retirement
Benefits, but prior to the completion of all such payments due and owing
hereunder, the Bank shall continue to make such payments, in equal
annual installments, over the remainder of the period specified in
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paragraph 6 hereof that would have been applicable to Xxxxxxx had he
survived. Such continuing payments shall be made to Xxxxxxx'x designated
beneficiary, in accordance with the last such designation received by
the Bank from Xxxxxxx prior to his death. If no such designation has
been received by the Bank from Xxxxxxx prior to his death or if said
payments are otherwise to be made as provided herein, said payments
shall be made to Xxxxxxx'x then living spouse, so long as she shall live
and thereafter to such person or persons, including her estate, as she
may appoint under her Will, making specific reference hereto; if Xxxxxxx
is not survived by a spouse or if she shall fail to so appoint, then
said payments shall be made to the then living children of Xxxxxxx, if
any, in equal shares, for their joint and survivor lives; and if none,
or after their respective joint and survivor lives, any balance thereof
in one lump sum to the estate of Xxxxxxx. Such continuing payments shall
be payable on January 31 of each year, commencing on the first such date
occurring after the death of Xxxxxxx.
8. DISABILITY BENEFIT. In the event that Xxxxxxx is determined to
be Disabled, as defined in the Blue Ball National Bank Long Term Disability Plan
(which definition is incorporated herein and made a part hereof), then the date
of such determination shall, for purposes of this Agreement, be deemed to be
Xxxxxxx'x Normal Retirement Date, and all benefits otherwise payable to Xxxxxxx
following the Normal Retirement Date shall be payable to Xxxxxxx as a Disability
Benefit.
9. TERMINATION BENEFIT. In the event of Xxxxxxx'x termination of
employment with the Bank before his Normal Retirement Date for any reason, other
than his death or Disability (as herein defined) or the occurrence of any
Acquisition Termination (as herein defined), the Bank shall pay to Xxxxxxx, as
compensation for services rendered prior to such termination, a single sum equal
to the total Deferred Amounts hereunder, exclusive of Additions thereto (herein
referred to as the "Termination Benefit"). In the event of the payment of a
Termination Benefit, any and all Additions credited to Xxxxxxx'x Retirement
Account shall be forfeited to the Bank. The Termination Benefit shall be payable
on the first day of the first month following the termination of Xxxxxxx'x
employment with the Bank.
10. ACQUISITION TERMINATION BENEFIT. In the event that Bank or
PennRock Financial Services Corp., of which Bank is a wholly-owned subsidiary,
should at any time prior to Xxxxxxx'x Normal Retirement Date be acquired by any
other entity, and in the event that Xxxxxxx'x employment with Bank or its
successor is subsequently terminated involuntarily prior to Xxxxxxx'x Normal
Retirement Date, then such termination shall be deemed an Acquisition
Termination hereunder. In such event, Bank or its successor shall pay to
Xxxxxxx, as compensation for services rendered prior to such termination, a
single sum equal to the total Deferred Amounts hereunder, together with all
Additions thereto (the "Acquisition Termination Benefit"). The Acquisition
Termination Benefit shall be payable on the first day of the first month
following the termination of Xxxxxxx'x employment with the Bank or its
successor.
11. HARDSHIP BENEFIT. In the event Xxxxxxx suffers a financial
hardship (as hereinafter defined), the Bank may, if it deems advisable in its
sole and absolute discretion, distribute to or utilize on behalf of Xxxxxxx as a
hardship benefit (the "Hardship Benefit") any portion of Xxxxxxx'x Retirement
Account
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up to, but not in excess of, the Termination Benefit to which Xxxxxxx would have
been entitled as of the date a Hardship Benefit is distributed or utilized. Any
Hardship Benefit shall be distributed or utilized at such times as the Bank
shall determine, and the Accrued Benefit in Xxxxxxx'x Benefit Account shall be
reduced by the amount so distributed and/or utilized. Financial Hardship shall
mean dire financial need of Xxxxxxx caused by temporary or permanent disability
or incapacity, medical or educational expenses, the purchase or maintenance of a
residence, or a material reduction in family income.
12. OFFSET FOR OBLIGATIONS TO BANK. If, at such time as Xxxxxxx
becomes entitled to benefit payments hereunder, Xxxxxxx has any debt, obligation
or other liability representing an amount owing to the Bank or an Affiliate of
the Bank, and if such debt, obligation, or other liability is due and owing at
the time benefit payments are payable hereunder, the Bank may offset the amount
owing it or an Affiliate against the amount of benefits otherwise distributable
hereunder.
13. BENEFICIARY DESIGNATION. Xxxxxxx shall have the right, at any
time, to submit in substantially the form attached hereto as Exhibit "C," a
written designation of primary and secondary beneficiaries to whom payment under
this Agreement shall be made in the event of his death prior to complete
distribution of the benefits due and payable under the Agreement. Each
beneficiary designation shall become effective only when receipt thereof is
acknowledged in writing by the Bank.
14. NO TRUST CREATED. Nothing created in this Agreement, and no
action taken pursuant to its provisions by either party hereto shall create, or
be construed to create, a trust of any kind, or a fiduciary relationship between
the Bank and Xxxxxxx, his designated beneficiary, other beneficiaries of Xxxxxxx
or any other person.
15. BENEFITS PAYABLE ONLY FROM GENERAL CORPORATE ASSETS; UNSECURED
GENERAL CREDITOR STATUS OF XXXXXXX.
(a) The payments to Xxxxxxx or his designated beneficiary or
any other beneficiary hereunder shall be made from assets which shall
continue, for all purposes, to be a part of the general, unrestricted
assets of the Bank; no person shall have any interest in any such assets
by virtue of the provisions of this Agreement. The Bank's obligation
hereunder shall be an unfunded and unsecured promise to pay money in the
future. To the extent that any person acquires a right to receive
payments from the Bank under the provisions hereof, such right shall be
no greater than the right of any unsecured creditor of the Bank, no such
person shall have nor require any legal or equitable right, interest or
claim in or to any property or assets of the Bank.
(b) This promise of future payment by Bank to Xxxxxxx shall
be unfunded and unsecured and shall not be construed as a transfer of
any present right to receive payment. Xxxxxxx shall derive no present
economic benefit from this Agreement. In the event that, in its
discretion, the Bank purchases an insurance policy or policies insuring
the life of Xxxxxxx (or any other property), to allow the Bank to
recover the cost of providing benefits, in whole or in part, hereunder,
neither Xxxxxxx, his designated beneficiary nor any other beneficiary
shall have any rights whatsoever therein or in the proceeds therefrom.
The Bank shall be the
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sole owner and beneficiary of any such insurance policy and shall
possess and may exercise all incidents of ownership therein. No such
policy, policies or other property shall be held in any trust for
Xxxxxxx or any other person nor as collateral security for any
obligation of the Bank hereunder.
16. NO CONTRACT OF EMPLOYMENT. Nothing contained herein shall be
construed to be a contract of employment for any term of years, nor as
conferring upon Xxxxxxx the right to continue to be employed by the Bank in his
present capacity, or in any capacity. It is expressly understood by the parties
hereto that this Agreement relates to the payment of deferred compensation for
Xxxxxxx'x services, payable after termination of his employment with the Bank,
and is not intended to be an employment contract.
17. BENEFITS NOT TRANSFERABLE. Neither Xxxxxxx, his designated
beneficiary, nor any other beneficiary under this Agreement shall have any power
or right to transfer, assign, anticipate, hypothecate or otherwise encumber any
part or all of the amounts payable hereunder. No such amounts shall be subject
to seizure by any creditor of any such beneficiary, by a proceeding at law or in
equity, nor shall such amounts be transferable by operation of law in the event
of bankruptcy, insolvency or death of Xxxxxxx, his designated beneficiary, or
any other beneficiary hereunder. Any such attempted assignment or transfer shall
be void.
18. DETERMINATION OF BENEFITS.
(a) Claim.
A person who believes that he is being denied a benefit to which
he is entitled under the Plan (hereinafter referred to as a "Claimant")
may file a written request for such benefit with the Bank, setting forth
his claim. The request must be addressed to any Senior Vice President of
the Bank at its then principal place of business.
(b) Claim Decision.
Upon receipt of a claim, the Bank shall advise the Claimant that
a reply will be forthcoming within ninety (90) days and shall, in fact,
deliver such reply within such period. The Bank may, however, extend the
reply period for an additional ninety (90) days for reasonable cause.
If the claim is denied in whole or in part, the Bank shall adopt
a written opinion, using language calculated to be understood by the
Claimant, setting forth:
(i) The specific reason or reasons for such denial;
(ii) The specific reference to pertinent provisions
of this Agreement on which such denial is based;
(iii) A description of any additional material or
information necessary for the Claimant to perfect his claim and an
explanation why such material or such information is necessary;
(iv) Appropriate information as to the steps to be
taken if the Claimant wishes to submit the claim for review; and
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(v) The time limits for requesting a review under
subsection c. and for review under subsection d. hereof.
(c) Request for Review.
Within sixty (60) days after the receipt by the Claimant of the
written opinion described above, the Claimant may request in writing
that the Secretary of the Bank review the determination of the Bank.
Such request must be addressed to the Secretary of the Bank, at its then
principal place of business. The Claimant or his duly authorized
representative may, but need not, review the pertinent documents and
submit issues and comments in writing for consideration by the Bank. If
the Claimant does not request a review of the Bank's determination by
the Secretary of the Bank within such sixty (60) day period, he shall be
barred and estopped from challenging the Bank's determination.
(d) Review of Decision.
Within sixty (60) days after the Secretary's receipt of a
request for review, he will review the Bank's determination. After
considering all materials presented by the Claimant, the Secretary will
render a written opinion, written in a manner calculated to be
understood by the Claimant, setting forth the specific reasons for the
decision and containing specific references to the pertinent provisions
of this Agreement on which the decision is based. If special
circumstances require that the sixty (60) day time period be extended,
the Secretary will so notify the Claimant and will render the decision
as soon as possible, but no later than one hundred twenty (120) days
after receipt of the request for review.
19. AMENDMENT. This Agreement may not be amended, altered or
modified, except by a written instrument signed by the parties hereto, or their
respective successors, and may not be otherwise terminated except as provided
herein.
20. INUREMENT. This Agreement shall be binding upon and inure to the
benefit of the Bank and its successors and assigns, and Xxxxxxx, his successors,
heirs, executors, administrators and beneficiaries.
21. NOTICE. Any notice, consent or demand required or permitted to
be given under the provisions of this Agreement shall be in writing, and shall
be signed by the party giving or making the same. If such notice, consent or
demand is mailed to a party hereto, it shall be sent by United States certified
mail, postage prepaid, addressed to such party's last known address as shown on
the records of the Bank. The date of such mailing shall be deemed the date of
notice, consent or demand. Either party may change the address to which notice
is to be sent by giving notice of the change of address in the manner aforesaid.
22. GOVERNING LAW. This Agreement, and the rights of the parties
hereunder, shall be governed by and construed in accordance with the laws of the
United States of America and of the Commonwealth of Pennsylvania.
IN WHEREOF, the parties have executed this Agreement, in duplicate, as
of the day and year first above written.
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ATTEST: BLUE BALL NATIONAL BANK
By:
--------------------------- ------------------------------
XXXXXX X. XXXXXX, Secretary XXXXXX XXXXX, XX.,
Vice President
(SEAL)
----------------------------
XXXXXX XXXXXXX Exhibit A
ELECTION OF DEFERRAL
TO: BLUE BALL NATIONAL BANK
Attention: Payroll Department
I hereby elect to defer a portion of my annual compensation under the
following Schedule:
Amount Deferred
1995 $10,000.00
1996 $11,000.00
1997 $12,100.00
1998 $13,310.00
1999 $14,641.00
2000 $16,105.00
2001 $17,716.00
2002 $19,487.00
2003 $21,436.00
2004 $23,579.00
I further authorize Blue Ball National Bank to credit all amounts
so deferred to the Retirement Account established pursuant to
that certain Xxxxxx Xxxxxxx Deferred Compensation Plan Agreement,
by and between the undersigned and Blue Ball National Bank, dated
the _____ day of _____________, 1995.
I understand that this authorization shall remain in effect until
revoked or amended. I understand that I may revoke deferral upon at least 20
days' prior written notice, effective on any January 1st, April 1st, July 1st or
October 1st. I further understand that I may file an amended Election of
Deferral at least 30 days prior to the beginning of a Fiscal Year of the Bank,
effective on the first day of such Fiscal Year.
Date:
----------------- ------------------------------
Xxxxxx Xxxxxxx Exhibit B
NOTICE OF DISCONTINUANCE
TO: BLUE BALL NATIONAL BANK
Attention: Payroll Department
I hereby give notice of my election to discontinue deferral of my
Compensation under that certain Xxxxxx Xxxxxxx Deferred Compensation Plan
Agreement, by and between Blue Ball National Bank and the undersigned, dated the
_____ day of ______________, 1995. This notice is submitted at least twenty (20)
days prior to January 1st, April 1st, July 1st, or October 1st, and shall be
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effective as of such date, as specified below.
Discontinue deferral as of [ ] January 1st, 19__
(xxxx one) [ ] April 1st, 19__
[ ] July 1st, 19__
[ ] October 1st, 19__
----------------------------
Xxxxxx Xxxxxxx
Dated:
----------------------
Exhibit C
DESIGNATION OF BENEFICIARY
UNDER THE
XXXXXX XXXXXXX
DEFERRED COMPENSATION PLAN AGREEMENT
I. Employee: Xxxxxx Xxxxxxx
XX. The above-named Employee's Revocable Beneficiary under the Xxxxxx
Xxxxxxx Deferred Compensation Plan Agreement is set forth below (CHECK
BOX TO LEFT OF APPLICABLE NUMBERED SUBPARAGRAPH AND FILL IN THE
BLANK(S); CHECK AND COMPLETE ONLY ONE NUMBERED SUBPARAGRAPH):
[x] 1. Employee's spouse, Xxxx X. Xxxxxxx, if living at the Employee's
death; if not, such of the children of the marriage of the
Employee and said spouse as shall be then living, equally, or
the issue of any deceased child per stirpes.
[ ] 2. Employee's spouse, _______________________, if living at the
Employee's death, if not, such of the Employee's children as
shall be then living, equally.
[ ] 3. Such of the following children of the Employee as shall be
living at the Employee's death, equally:
_________________________, __________________________,
_____________________________________________________.
[ ] If this box is checked, and if paragraph 1, 2 or 3 is checked,
then the living children of any deceased child designated shall
take the share, divided equally, which such child would have
taken, if living.
[ ] 4. Employee's ______________________, if living at the Employee's
death, if not, Employee's ________________, if then living, if
not, Employee's ________________, if then living. (Insert
relationship to Employee and name).
[ ] 5. Such of the following as shall be living at the Employee's
death, equally: Employee's ____________________________. (Insert
relationship to Employee and name).
[ ] 6. Employee's _________________________, if living at the
Employee's death