EX-99.1 2 dex991.htm SPLIT-DOLLAR AGREEMENT BANK OF THE SIERRA SPLIT-DOLLAR AGREEMENT
BANK OF THE SIERRA
THIS SPLIT-DOLLAR AGREEMENT (the “Agreement”) is adopted this 8th day of August, 2005, by and between BANK OF THE SIERRA, a state-chartered commercial bank located in Porterville, California (the “Bank”), and XXXXX X. XXXXXXXX (the “Executive”).
The purpose of this Agreement is to retain and reward the Executive, by dividing the death proceeds of certain life insurance policies which are owned by the Bank on the life of the Executive with the designated beneficiary of the Executive. The Bank will pay the life insurance premiums from its general assets.
Article 1
Whenever used in this Agreement, the following terms shall have the meanings specified:
1.1 | “Bank’s Interest” means the benefit set forth in Section 2.1. |
1.2 | “Beneficiary” means each designated person, or the estate of the deceased Executive, entitled to benefits, if any, upon the death of the Executive. |
1.3 | “Beneficiary Designation Form” means the form established from time to time by the Plan Administrator that the Executive completes, signs and returns to the Plan Administrator to designate one or more Beneficiaries. |
1.4 | “Board” means the Board of Directors of the Bank as from time to time constituted. |
1.5 | “Code” means the Internal Revenue Code of 1986, as amended. |
1.6 | “Executive’s Interest” means the benefit set forth in Section 2.2. |
1.7 | “Insurer” means the insurance company issuing the Policy on the life of the Executive. |
1.8 | “Net Death Proceeds” means the total death proceeds of the Policy minus the greater of (i) the cash surrender value or (ii) the aggregate premiums paid by the Bank. |
1.9 | “Normal Retirement Age” means the Executive attaining age sixty-five (65). |
1.10 | “Normal Retirement Date” means the later of Normal Retirement Age or Separation from Service. |
1.11 | “Plan Administrator” means the plan administrator described in Article 12. |
1.12 | “Policy” or “Policies” means the individual insurance policy or policies adopted by the Bank for purposes of insuring the Executive’s life under this Agreement. |
BANK OF THE SEIRRA
1.13 | “Salary Continuation Agreement” means the Salary Continuation Agreement between the Bank and the Executive executed on even date herewith. |
1.14 | “Separation from Service” means that the Executive’s service, as an employee and independent contractor, to the Bank and any member of a controlled group as defined in Section 414 of the Code to which the Bank belongs, has terminated for any reason, other than by reason of a leave of absence approved by the Bank or the death of the Executive. |
Article 2
Article 3
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BANK OF THE SEIRRA
Article 4
4.1 | Premium Payment. The Bank shall pay all premiums due on all Policies. |
4.3 | Imputed Income. The Bank shall impute the economic benefit to the Executive on an annual basis, by adding the economic benefit to the Executive’s W-2, or if applicable, Form 1099. |
Article 5
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BANK OF THE SEIRRA
Article 6
6.3 | Acknowledgment. No designation or change in designation of a Beneficiary shall be effective until received, accepted and acknowledged in writing by the Bank or its designated agent. |
Article 7
The Executive may irrevocably assign without consideration all of the Executive’s Interest in this Agreement to any person, entity, or trust. In the event the Executive shall transfer
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BANK OF THE SEIRRA
all of the Executive’s Interest, then all of the Executive’s Interest in this Agreement shall be vested in the Executive’s transferee, who shall be substituted as a party hereunder, and the Executive shall have no further interest in this Agreement.
Article 8
The Insurer shall be bound only by the terms of its given Policy. The Insurer shall not be bound by or deemed to have notice of the provisions of this Agreement. The Insurer shall have the right to rely on the Bank’s representations with regard to any definitions, interpretations or Policy interests as specified under this Agreement.
Article 9
9.1.1 | Initiation – Written Claim. The claimant initiates a claim by submitting to the Bank a written claim for the benefits. |
(a) | The specific reasons for the denial; |
(b) | A reference to the specific provisions of the Agreement on which the denial is based; |
(c) | A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why it is needed; |
(d) | An explanation of the Agreement’s review procedures and the time limits applicable to such procedures; and |
(e) | A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review. |
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BANK OF THE SEIRRA
9.2 | Review Procedure. If the Bank denies part or all of the claim, the claimant shall have the opportunity for a full and fair review by the Bank of the denial, as follows: |
9.2.1 | Initiation – Written Request. To initiate the review, the claimant, within 60 days after receiving the Bank’s notice of denial, must file with the Bank a written request for review. |
(a) | The specific reasons for the denial; |
(b) | A reference to the specific provisions of the Agreement on which the denial is based; |
(c) | A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant (as defined in applicable ERISA regulations) to the claimant’s claim for benefits; and |
(d) | A statement of the claimant’s right to bring a civil action under ERISA Section 502(a). |
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BANK OF THE SEIRRA
Article 10
This Agreement may be amended or terminated only by a written agreement signed by the Bank and the Executive; however, this Agreement will automatically terminate upon the Executive’s Termination for Cause, Early Voluntary Termination (as defined in the Salary Continuation Agreement ) or in the event the Insurer refuses to pay a death benefit according to the terms of the Policy.
Article 11
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BANK OF THE SEIRRA
Article 12
12.1 | Binding Effect. This Agreement shall bind the Executive and the Bank, their beneficiaries, survivors, executors, administrators and transferees and any Beneficiary. |
12.3 | Applicable Law. The Agreement and all rights hereunder shall be governed by and construed according to the laws of the State of California, except to the extent preempted by the laws of the United States of America. |
Bank of the Sierra
00 X. Xxxx Xx.
Xxxxxxxxxxx, Xxxxxxxxxx 00000
Attn: Director of Human Resources
Such notice shall be deemed given as of the date of delivery or, if delivery is made by mail, as of the date shown on the postmark or the receipt for registration or certification.
Any notice or filing required or permitted to be given to the Executive under this Agreement shall be sufficient if in writing and hand-delivered, or sent by mail, to the last known address of the Executive.
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BANK OF THE SEIRRA
Split-Dollar Agreement
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date indicated above.
EXECUTIVE: | BANK OF THE SIERRA | |||||||
/s/ Xxxxx X. Xxxxxxxx | By | /s/ Xxxxx X. Xxxxx | ||||||
Xxxxx X. Xxxxxxxx | Xxxxx X. Xxxxx | |||||||
Title: | President & Chief Executive Officer |
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BANK OF THE SEIRRA
Split-Dollar Agreement
BENEFICIARY DESIGNATION FORM
¨ | New Designation |
¨ | Change in Designation |
I, Xxxxx X. Xxxxxxxx, designate the following as Beneficiary under the Agreement:
Primary: | ||
% | ||
% | ||
% | ||
Contingent: | ||
% | ||
% | ||
% |
Notes: |
• | Please PRINT CLEARLY or TYPE the names of the beneficiaries. |
• | To name a trust as beneficiary, please provide the name of the trustee(s) and the exact name and date of the trust agreement. |
• | To name your estate as beneficiary, please write “Estate of [your name]”. |
• | Be aware that none of the contingent beneficiaries will receive anything unless ALL of the primary beneficiaries predecease you. |
I understand that I may change these beneficiary designations by delivering a new written designation to the Administrator, which shall be effective only upon receipt and acknowledgment by the Administrator prior to my death. I further understand that the designations will be automatically revoked if the beneficiary predeceases me, or, if I have named my spouse as beneficiary and our marriage is subsequently dissolved.
Name: | Xxxxx X. Xxxxxxxx | |||||
Signature: | Date: |
SPOUSAL CONSENT (Required if Spouse not named beneficiary):
I consent to the beneficiary designation above, and acknowledge that if I am named beneficiary and our marriage is subsequently dissolved, the designation will be automatically revoked.
Spouse Name: | ||||||
Signature: | Date: |
Received by the Plan Administrator this day of , 2
By: | ||
Title: |
POLICY ENDORSEMENT
Contract Owner: BANK OF THE SIERRA
The undersigned Owner requests that the policy(ies) shown in the attached Schedule Page issued by the Massachusetts Mutual Life Insurance Company (the “Insurer”) provide for the following beneficiary designation:
The Definitions and General Provisions on page 3 are a part of this Policy Endorsement.
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its successors or assigns, as Beneficiary, to the extent claimed by said Owner.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions of paragraph 1 of this Policy Endorsement shall be paid in one sum in accordance with the written direction of the Owner. Such direction will be provided to the Insurer at the time of claim. The Insurer will be protected in relying solely on the Owner to provide the name(s) of the party(ies) to pay any excess not paid under paragraph 1. If the Owner fails to provide the name(s) of the party(ies) at the time of claim, then any proceeds payable under this paragraph shall be paid in one sum to the Beneficiary.
3. It is hereby provided that (i) any payment made to the Beneficiary or other party under paragraph 2 of this Policy Endorsement shall be a full discharge of the Insurer to the extent thereof; (ii) such discharge shall be binding on all parties claiming any interest under the Policy; and (iii) the Insurer shall have no responsibility with respect to the amounts so claimed.
4. It is agreed by the undersigned that this designation shall be subject in all respects to the contractual terms of the Policy.
The undersigned is signing in a representative capacity for the Owner and warrants that he or she has the authority to bind the entity on whose behalf this document is being executed.
Signed at Porterville, California, this 8th day of August, 2005.
OWNER: | ||||||||
BANK OF THE SIERRA | ||||||||
By: | By: | |||||||
(Signature: Bank Officer #1) | (Signature Bank Officer #2) | |||||||
Xxxxx X. Xxxxx | Xxxxxxx X. Xxxxxx | |||||||
(Printed) | (Printed) | |||||||
Title: | President & CEO | Title: | Senior Vice President & CFO |
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Schedule Page
Policy(ies) Subject to Policy Endorsement
Policy Number | Insured | |
Xxxxx X. Xxxxxxxx |
2 of 3
DEFINITIONS
Certain words in this endorsement have special meanings. These words are:
• | Proceeds means the amount payable when the Insured dies. If the policy provides for periodic payments after the Insured dies, “proceeds” means the commuted value of the future payments. |
• | Insurer means the insurance company that issued this policy. |
• | Lawful children or lawful issue of a person means only the lawful children born to or adopted by that person. |
GENERAL PROVISIONS
Minors. Any money payable to a minor will be paid to the legal guardian of the minor. Any right given to a minor can be exercised only by the legal guardian of the minor. But, if provided by this designation or by law, payment will be made to, and any right can be exercised by, someone other than the minor’s legal guardian.
Policy Provisions Apply. The provisions of “Payment Options” (“Optional Methods of Settlement”) of the policy apply to this designation.
Withdrawals. If this designation permits withdrawals of less than the entire proceeds held under Option D or Option A, not more than four withdrawals may be made in any one calendar year. But if this designation permits the entire proceeds to be withdrawn then any balance of the proceeds may be withdrawn at any time.
If a Beneficiary has the right to withdraw the commuted value of Option B payments, he or she shall have the right to place that commuted value under any other payment option (Optional Methods of Settlement).
Proof of Decisions. The Insurer must decide matters of fact in administering the terms of this endorsement. When making these decisions, the Insurer may require proof satisfactory to it, by affidavit or other written evidence. If the Insurer makes a decision based on this proof it will have no further liability under the policy in connection with the decision.
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POLICY ENDORSEMENT
Contract Owner: BANK OF THE SIERRA
The undersigned Owner requests that the policy(ies) shown in the attached Schedule Page issued by the West Coast Life Insurance Comapny (the “Insurer”) provide for the following beneficiary designation:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its successors or assigns, as Beneficiary, to the extent claimed by said Owner.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions of paragraph 1 of this Policy Endorsement shall be paid in one sum in accordance with the written direction of the Owner. Such direction will be provided to the Insurer at the time of claim. The Insurer will be protected in relying solely on the Owner to provide the name(s) of the party(ies) to pay any excess not paid under paragraph 1. If the Owner fails to provide the name(s) of the party(ies) at the time of claim, then any proceeds payable under this paragraph shall be paid in one sum to the Beneficiary.
3. It is hereby provided that (i) any payment made to the Beneficiary or other party under paragraph 2 of this Policy Endorsement shall be a full discharge of the Insurer to the extent thereof; (ii) such discharge shall be binding on all parties claiming any interest under the Policy; and (iii) the Insurer shall have no responsibility with respect to the amounts so claimed.
4. It is agreed by the undersigned that this designation shall be subject in all respects to the contractual terms of the Policy.
The undersigned is signing in a representative capacity for the Owner and warrants that he or she has the authority to bind the entity on whose behalf this document is being executed.
Signed at Porterville, California, this 8th day of August, 2005.
OWNER: | ||||||||
BANK OF THE SIERRA | ||||||||
By: | By: | |||||||
(Signature: Bank Officer #1) | (Signature Bank Officer #2) | |||||||
Xxxxx X. Xxxxx | Xxxxxxx X. Xxxxxx | |||||||
(Printed) | (Printed) | |||||||
Title: | President & CEO | Title: | Senior Vice President & CFO |
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Schedule Page
Policy(ies) Subject to Policy Endorsement
Policy Number | Insured | |
Xxxxx X. Xxxxxxxx |
2 of 2