AMENDED AND RESTATED EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT EFFECTIVE JANUARY 1, 2006
EXHIBIT
10.7
AMENDED
AND RESTATED EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT
EFFECTIVE
JANUARY 1, 2006
This
Agreement, made and entered into this 1st
day of
January, 2006, by and between Xxxxxxx Merchants Bank, a Bank organized and
existing under the laws of the State of Maine hereinafter referred to as "the
Bank", and Xxxxx X. Xxxxx, a Key Employee and the Executive of the Bank,
hereinafter referred
to as "the Executive".
The
Bank
and the Executive are parties to this Amended and Restated Executive
Supplemental Retirement Plan Agreement between Xxxxxxx Merchants Bank and Xxxxx
X. Xxxxx that provides for the payment of certain benefits. This Amended and
Restated Executive Supplemental Retirement Plan Agreement effective January
1,
2006 shall bring the Executive Supplemental Retirement Plan Agreement dated
June
26, 1997, in compliance with Internal Revenue Code §409A enacted on October 22,
2004. The benefits provided hereunder shall amend and restate the existing
Executive Supplemental Retirement Plan Agreement dated June 26, 1997, and any
and all subsequent amendments and the benefits provided thereby;
The
Executive has been in the employ of the Bank for several years and has now
and
for years past faithfully served the Bank. It is the consensus of the
Compensation Committee of the Board of Directors of the Bank (The Board) that
the Executive’s employment has been of exceptional merit, in excess of the
compensation paid and an invaluable contribution to the profits and position
of
the Bank in its field of activity. The Board further believes that the
Executive's experience, knowledge of corporate affairs, reputation and industry
contacts are of such value and his continued employment is so essential to
the
Bank's future growth and profits that it would suffer severe financial loss
should the Executive terminate the Executive’s employment.
Accordingly,
it is the desire of the Bank and the Executive to enter into this Agreement
under which the Bank will agree to make certain payments to the Executive upon
the Executive’s retirement and, alternatively, to the Executive’s
beneficiary(ies) in the event of the Executive’s premature death while employed
by the Bank.
It
is the
intent of the parties hereto that this Agreement be considered an arrangement
maintained primarily to provide supplemental retirement benefits for the
Executive, as a member of a select group of management or highly-compensated
employees of the Bank for purposes of the Employee Retirement Income Security
Act of 1974 (ERISA). The Executive is fully advised of the Bank’s financial
status and has had substantial input in the design and operation of this benefit
plan.
Therefore,
in consideration of the Executive’s employment performed in the past and those
to be performed in the future and based upon the mutual promises and covenants
herein contained, the Bank and the Executive, agree as follows:
I. |
DEFINITIONS
|
A. |
Effective
Date:
|
The
Effective Date of this Agreement shall be January 1, 2006.
B. |
Plan
Year:
|
Any
reference to “Plan Year” shall mean a calendar year from January 1st
to
December 31st.
In the
year of implementation, the term “Plan Year” shall mean the period from the
effective date to December 31st
of the
year of the effective date.
C.
|
Retirement
Date:
|
Retirement
Date shall mean retirement from employment with the Bank which becomes effective
on the first day of the calendar month following the month in which the
Executive reaches the Executive’s sixty-fifth (65th)
birthday or such later date as the Executive may actually retire.
D. |
Termination
of Employment:
|
Termination
of Employment shall mean voluntary resignation of employment by the Executive
or
the Bank’s discharge of the Executive without cause (“cause” defined in
Subparagraph III (D) hereinafter), prior to the Executive’s
retirement.
E. |
Pre-Retirement
Account:
|
A
Pre-Retirement Account shall be established as a liability reserve account
on
the books of the Bank for the benefit of the Executive. Prior to termination
of
employment or the Executive’s retirement, such liability reserve account shall
be increased or decreased each Plan Year (including the Plan Year in which
the
Executive ceases to be employed by the Bank) by an amount equal to the annual
earnings or loss for that Plan Year determined by the Index [described in
subparagraph I (G) hereinafter], less the Cost of Funds Expense for that Plan
Year [described in subparagraph I (H) hereinafter].
F. |
Index
Retirement Benefit:
|
The
Index
Retirement Benefit for the Executive for any year shall be equal to the excess
of the annual earnings (if any) determined by the Index [subparagraph I (G)]
for
that Plan Year over the Cost of Funds Expense [subparagraph I (H)] for that
Plan
Year.
2
G. |
Index:
|
The
Index
for any Plan Year shall be the aggregate annual after-tax income from the life
insurance contracts described hereinafter as defined by FASB Technical Bulletin
85-4. This Index shall be applied as if such insurance contracts were purchased
on the effective date hereof.
Insurance
Company:
|
Xxxxxxxxx
Xxxxxxxx Life Insurance
|
Policy
Form:
|
Flexible
Premium Adjustable Life
|
Policy
Name:
|
Executive
Security Plan III
|
Insured’s
Age and Sex:
|
57,
Male
|
Riders:
|
None
|
Ratings:
|
None
|
Option:
|
A
|
Face
Amount:
|
$1,495,000
|
Premiums
Paid:
|
$604,000
|
Number
of Premium Payments:
|
One
|
Assumed
Purchase Date:
|
June
26, 1997
|
If such contracts of life insurance are actually purchased by the Bank then the actual policies as of the dates they were purchased shall be used in calculations under this Agreement. If such contracts of life insurance are not purchased or are subsequently surrendered or lapsed, then the Bank shall receive annual policy illustrations that assume the above described policies were purchased from the above named insurance company(ies) on the Effective Date from which the increase in policy value will be used to calculate the amount of the Index.
In
either
case, references to the life insurance contract are merely for purposes of
calculating a benefit. The Bank has no obligation to purchase such life
insurance and, if purchased, the Executive and his beneficiary(ies) shall have
no ownership interest in such policy and shall always have no greater interest
in the benefits under this Agreement than that of an unsecured general creditor
of the Bank.
H. |
Cost
of Funds Expense:
|
The
Cost
of Funds Expense for any Plan Year shall be calculated by taking the sum of
the
amount of premiums set forth in the Indexed policies described above plus the
amount of any after-tax benefits
paid to the Executive pursuant to this Agreement (Paragraph III hereinafter)
plus the amount of all previous years after-tax Costs of Funds Expense, and
multiplying that sum by the average after-tax cost of funds of the Bank's third
quarter Call Report for the Plan Year as filed with the Federal
Reserve.
3
I.
|
Change
of Control:
|
In
accordance with Internal Revenue Code §409A, the Change of Control shall be
defined as the occurrence of any one of the following:
a.
|
the
acquisition of more than fifty percent (50%) of the value or voting
power
of the Bank’s Holding Company stock by a person or
group;
|
b.
|
the
acquisition in a period of twelve (12) months or less of at least
thirty-five percent (35%) of the Bank’s Holding Company stock by a person
or group;
|
c.
|
the
replacement of a majority of the Bank’s Holding Company board in a period
of twelve (12) months or less by Directors who were not endorsed
by a
majority of the current board members;
or
|
d.
|
the
acquisition in a period of twelve (12) months or less of forty percent
(40%) or more of the Bank’s Holding Company assets by an unrelated
entity.
|
For
the
purposes of this Agreement, transfers on account of deaths or gifts, transfers
between family members or transfers to a qualified retirement plan maintained
by
the Bank shall not be considered in determining whether there has been a change
in control.
J. |
Normal
Retirement Age:
|
Normal
Retirement Age shall mean the date on which the Executive attains age sixty-five
(65).
II. |
EMPLOYMENT
|
No
provision of this Agreement shall be deemed to restrict or limit any existing
employment agreement by and between the Bank and the Executive, nor shall any
conditions herein create specific employment rights to the Executive nor limit
the right of the Employer to discharge the Executive with or without cause.
In a
similar fashion, no provision shall limit the Executive's rights to voluntarily
sever his employment at any time.
III. |
INDEX
BENEFITS
|
The
following benefits provided by the Bank to the Executive are in the nature
of a
fringe benefit and shall in no event be construed to effect nor limit the
Executive's current or prospective salary increases, cash bonuses or
profit-sharing distributions or credits.
4
A.
|
Retirement
Benefits:
|
Should
the Executive continue to be employed by the Bank until his "Normal Retirement
Age" defined in subparagraph I (J), he shall be entitled to receive the balance
in his Pre-Retirement Account [as defined in subparagraph I (E)] in ten (10)
equal annual installments commencing thirty (30) days following the Executive’s
Normal Retirement Date. In addition to these payments, commencing with the
Plan
Year in which the Executive attains the Executive’s Retirement Date, the Index
Retirement Benefit [as defined in subparagraph I (F) above] for each year shall
be paid to the Executive until his death.
In
accordance with Internal Revenue Code §409A, if the Executive is a Key Employee,
and said Bank is publicly traded at the time of retirement, any such benefit
payment shall be withheld for six (6) months following such retirement.
B.
|
Termination
of Employment:
|
Subject
to subparagraph III (E) hereinafter, should the Executive suffer a Termination
of Employment [defined in subparagraph I (D)], the Executive shall be entitled
to receive the percentage of the Pre-Retirement Account that corresponds to
the
years of employment with the Bank, as stated in the schedule below, paid in
ten
(10) equal annual installments commencing thirty (30) days following said
Termination of Employment. In addition to these payments, the Executive shall
be
entitled to receive the percentage of the Index Retirement Benefit that
corresponds to the years of employment with the Bank as stated in the schedule
below, and shall be paid to the Executive until his death.
In
accordance with Internal Revenue Code §409A, if the Executive is a Key Employee,
and said Bank is publicly traded at the time of termination of employment,
any
such benefit payment shall be withheld for six (6) months following such
termination of employment.
Total
Years
|
|
of
Employment
|
Vested
Percentage
|
with
the Bank
|
(to
a maximum of 100%)
|
0-14
years
|
0%
|
15-19
years
|
75%
|
20
years
|
100%
|
5
C.
|
Death:
|
Should
the Executive die prior to having received the full balance of the
Pre-Retirement Account, the unpaid balance of the Pre-Retirement Account shall
be paid in a lump sum to the beneficiary selected by the Executive and filed
with the Bank. In the absence of or a failure to designate a beneficiary, the
unpaid balance shall be paid in a lump sum to the personal representative of
the
Executive's estate.
D.
|
Discharge
for Cause:
|
Should
the Executive be discharged for cause at any time prior to his Retirement Date,
all Index Benefits under this Agreement [subparagraphs III (A), (B) or (C)]
shall be forfeited. The term “for cause” shall mean the conviction of a felony
or gross-misdemeanor involving moral turpitude, fraud, dishonesty or willful
violation of any law that results in an adverse effect on the Bank. If a dispute
arises as to discharge "for cause", such dispute shall be resolved by
arbitration as set forth in this Agreement.
E.
|
Death
Benefit:
|
Except
as
set forth above, there is no death benefit provided under this
Agreement.
IV. |
RESTRICTIONS
UPON FUNDING
|
The
Bank
shall have no obligation to set aside, earmark or entrust any fund or money
with
which to pay its obligations under this Agreement. The Executive, his
beneficiary(ies) or any successor in interest to him shall be and remain simply
a general creditor of the Bank in the same manner as any other creditor having
a
general claim for matured and unpaid compensation.
The
Bank
reserves the absolute right at its sole discretion to either fund the
obligations undertaken by this Agreement or to refrain from funding the same
and
to determine the exact nature and method of such funding. Should the Bank elect
to fund this Agreement, in whole or in part, through the purchase of life
insurance, mutual funds, disability policies or annuities, the Bank reserves
the
absolute right, in its sole discretion, to terminate such funding at any time,
in whole or in part. At no time shall the Executive be deemed to have any lien
or right, title or interest in or to any specific funding investment or to
any
assets of the Bank.
If
the
Bank elects to invest in a life insurance, disability or annuity policy upon
the
life of the Executive, then the Executive shall assist the Bank by freely
submitting to a physical exam and supplying such additional information
necessary to obtain such insurance or annuities.
6
V.
|
CHANGE
OF CONTROL
|
Upon
a
Change of Control [as defined in subparagraph I (I) herein], the Executive
shall
immediately become one hundred percent (100%) vested in all benefits promised
in
this Agreement. If the Executive’s employment is subsequently terminated then he
shall receive the benefits promised in this Agreement upon the Normal Retirement
Age as defined in Subparagraph I (J). Payment shall be made in accordance with
Internal Revenue Code §409A. The Executive will also remain eligible for all
promised death benefits in this Agreement. In addition, no sale, merger or
consolidation of the Bank shall take place unless the new or surviving entity
expressly acknowledges the obligations under this Agreement and agrees to abide
by its terms.
VI. |
MISCELLANEOUS
|
A. |
Alienability
and Assignment Prohibition:
|
Neither
the Executive, his/her surviving spouse nor any other beneficiary under this
Agreement shall have any power or right to transfer, assign, anticipate,
hypothecate, mortgage, commute, modify or otherwise encumber in advance any
of
the benefits payable hereunder nor shall any of said benefits be subject to
seizure for the payment of any debts, judgments, alimony or separate maintenance
owed by the Executive or his beneficiary, nor be transferable by operation
of
law in the event of bankruptcy, insolvency or otherwise. In the event the
Executive or any beneficiary attempts assignment, commutation, hypothecation,
transfer or disposal of the benefits hereunder, the Bank's liabilities shall
forthwith cease and terminate.
B. |
Binding
Obligation of Bank and any Successor in Interest:
|
The
Bank
expressly agrees that it shall not merge or consolidate into or with another
bank or sell substantially all of its assets to another bank, firm or person
until such bank, firm or person expressly agrees, in writing, to assume and
discharge the duties and obligations of the Bank under this Agreement. This
Agreement shall be binding upon the parties hereto, their successors,
beneficiary(ies), heirs and personal representatives.
C. |
Revocation:
|
It
is
agreed by and between the parties hereto that, during the lifetime of the
Executive, this Agreement may be amended or revoked at any time or times, in
whole or in part, by the mutual written assent of the Executive and the
Bank.
7
D. |
Gender:
|
Whenever
in this Agreement words are used in the masculine or neuter gender, they shall
be read and construed as in the masculine, feminine or neuter gender, whenever
they should so apply.
E. |
Effect
on Other Bank Benefit Plans:
|
Nothing
contained in this Agreement shall affect the right of the Executive to
participate in or be covered by any qualified or non-qualified pension,
profit-sharing, group, bonus or other supplemental compensation or fringe
benefit plan constituting a part of the Bank's existing or future compensation
structure.
F. |
Headings:
|
Headings
and subheadings in this Agreement are inserted for reference and convenience
only and shall not be deemed a part of this Agreement.
G. |
Applicable
Law:
|
The
validity and interpretation of this Agreement shall be governed by the laws
of
the State of Maine.
H. |
Amend
and Restate Entire Agreement:
|
This
Agreement shall amend the Executive Supplemental Retirement Plan Agreement
dated
the 26th
day of
June, 1997 and any and all subsequent amendments, and shall restate the entire
agreement of the parties pertaining to this particular Amended and Restated
Executive Executive Supplemental Retirement Plan Agreement effective January
1,
2006.
VII. |
ADMINISTRATIVE
AND CLAIMS PROVISIONS
|
A. |
Plan
Administrator:
|
The
“Plan
Administrator” of this plan shall be Xxxxxxx Merchants Bank. As Administrator,
the Bank shall be responsible for the management, control and administration
of
the Supplemental Retirement Plan Agreement as established herein. The Plan
Administrator may delegate to others certain aspects of the management and
operation responsibilities of the plan including the employment of advisors
and
the delegation of ministerial duties to qualified individuals.
8
B. |
Claims
Procedure:
|
a. |
Filing
a Claim for Benefits:
|
Any
insured, beneficiary, or other individual, (“Claimant”) entitled to benefits
under this Executive Plan will file a claim request with the Plan Administrator.
The Plan Administrator will, upon written request of a Claimant, make available
copies of all forms and instructions necessary to file a claim for benefits
or
advise the Claimant where such forms and instructions may be obtained. If the
claim relates to disability benefits, then the Plan Administrator shall
designate a sub-committee to conduct the initial review of the claim (and
applicable references below to the Plan Administrator shall mean such
sub-committee).
b. |
Denial
of Claim:
|
A
claim for benefits under this Executive Plan will be denied if the
Bank
determines that the Claimant is not entitled to receive benefits
under the
Executive Plan. Notice of a denial shall be furnished the Claimant
within
a reasonable period of time after receipt of the claim for benefits
by the
Plan Administrator. This time period shall not exceed more than ninety
(90) days after the receipt of the properly submitted claim. In the
event
that the claim for benefits pertains to disability, the Plan Administrator
shall provide written notice within forty-five (45) days. However,
if the
Plan Administrator determines, in its discretion, that an
extension of time for processing the claim is required, such extension
shall not exceed an additional ninety (90) days. In the case of a
claim
for disability benefits, the forty-five (45) day review period may
be
extended for up to thirty (30) days if necessary due to circumstances
beyond the Plan Administrator’s control, and for an additional thirty (30)
days, if necessary. Any
extension notice shall indicate the special circumstances requiring
an
extension of time and the date by which the Plan Administrator expects
to
render the determination on review.
|
c. |
Content
of Notice:
|
The
Plan Administrator shall provide written notice to every Claimant
who is
denied a claim for benefits which notice shall set forth the
following:
|
(i.) |
The
specific reason or reasons for the
denial;
|
9
(ii.)
|
Specific
reference to pertinent Executive Plan provisions on which the denial
is
based;
|
(iii.)
|
A
description of any additional material or information necessary for
the
Claimant to perfect the claim, and any explanation of why such material
or
information is necessary; and
|
(iv.)
|
Any
other information required by applicable regulations, including with
respect to disability benefits.
|
d. |
Review
Procedure:
|
The
purpose of the Review Procedure is to provide a method by which a
Claimant
may have a reasonable opportunity to appeal a denial of a claim to
the
Plan Administrator for a full and fair review. The Claimant, or his
duly
authorized representative, may:
|
(i.)
|
Request
a review upon written application to the Plan Administrator. Application
for review must be made within sixty (60) days of receipt of written
notice of denial of claim. If the denial of claim pertains to disability,
application for review must be made within one hundred eighty (180)
days
of receipt of written notice of the denial of
claim;
|
(ii.)
|
Review
and copy (free of charge) pertinent Executive Plan documents, records
and
other information relevant to the Claimant’s claim for
benefits;
|
(iii.)
|
Submit
issues and concerns in writing, as well as documents, records, and
other
information relating to the claim.
|
e. |
Decision
on Review:
|
A
decision on review of a denied claim shall be made in the following
manner:
(i.)
|
The
Plan Administrator may, in its sole discretion, hold a hearing on
the
denied claim. If the Claimant’s initial claim is for disability benefits,
any review of a denied claim shall be made by members of the Plan
Administrator other than the original decision maker(s) and such
person(s)
shall not be a subordinate of the original decision maker(s). The
decision
on review shall be made promptly, but generally not later than sixty
(60)
days after receipt of the application for review. In the event that
the
denied claim pertains to disability, such decision shall not be made
later
than forty-five (45) days after receipt of the application for review.
If
the Plan Administrator determines that an extension of time for processing
is required, written notice of the extension shall be furnished to
the
Claimant prior to the termination of the initial sixty (60) day period.
In
no event shall the extension exceed a period of sixty (60) days from
the
end of the initial period. In the event the denied claim pertains
to
disability, written notice of such extension shall be furnished to
the
Claimant prior to the termination of the initial forty-five (45)
day
period. In no event shall the extension exceed a period of thirty
(30)
days from the end of the initial period. The extension notice shall
indicate the special circumstances requiring an extension of time
and the
date by which the Plan Administrator expects to render the determination
on review.
|
10
(ii.)
|
The
decision on review shall be in writing and shall include specific
reasons
for the decision written in an understandable manner with specific
references to the pertinent Executive Plan provisions upon which
the
decision is based.
|
(iii.)
|
The
review will take into account all comments, documents, records and
other
information submitted by the Claimant relating to the claim without
regard
to whether such information was submitted or considered in the initial
benefit determination. Additional considerations shall be required
in the
case of a claim for disability benefits. For example, the
claim will be reviewed without deference to the initial adverse benefits
determination and, if the initial adverse benefit determination was
based
in whole or in part on a medical judgment, the Plan Administrator
will
consult with a health care professional with appropriate training
and
experience in the field of medicine involving the medical judgment.
The
health care professional who is consulted on appeal will not be the
same
individual who was consulted during the initial determination or
the
subordinate of such individual. If the Plan Administrator obtained
the
advice of medical or vocational experts in making the initial adverse
benefits determination (regardless of whether the advice was relied
upon),
the Plan Administrator will identify such
experts.
|
11
(iv.)
|
The
decision on review will include a statement that the Claimant is
entitled
to receive, upon request and free of charge, reasonable access to,
and
copies of, all documents, records or other information relevant to
the
Claimant’s claim for benefits.
|
f.
|
Exhaustion
of Remedies:
|
A
Claimant must follow the claims review procedures under this Executive
Plan and exhaust his or her administrative remedies before taking
any
further action with respect to a claim for
benefits.
|
C.
|
Arbitration:
|
If
claimants continue to dispute the benefit denial based upon completed
performance of this Executive Plan or the meaning and effect of the terms and
conditions thereof, then claimants may submit the dispute to an Arbitrator
for
final arbitration. The Arbitrator shall be selected by mutual agreement of
the
Bank and the claimants. The Arbitrator shall operate under any generally
recognized set of arbitration rules. The parties hereto agree that they and
their heirs, personal representatives, successors and assigns shall be bound
by
the decision of such Arbitrator with respect to any controversy properly
submitted to it for determination.
Where
a
dispute arises as to the Bank’s discharge of the Executive “for cause,” such
dispute shall likewise be submitted to arbitration as above described and the
parties hereto agree to be bound by the decision thereunder.
VIII.
|
TERMINATION
OR MODIFICATION OF AGREEMENT BY REASON OF CHANGES IN THE LAW, RULES
OR
REGULATIONS
|
The
Bank
is entering into this Agreement upon the assumption that certain existing tax
laws, rules and regulations will continue in effect in their current form.
If
any said assumptions should change and said change has a detrimental effect
on
this Executive Plan, then the Bank reserves the right to terminate or modify
this Agreement accordingly with the mutual consent of the Executive. If this
Agreement is terminated, any payment made to the Executive shall be in
accordance with Internal Revenue Code §409A. Upon a Change of Control
(Subparagraph I [J]), this paragraph shall become null and void effective
immediately upon said Change of Control.
12
IN
WITNESS WHEREOF,
the
parties hereto acknowledge that each has carefully read this Agreement and
executed the original thereof on the date set forth hereinabove, and that,
upon
execution, each has received a conforming copy.
XXXXXXX
MERCHANTS BANK
Bangor,
ME
|
|||
|
|||
By:
|
|||
Witness
|
(Bank
Officer other than Insured) Title
|
||
Witness
|
Xxxxx
X. Xxxxx
|
13
BENEFICIARY
DESIGNATION FORM
FOR
THE AMENDED AND RESTATED EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT
EFFECTIVE JANUARY 1, 2006
I.
|
DESIGNATIONS (Please
refer to the beneficiary designation instructions below prior to
completion of this form.)
|
|||||||||||||||||||
A.
|
Person(s)
as a Primary & Secondary Designation:
(Please
indicate the percentage for each beneficiary.)
|
|||||||||||||||||||
1.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
2.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
3.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
4.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
B.
|
Estate
as a Primary Designation:
|
|||||||||||||||||||
My
Primary Beneficiary is The Estate of
|
as
set forth in the last will and
|
|||||||||||||||||||
Testament
dated the
|
day
of
|
,
200
|
and
any codicils thereto.
|
14
C.
|
Trust
as a Primary Designation:
|
|||||||||||||||||||
Name
of the Trust:
|
||||||||||||||||||||
Execution
Date of the Trust:
|
Name
of the Trustee:
|
|||||||||||||||||||
Beneficiary(ies)
of the Trust:
(please
indicate the percentage for each beneficiary):
|
||||||||||||||||||||
Name(s):
|
||||||||||||||||||||
Name(s):
|
||||||||||||||||||||
Is
this an Irrevocable Life Insurance Trust? oYes oNo
|
||||||||||||||||||||
(If
yes and this designation is for a Joint Beneficiary Agreement, an
Assignment of Rights form must
be
completed.)
|
II.
|
SECONDARY
(CONTINGENT) DESIGNATION
|
|||||||||||
A.
|
Estate
as a Secondary (Contingent) Designation:
|
|||||||||||
My
Primary Beneficiary is The Estate of
|
as
set forth in the last will and
|
|||||||||||
Testament
dated the
|
day
of
|
,
200
|
and
any codicils thereto.
|
|||||||||
B.
|
Trust
as a Secondary (Contingent) Designation:
|
|||||||||||
Name
of the Trust:
|
||||||||||||
Execution
Date of the Trust:
|
Name
of the Trustee:
|
|||||||||||
Beneficiary(ies)
of the Trust:
(please
indicate the percentage for each beneficiary):
|
||||||||||||
Name(s):
|
||||||||||||
Name(s):
|
||||||||||||
Is
this an Irrevocable Life Insurance Trust? oYes oNo
|
||||||||||||
(If
yes and this designation is for a Joint Beneficiary Designation Agreement,
an Assignment of Rights form must
be
completed.)
|
III. |
SIGN
AND DATE
|
All
sums
payable under the Amended and Restate Executive Salary Continuation Agreement
effective January 1, 2006, by reason of my death shall be paid to the Primary
Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies)
shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This
beneficiary designation is valid until the participant notifies the bank in
writing.
Xxxxx
X. Xxxxx
|
Date
|
15
BENEFICIARY
DESIGNATION INSTRUCTIONS
· |
If
you make a mistake in completing this form, line out the erroneous
information, add the correct information and initial the correction.
The
printed material on this form should not be deleted or altered in
any
way.
|
· |
In
all cases, the relationship of the beneficiary should be included
with the
beneficiary designations.
|
· |
A
Secondary Beneficiary will receive benefits only if the Primary
Beneficiary(ies) does not survive the Insured. If naming more than
one
Secondary Beneficiary at 100% each, please indicate on designations
1, 2,
3 or 4 on the designation line which states: “If deceased, designate ____
%”.
|
· |
If
a married woman is named beneficiary, her full legal name should
be
shown.
|
For
Example: Xxxx
X.
Xxxxx, not Xxx. Xxxx X. Xxxxx. Likewise, if this form is to be signed by a
married woman,
she should sign her full legal name.
· |
When
two or more beneficiaries are named, and they are not to share the
benefits equally, enter the percentage each beneficiary is to receive
on
the form in the space provided. Dollars
and cents should not be specified. When added together, the sum of
the
percentages going to the two or more named beneficiaries should equal
100%.
|
· |
If
a trustee is named beneficiary, show the exact name of the trust,
date of
the trust agreement, and the name and address of the
trustee.
|
For
Example: The
Xxxx
X. Xxxxx Revocable Life Insurance Trust, dated January 1, 1994, Xxxx Xxxxx
Trustee, 000 Xxxxx Xxxx, Xxxxxxxx, XX 00000.
16
AMENDED
AND RESTATED EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT
EFFECTIVE
JANUARY 1, 2006
This
Agreement, made and entered into this 1st
day of
January, 2006, by and between Xxxxxxx Merchants Bank, a Bank organized
and
existing under the laws of the State of Maine hereinafter referred to as
"the
Bank", and Xxxxxxx X. Lucy, a Key Employee and the Executive of the Bank,
hereinafter referred
to as "the Executive".
The
Bank
and the Executive are parties to this Amended and Restated Executive
Supplemental Retirement Plan Agreement between Xxxxxxx Merchants Bank and
Xxxxxxx X. Lucy that provides for the payment of certain benefits. This
Amended
and Restated Executive Supplemental Retirement Plan Agreement effective
January
1, 2006 shall bring the Executive Supplemental Retirement Plan Agreement
dated
February 15, 1999, in compliance with Internal Revenue Code §409A enacted on
October 22, 2004. The benefits provided hereunder shall amend and restate
the
existing Executive Supplemental Retirement Plan Agreement dated February
15,
1999, and any and all subsequent amendments, and the benefits provided
thereby;
The
Executive has been in the employ of the Bank for several years and has
now and
for years past faithfully served the Bank. It is the consensus of the
Compensation Committee of the Board of Directors of the Bank (The Board)
that
the Executive’s employment has been of exceptional merit, in excess of the
compensation paid and an invaluable contribution to the profits and position
of
the Bank in its field of activity. The Board further believes that the
Executive's experience, knowledge of corporate affairs, reputation and
industry
contacts are of such value and his continued employment is so essential
to the
Bank's future growth and profits that it would suffer severe financial
loss
should the Executive terminate the Executive’s employment.
Accordingly,
it is the desire of the Bank and the Executive to enter into this Agreement
under which the Bank will agree to make certain payments to the Executive
upon
the Executive’s retirement and, alternatively, to the Executive’s
beneficiary(ies) in the event of the Executive’s premature death while employed
by the Bank.
It
is the
intent of the parties hereto that this Agreement be considered an arrangement
maintained primarily to provide supplemental retirement benefits for the
Executive, as a member of a select group of management or highly-compensated
employees of the Bank for purposes of the Employee Retirement Income Security
Act of 1974 (ERISA). The Executive is fully advised of the Bank's financial
status and has had substantial input in the design and operation of this
benefit
plan.
Therefore,
in consideration of the Executive’s employment performed in the past and those
to be performed in the future and based upon the mutual promises and covenants
herein contained, the Bank and the Executive, agree as follows:
I. |
DEFINITIONS
|
A. |
Effective
Date:
|
The
Effective Date of this Agreement shall be January 1, 2006.
B. |
Plan
Year:
|
Any
reference to “Plan Year” shall mean a calendar year from January 1st
to
December 31st.
In the
year of implementation, the term “Plan Year” shall mean the period from the
effective date to December 31st
of the
year of the effective date.
C.
|
Retirement
Date:
|
Retirement
Date shall mean retirement from employment with the Bank which becomes
effective
on the first day of the calendar month following the month in which the
Executive reaches the Executive’s sixty-fifth (65th) birthday or such later date
as the Executive may actually retire.
D. |
Early
Retirement Date
|
Early
Retirement Date shall mean a retirement from employment which is effective
prior
to the Retirement Date stated above, provided the Executive has attained
age
fifty-five (55).
E. |
Termination
of Employment:
|
Termination
of Employment shall mean voluntary resignation of employment by the Executive
or
the Bank’s discharge of the Executive without cause (“cause” defined in
Subparagraph III (E) hereinafter), prior to the Executive’s
retirement.
F. |
Pre-Retirement
Account:
|
A
Pre-Retirement Account shall be established as a liability reserve account
on
the books of the Bank for the benefit of the Executive. Prior to termination
of
employment or the Executive’s retirement, such liability reserve account shall
be increased or decreased each Plan Year (including the Plan Year in which
the
Executive ceases to be employed by the Bank) by an amount equal to the
annual
earnings or loss for that Plan Year determined by the Index (described
in
Subparagraph I (H) hereinafter), less the Cost of Funds Expense for that
Plan
Year (described in Subparagraph I (I) hereinafter).
2
G. |
Index
Retirement Benefit:
|
The
Index
Retirement Benefit for the Executive for any year shall be equal to the
excess
of the annual earnings (if any) determined by the Index [Subparagraph I
(H)] for
that Plan Year over the Cost of Funds Expense [Subparagraph I (I)] for
that Plan
Year.
H. |
Index:
|
The
Index
for any Plan Year shall be the aggregate annual after-tax income from the
life
insurance contracts described hereinafter as defined by FASB Technical
Bulletin
85-4. This Index shall be applied as if such insurance contracts were purchased
on the effective date hereof.
Insurance
Company:
|
Security
Life of Denver
|
Policy
Form:
|
Whole
Life
|
Name:
|
Corp
IV
|
Insured’s
Age and Sex:
|
40,
Male
|
Riders:
|
None
|
Ratings:
|
None
|
Option:
|
Level
Death Benefit
|
Face
Amount:
|
$319,582
|
Premiums
Paid:
|
$107,000
|
Number
of Premium Payments:
|
One
|
Assumed
Purchase Date:
|
May
22, 1998
|
Insurance
Company:
|
Jefferson
Pilot
|
Policy
Form:
|
Flexible
Premium Adjustable Life
|
Name:
|
Executive
Security Plan VI
|
Insured’s
Age and Sex:
|
42,
Male
|
Riders:
|
None
|
Ratings:
|
None
|
Option:
|
Level
Death Benefit
|
Face
Amount:
|
$270,000
|
Cash
Surrender Value as of 12/31/05:
|
$99,658
|
Number
of Premium Payments:
|
One
|
Assumed
Cash Value Date:
|
December
31, 2005
|
Insurance
Company:
|
Union
Central Life Insurance/SLD
|
Policy
Form:
|
Universal
Life Insurance
|
Name:
|
COLI
UL
|
Insured’s
Age and Sex:
|
42,
Male
|
Riders:
|
None
|
Ratings:
|
None
|
Option:
|
Level
Death Benefit
|
Face
Amount:
|
$288,400
|
Cash
Surrender Value as of 12/31/05:
|
$99,687
|
Number
of Premium Payments:
|
One
|
Assumed
Cash Value Date:
|
December
31, 2005
|
3
If
such
contracts of life insurance are actually purchased by the Bank then the
actual
policies as of the dates they were purchased shall be used in calculations
under
this Agreement. If such contracts of life insurance are not purchased or
are
subsequently surrendered, lapsed or the Insured has pre-deceased the executive,
then the Bank shall receive annual policy illustrations that assume the
above
described policies were purchased from the above named insurance company(ies)
on
the Effective Date from which the increase in policy value will be used
to
calculate the amount of the Index.
In
either
case, references to the life insurance contract are merely for purposes
of
calculating a benefit. The Bank has no obligation to purchase such life
insurance and, if purchased, the Executive and the Executive’s beneficiary(ies)
shall have no ownership interest in such policy and shall always have no
greater
interest in the benefits under this Agreement than that of an unsecured
general
creditor of the Bank.
I. |
Cost
of Funds Expense:
|
The
Cost
of Funds Expense for any Plan Year shall be calculated by taking the sum
of the
amount of premiums set forth in the Indexed policies described above plus
the
amount of any after-tax benefits
paid to the Executive pursuant to this Agreement (Paragraph III hereinafter)
plus the amount of all previous years after-tax Costs of Funds Expense,
and
multiplying that sum by the average after-tax cost of funds of the Bank's
third
quarter Call Report for the Plan Year as filed with the Federal
Reserve.
J.
|
Change
of Control:
|
In
accordance with Internal Revenue Code §409A, the Change of Control shall be
defined as the occurrence of any one of the following:
a.
|
the
acquisition of more than fifty percent (50%) of the value or
voting power
of the Bank’s Holding Company stock by a person or
group;
|
b.
|
the
acquisition in a period of twelve (12) months or less of at least
thirty-five percent (35%) of the Bank’s Holding Company stock by a person
or group;
|
4
c.
|
the
replacement of a majority of the Bank’s Holding Company board in a period
of twelve (12) months or less by Directors who were not endorsed
by a
majority of the current board members;
or
|
d.
|
the
acquisition in a period of twelve (12) months or less of forty
percent
(40%) or more of the Bank’s Holding Company assets by an unrelated
entity.
|
For
the
purposes of this Agreement, transfers on account of deaths or gifts, transfers
between family members or transfers to a qualified retirement plan maintained
by
the Bank shall not be considered in determining whether there has been
a change
in control.
K. |
Normal
Retirement Age:
|
Normal
Retirement Age shall mean the date on which the Executive attains age sixty-five
(65).
II. |
EMPLOYMENT
|
No
provision of this Agreement shall be deemed to restrict or limit any existing
employment agreement by and between the Bank and the Executive, nor shall
any
conditions herein create specific employment rights to the Executive nor
limit
the right of the Employer to discharge the Executive with or without cause.
In a
similar fashion, no provision shall limit the Executive's rights to voluntarily
sever the Executive’s employment at any time.
III. |
INDEX
BENEFITS
|
The
following benefits provided by the Bank to the Executive are in the nature
of a
fringe benefit and shall in no event be construed to effect nor limit the
Executive's current or prospective salary increases, cash bonuses or
profit-sharing distributions or credits.
A.
|
Retirement
Benefits:
|
Should
the Executive continue to be employed by the Bank until the Executive’s "Normal
Retirement Age" defined in Subparagraph I (K), the Executive shall be entitled
to receive the balance in the Executive’s Pre-Retirement Account [as defined in
Subparagraph I (F)] in ten (10)ten
(10)
equal
annual installments commencing
thirty (30) days following the Executive’s Retirement Date. In addition to these
payments, commencing with the Plan Year in which the Executive attains
the
Executive’s Retirement Date, the Index Retirement Benefit (as defined in
Subparagraph I (G) above) for each year shall be paid to the Executive
until the
Executive’s death. Notwithstanding the foregoing, the total amount of said
annual benefit (i.e. the Pre-Retirement Account and the Index Retirement
Benefit
combined) to be received by the Executive at the Retirement Date shall
be a
maximum of Thirty Thousand and 00/100th
Dollars
($30,000.00).
5
In
accordance with Internal Revenue Code §409A, if the Executive is a Key Employee,
and said Bank is publicly traded at the time of retirement, any such benefit
payment shall be withheld for six (6) months following such retirement.
B.
|
Early
Retirement Date
|
Should
the Executive elect Early Retirement, he shall be entitled to receive the
balance in the Pre-Retirement Account paid at said Early Retirement Date
in ten
(10) equal annual installments commencing thirty (30) days following the
Early
Retirement Date [Subparagraph I (D)]. At the Normal Retirement Age, the
Index
Retirement Benefit [Subparagraph I (G)] shall be paid to the Executive
annually
until the Executive’s death. Notwithstanding the foregoing, the total amount of
said annual benefit (i.e. the Pre-Retirement Account and the Index Retirement
Benefit combined) to be received by the Executive at the Early Retirement
Date
shall be a maximum of Thirty Thousand and 00/100th
Dollars
($30,000.00).
In
accordance with Internal Revenue Code §409A, if the Executive is a Key Employee,
and said Bank is publicly traded at the time of retirement, any such benefit
payment shall be withheld for six (6) months following such retirement.
C.
|
Termination
of Service:
|
Subject
to subparagraph III (D) hereinafter, should the Executive suffer a Termination
of Employment [defined in subparagraph I (D)], the Executive shall be entitled
to receive the percentage of the Pre-Retirement Account that corresponds
to the
years of employment with the Bank, as stated in the schedule below, paid
in ten
(10) equal annual installments commencing thirty (30) days following said
Termination of Employment. In addition to these payments, the Executive
shall be
entitled to receive the percentage of the Index Retirement Benefit that
corresponds to the years of employment with the Bank as stated in the schedule
below, and shall be paid to the Executive until his death.
In
accordance with Internal Revenue Code §409A, if the Executive is a Key Employee,
and said Bank is publicly traded at the time of termination of employment,
any
such benefit payment shall be withheld for six (6) months following such
termination of employment.
Total
Years
|
|
of
Employment
|
Vested
Percentage
|
with
the Bank
|
(to
a maximum of 100%)
|
0-14
years
|
0%
|
15-19
years
|
75%
|
20
years
|
100%
|
6
D.
|
Death:
|
Should
the Executive die prior to having received the full balance of the
Pre-Retirement Account, the unpaid balance of the Pre-Retirement Account
shall
be paid in a lump sum to the beneficiary selected by the Executive and
filed
with the Bank. In the absence of or a failure to designate a beneficiary,
the
unpaid balance shall be paid in a lump sum to the personal representative
of the
Executive's estate.
E.
|
Discharge
for Cause:
|
Should
the Executive be discharged for cause at any time prior to the Executive’s
Retirement Date, all Index Benefits under this Agreement [Subparagraphs
III (A),
(B), (C) or (D)] shall be forfeited. The term “for cause” shall mean
gross
negligence or gross neglect or the
conviction of a felony or gross misdemeanor involving moral turpitude,
fraud,
dishonesty or willful violation of any law that results in any
adverse
effect on the Bank. If a dispute arises as to discharge "for cause", such
dispute shall be resolved by arbitration as set forth in this
Agreement.
F.
|
Death
Benefit:
|
Except
as
set forth above, there is no death benefit provided under this
Agreement.
IV. |
RESTRICTIONS
UPON FUNDING
|
The
Bank
shall have no obligation to set aside, earmark or entrust any fund or money
with
which to pay its obligations under this Agreement. The Executive, the
Executive’s beneficiary(ies) or any successor in interest to the Executive shall
be and remain simply a general creditor of the Bank in the same manner
as any
other creditor having a general claim for matured and unpaid
compensation.
The
Bank
reserves the absolute right, at its sole discretion, to either fund the
obligations undertaken by this Agreement or to refrain from funding the
same and
to determine the exact nature and method of such funding. Should the Bank
elect
to fund this Agreement, in whole or in part, through the purchase of life
insurance, mutual funds, disability policies or annuities, the Bank reserves
the
absolute right, in its sole discretion, to terminate such funding at any
time,
in whole or in part. At no time shall the Executive be deemed to have any
lien
or right, title or interest in or to any specific funding investment or
to any
assets of the Bank.
7
If
the
Bank elects to invest in a life insurance, disability or annuity policy
upon the
life of the Executive, then the Executive shall assist the Bank by freely
submitting to a physical exam and supplying such additional information
necessary to obtain such insurance or annuities.
V.
|
CHANGE
OF CONTROL
|
Upon
a
Change of Control (as defined in Subparagraph I (J) herein), the Executive
shall
immediately become one hundred percent (100%) vested in all benefits promised
in
this Agreement. If the Executive’s employment is subsequently terminated then
the Executive shall receive the benefits promised in this Agreement upon
Early
Retirement Date (Subparagraph I [D]). Payment shall be made in accordance
with
Internal Revenue Code §409A. The Executive will also remain eligible for all
promised death benefits in this Agreement. In addition, no sale, merger
or
consolidation of the Bank shall take place unless the new or surviving
entity
expressly acknowledges the obligations under this Agreement and agrees
to abide
by its terms.
VI. |
MISCELLANEOUS
|
A. |
Alienability
and Assignment Prohibition:
|
Neither
the Executive, his/her surviving spouse nor any other beneficiary under
this
Agreement shall have any power or right to transfer, assign, anticipate,
hypothecate, mortgage, commute, modify or otherwise encumber in advance
any of
the benefits payable hereunder nor shall any of said benefits be subject
to
seizure for the payment of any debts, judgments, alimony or separate maintenance
owed by the Executive or the Executive’s beneficiary, nor be transferable by
operation of law in the event of bankruptcy, insolvency or otherwise. In
the
event the Executive or any beneficiary attempts assignment, commutation,
hypothecation, transfer or disposal of the benefits hereunder, the Bank's
liabilities shall forthwith cease and terminate.
B. |
Binding
Obligation of Bank and any Successor in Interest:
|
The
Bank
expressly agrees that it shall not merge or consolidate into or with another
bank or sell substantially all of its assets to another bank, firm or person
until such bank, firm or person expressly agrees, in writing, to assume
and
discharge the duties and obligations of the Bank under this Agreement.
This
Agreement shall be binding upon the parties hereto, their successors,
beneficiary(ies), heirs and personal representatives.
8
C. |
Revocation:
|
It
is
agreed by and between the parties hereto that, during the lifetime of the
Executive, this Agreement may be amended or revoked at any time or times,
in
whole or in part, by the mutual written assent of the Executive and the
Bank.
D. |
Gender:
|
Whenever
in this Agreement words are used in the masculine or neuter gender, they
shall
be read and construed as in the masculine, feminine or neuter gender, whenever
they should so apply.
E. |
Effect
on Other Bank Benefit Plans:
|
Nothing
contained in this Agreement shall affect the right of the Executive to
participate in or be covered by any qualified or non-qualified pension,
profit-sharing, group, bonus or other supplemental compensation or fringe
benefit plan constituting a part of the Bank's existing or future compensation
structure.
F. |
Headings:
|
Headings
and subheadings in this Agreement are inserted for reference and convenience
only and shall not be deemed a part of this Agreement.
G. |
Applicable
Law:
|
The
validity and interpretation of this Agreement shall be governed by the
laws of
the State of Maine.
H. |
Amend
and Restate Entire Agreement:
|
This
Agreement shall amend the Executive Supplemental Retirement Plan Agreement
dated
the 15th
day of
February, 1999, and any and all subsequent amendments, and shall restate
the
entire agreement of the parties pertaining to this particular Amended and
Restated Executive Supplemental Retirement Plan Agreement effective January
1,
2006.
9
VII. |
ADMINISTRATIVE
AND CLAIMS PROVISIONS
|
A. |
Plan
Administrator:
|
The
“Plan
Administrator” of this plan shall be Xxxxxxx Merchants Bank. As Administrator,
the Bank shall be responsible for the management, control and administration
of
the Supplemental Retirement Plan Agreement as established herein. The Plan
Administrator may delegate to others certain aspects of the management
and
operation responsibilities of the plan including the employment of advisors
and
the delegation of ministerial duties to qualified individuals.
B. |
Claims
Procedure:
|
a. |
Filing
a Claim for Benefits:
|
Any
insured, beneficiary, or other individual, (“Claimant”) entitled to benefits
under this Executive Plan will file a claim request with the Plan Administrator.
The Plan Administrator will, upon written request of a Claimant, make available
copies of all forms and instructions necessary to file a claim for benefits
or
advise the Claimant where such forms and instructions may be obtained.
If the
claim relates to disability benefits, then the Plan Administrator shall
designate a sub-committee to conduct the initial review of the claim (and
applicable references below to the Plan Administrator shall mean such
sub-committee).
b. |
Denial
of Claim:
|
A
claim for benefits under this Executive Plan will be denied if
the Bank
determines that the Claimant is not entitled to receive benefits
under the
Executive Plan. Notice of a denial shall be furnished the Claimant
within
a reasonable period of time after receipt of the claim for benefits
by the
Plan Administrator. This time period shall not exceed more than
ninety
(90) days after the receipt of the properly submitted claim.
In the event
that the claim for benefits pertains to disability, the Plan
Administrator
shall provide written notice within forty-five (45) days. However,
if the
Plan Administrator determines, in its discretion, that an
extension of time for processing the claim is required, such
extension
shall not exceed an additional ninety (90) days. In the case
of a claim
for disability benefits, the forty-five (45) day review period
may be
extended for up to thirty (30) days if necessary due to circumstances
beyond the Plan Administrator’s control, and for an additional thirty (30)
days, if necessary. Any
extension notice shall indicate the special circumstances requiring
an
extension of time and the date by which the Plan Administrator
expects to
render the determination on review.
|
10
c. |
Content
of Notice:
|
The
Plan Administrator shall provide written notice to every Claimant
who is
denied a claim for benefits which notice shall set forth the
following:
|
(i.) |
The
specific reason or reasons for the
denial;
|
(ii.)
|
Specific
reference to pertinent Executive Plan provisions on which the
denial is
based;
|
(iii.)
|
A
description of any additional material or information necessary
for the
Claimant to perfect the claim, and any explanation of why such
material or
information is necessary; and
|
(iv.)
|
Any
other information required by applicable regulations, including
with
respect to disability benefits.
|
d. |
Review
Procedure:
|
The
purpose of the Review Procedure is to provide a method by which
a Claimant
may have a reasonable opportunity to appeal a denial of a claim
to the
Plan Administrator for a full and fair review. The Claimant,
or his duly
authorized representative, may:
|
(i.)
|
Request
a review upon written application to the Plan Administrator.
Application
for review must be made within sixty (60) days of receipt of
written
notice of denial of claim. If the denial of claim pertains to
disability,
application for review must be made within one hundred eighty
(180) days
of receipt of written notice of the denial of
claim;
|
(ii.)
|
Review
and copy (free of charge) pertinent Executive Plan documents,
records and
other information relevant to the Claimant’s claim for
benefits;
|
(iii.)
|
Submit
issues and concerns in writing, as well as documents, records,
and other
information relating to the claim.
|
11
e. |
Decision
on Review:
|
A
decision on review of a denied claim shall be made in the following
manner:
(i.)
|
The
Plan Administrator may, in its sole discretion, hold a hearing
on the
denied claim. If the Claimant’s initial claim is for disability benefits,
any review of a denied claim shall be made by members of the
Plan
Administrator other than the original decision maker(s) and such
person(s)
shall not be a subordinate of the original decision maker(s).
The decision
on review shall be made promptly, but generally not later than
sixty (60)
days after receipt of the application for review. In the event
that the
denied claim pertains to disability, such decision shall not
be made later
than forty-five (45) days after receipt of the application for
review. If
the Plan Administrator determines that an extension of time for
processing
is required, written notice of the extension shall be furnished
to the
Claimant prior to the termination of the initial sixty (60) day
period. In
no event shall the extension exceed a period of sixty (60) days
from the
end of the initial period. In the event the denied claim pertains
to
disability, written notice of such extension shall be furnished
to the
Claimant prior to the termination of the initial forty-five (45)
day
period. In no event shall the extension exceed a period of thirty
(30)
days from the end of the initial period. The extension notice
shall
indicate the special circumstances requiring an extension of
time and the
date by which the Plan Administrator expects to render the determination
on review.
|
(ii.)
|
The
decision on review shall be in writing and shall include specific
reasons
for the decision written in an understandable manner with specific
references to the pertinent Executive Plan provisions upon which
the
decision is based.
|
(iii.)
|
The
review will take into account all comments, documents, records
and other
information submitted by the Claimant relating to the claim without
regard
to whether such information was submitted or considered in the
initial
benefit determination. Additional considerations shall be required
in the
case of a claim for disability benefits. For example, the
claim will be reviewed without deference to the initial adverse
benefits
determination and, if the initial adverse benefit determination
was based
in whole or in part on a medical judgment, the Plan Administrator
will
consult with a health care professional with appropriate training
and
experience in the field of medicine involving the medical judgment.
The
health care professional who is consulted on appeal will not
be the same
individual who was consulted during the initial determination
or the
subordinate of such individual. If the Plan Administrator obtained
the
advice of medical or vocational experts in making the initial
adverse
benefits determination (regardless of whether the advice was
relied upon),
the Plan Administrator will identify such
experts.
|
12
(iv.)
|
The
decision on review will include a statement that the Claimant
is entitled
to receive, upon request and free of charge, reasonable access
to, and
copies of, all documents, records or other information relevant
to the
Claimant’s claim for benefits.
|
f.
|
Exhaustion
of Remedies:
|
A
Claimant must follow the claims review procedures under this
Executive
Plan and exhaust his or her administrative remedies before taking
any
further action with respect to a claim for
benefits.
|
C.
|
Arbitration:
|
If
claimants continue to dispute the benefit denial based upon completed
performance of this Executive Plan or the meaning and effect of the terms
and
conditions thereof, then claimants may submit the dispute to an Arbitrator
for
final arbitration. The Arbitrator shall be selected by mutual agreement
of the
Bank and the claimants. The Arbitrator shall operate under any generally
recognized set of arbitration rules. The parties hereto agree that they
and
their heirs, personal representatives, successors and assigns shall be
bound by
the decision of such Arbitrator with respect to any controversy properly
submitted to it for determination.
Where
a
dispute arises as to the Bank’s discharge of the Executive “for cause,” such
dispute shall likewise be submitted to arbitration as above described and
the
parties hereto agree to be bound by the decision thereunder.
13
VIII.
|
TERMINATION
OR MODIFICATION OF AGREEMENT BY REASON OF CHANGES IN THE LAW,
RULES OR
REGULATIONS
|
The
Bank
is entering into this Agreement upon the assumption that certain existing
tax
laws, rules and regulations will continue in effect in their current form.
If
any said assumptions should change and said change has a detrimental effect
on
this Executive Plan, then the Bank reserves the right to terminate or modify
this Agreement accordingly with the mutual consent of the Executive. If
this
Agreement is terminated, any payment made to the Executive shall be in
accordance with Internal Revenue Code §409A. Upon a Change of Control
(Subparagraph I [J]), this paragraph shall become null and void effective
immediately upon said Change of Control.
IN
WITNESS WHEREOF,
the
parties hereto acknowledge that each has carefully read this Agreement
and
executed the original thereof on the date set forth hereinabove, and that,
upon
execution, each has received a conforming copy.
XXXXXXX
MERCHANTS BANK
Bangor,
ME
|
|||
|
|||
By:
|
|||
Witness
|
(Bank
Officer other than Insured) Title
|
||
Witness
|
Xxxxxxx
X. Xxxx
|
14
BENEFICIARY
DESIGNATION FORM
FOR
THE AMENDED AND RESTATED EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN AGREEMENT
EFFECTIVE JANUARY 1, 2006
I.
|
DESIGNATIONS (Please
refer to the beneficiary designation instructions below prior
to
completion of this form.)
|
|||||||||||||||||||
A.
|
Person(s)
as a Primary & Secondary Designation:
(Please
indicate the percentage for each beneficiary.)
|
|||||||||||||||||||
1.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
2.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
3.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
4.
|
Name:
|
Relationship:
|
SS#:
|
%
if living:
|
||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
If
deceased, designate %
|
to:
|
Relationship:
|
SS#:
|
|||||||||||||||||
Address:
|
||||||||||||||||||||
(Street)
|
(City)
|
(State)
|
(Zip)
|
|||||||||||||||||
B.
|
Estate
as a Primary Designation:
|
|||||||||||||||||||
My
Primary Beneficiary is The Estate of
|
as
set forth in the last will and
|
|||||||||||||||||||
Testament
dated the
|
day
of
|
,
200
|
and
any codicils thereto.
|
15
C.
|
Trust
as a Primary Designation:
|
|||||||||||||||||||
Name
of the Trust:
|
||||||||||||||||||||
Execution
Date of the Trust:
|
Name
of the Trustee:
|
|||||||||||||||||||
Beneficiary(ies)
of the Trust:
(please
indicate the percentage for each beneficiary):
|
||||||||||||||||||||
Name(s):
|
||||||||||||||||||||
Name(s):
|
||||||||||||||||||||
Is
this an Irrevocable Life Insurance Trust? oYes oNo
|
||||||||||||||||||||
(If
yes and this designation is for a Joint Beneficiary Agreement,
an
Assignment of Rights form must
be
completed.)
|
II.
|
SECONDARY
(CONTINGENT) DESIGNATION
|
|||||||||||
A.
|
Estate
as a Secondary (Contingent) Designation:
|
|||||||||||
My
Primary Beneficiary is The Estate of
|
as
set forth in the last will and
|
|||||||||||
Testament
dated the
|
day
of
|
,
200
|
and
any codicils thereto.
|
|||||||||
B.
|
Trust
as a Secondary (Contingent) Designation:
|
|||||||||||
Name
of the Trust:
|
||||||||||||
Execution
Date of the Trust:
|
Name
of the Trustee:
|
|||||||||||
Beneficiary(ies)
of the Trust:
(please
indicate the percentage for each beneficiary):
|
||||||||||||
Name(s):
|
||||||||||||
Name(s):
|
||||||||||||
Is
this an Irrevocable Life Insurance Trust? oYes oNo
|
||||||||||||
(If
yes and this designation is for a Joint Beneficiary Designation
Agreement,
an Assignment of Rights form must
be
completed.)
|
III. |
SIGN
AND DATE
|
All
sums
payable under the Amended and Restate Executive Salary Continuation Agreement
effective January 1, 2006, by reason of my death shall be paid to the Primary
Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies)
shall survive me, then to the Secondary (Contingent) Beneficiary(ies).
This
beneficiary designation is valid until the participant notifies the bank
in
writing.
Xxxxxxx
X. Lucy
|
Date
|
16
BENEFICIARY
DESIGNATION INSTRUCTIONS
· |
If
you make a mistake in completing this form, line out the erroneous
information, add the correct information and initial the correction.
The
printed material on this form should not be deleted or altered
in any
way.
|
· |
In
all cases, the relationship of the beneficiary should be included
with the
beneficiary designations.
|
· |
A
Secondary Beneficiary will receive benefits only if the Primary
Beneficiary(ies) does not survive the Insured. If naming more
than one
Secondary Beneficiary at 100% each, please indicate on designations
1, 2,
3 or 4 on the designation line which states: “If deceased, designate ____
%”.
|
· |
If
a married woman is named beneficiary, her full legal name should
be
shown.
|
For
Example: Xxxx
X.
Xxxxx, not Xxx. Xxxx X. Xxxxx. Likewise, if this form is to be signed by
a
married woman,
she should sign her full legal name.
· |
When
two or more beneficiaries are named, and they are not to share
the
benefits equally, enter the percentage each beneficiary is to
receive on
the form in the space provided. Dollars
and cents should not be specified. When added together, the sum
of the
percentages going to the two or more named beneficiaries should
equal
100%.
|
· |
If
a trustee is named beneficiary, show the exact name of the trust,
date of
the trust agreement, and the name and address of the
trustee.
|
For
Example: The
Xxxx
X. Xxxxx Revocable Life Insurance Trust, dated January 1, 1994, Xxxx Xxxxx
Trustee, 000 Xxxxx Xxxx, Xxxxxxxx, XX 00000.
17