Exhibit 10.13
Cortland Bancorp
Director Retirement Agreement
This
Director Retirement Agreement
(this Agreement) is entered into as of this
day of
, 2011, by and between Cortland Bancorp (the Company), a bank holding
company located in Cortland, Ohio, and Joseph E. Koch, a director of the Company (the Director).
Whereas
, to encourage the Director to remain a member of the Companys board of
directors, the Company desires to provide a retirement benefit for the Director after termination
of director service, payable from the Companys general assets, and
Whereas
, none of the conditions or events included in the definition of the term
golden parachute payment that is set forth in section 18(k)(4)(A)(ii) of the Federal Deposit
Insurance Act [12 U.S.C. 1828(k)(4)(A)(ii)] and in Federal Deposit Insurance Corporation Rule
359.1(f)(1)(ii) [12 CFR 359.1(f)(1)(ii)] exists or, to the best knowledge of the Company, is
contemplated insofar as the Company or The Cortland Savings and Banking Company is concerned.
Now Therefore
, in consideration of the foregoing premises and other good and valuable
consideration, the receipt and acceptance of which are hereby acknowledged, the Director and the
Company hereby agree as follows.
Article 1
Definitions
1.1
Accrual Balance
means the liability that should be accrued by the Company under
generally accepted accounting principles (GAAP) for the Companys obligation to the Director
under this Agreement, by applying Accounting Principles Board Opinion No. 12, as amended by
Statement of Financial Accounting Standards No. 106, and the calculation method and discount rate
specified hereinafter. The Accrual Balance at Normal Retirement Age shall equal the present value
of the normal retirement benefits. The discount rate means the rate used by the Plan Administrator
for determining the Accrual Balance. The rate is based on the yield on a 20-year corporate bond
rated Aa by Moodys, rounded to the nearest
1
/
4
%. The Plan Administrator may adjust the discount
rate to maintain the rate within reasonable standards according to GAAP.
1.2
Beneficiary
means each designated person, determined according to Article 4, or the
estate of the deceased Director, entitled to benefits, if any, at the Directors death.
1.3
Beneficiary Designation Form
means the form established from time to time by the Plan
Administrator that the Director completes, signs, and returns to the Plan Administrator to
designate one or more Beneficiaries.
1.4
Change in Control
means a change in control as defined in Code section 409A and rules,
regulations, and guidance of general application thereunder issued by the Department of the
Treasury from time to time, which currently define the term change in control to include the
following transactions
(a)
Change in ownership
: a change in ownership of the Company occurs on the date any one person
or group accumulates ownership of Company stock constituting more than 50% of the total fair
market value or total voting power of Company stock,
(b)
Change in effective control
: (
x
) any one person, or more than one person acting as a group,
acquires within a 12-month period ownership of Company stock possessing 30% or more of the total
voting power of Company stock, or (
y
) a majority of the Companys board of directors is replaced
during any 12-month period by directors whose appointment or election is not endorsed in advance
by a majority of the Companys board of directors, or
(c)
Change in ownership of a substantial portion of assets
: a change in ownership of a
substantial portion of the Companys assets occurs if in a 12-month period any one person or
more than one person acting as a group acquires from the Company assets having a total gross
fair market value equal to or exceeding 40% of the total gross fair market value of all of the
Companys assets immediately before the acquisition or acquisitions. For this purpose, gross
fair market value means the value of the Companys assets, or the value of the assets being
disposed of, determined without regard to any liabilities associated with the assets.
1.5
Code
means the Internal Revenue Code of 1986, as amended, and rules, regulations, and
guidance of general application issued by the Department of the Treasury under the Internal Revenue
Code of 1986, as amended.
1.6
Disability
means, because of a medically determinable physical or mental impairment that
can be expected to result in death or that can be expected to last for a continuous period of at
least 12 months, (
x
) the Director is unable to engage in any substantial gainful activity, or (
y
)
the Director is receiving income replacement benefits for a period of at least three months under
an accident and health plan. Medical determination of disability may be made either by the Social
Security Administration or by the provider of an accident or health plan covering employees of the
Company or its subsidiaries. Upon request of the Plan Administrator, the Director must submit
proof to the Plan Administrator of the Social Security Administrations or providers
determination.
1.7
Early Termination
means Separation from Service before Normal Retirement Age for reasons
other than death, Disability, or Termination with Cause. Early Termination excludes a Separation
from Service governed by section 2.4.
1.8
Effective Date
means March 1, 2011.
1.9
Normal Retirement Age
means age 70.
1.10
Plan Administrator
or
Administrator
means the plan administrator described in Article
7.
1.11
Plan Year
means each consecutive 12-month period from the Effective Date of this
Agreement.
1.12
Separation from Service
means the Directors service as a director and independent
contractor to the Company and any member of a controlled group, as defined in Code section 414,
terminates for any reason, other than because of a leave of absence approved by the Company or the
Directors death. For purposes of this Agreement, if there is a dispute about the status of the
Director or the date of the Directors Separation from Service, the Company shall have the sole and absolute
right to decide the dispute unless a Change in Control shall have occurred.
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1.13
Termination with Cause
or
Cause
means the Director is not nominated by the board or
nominating committee for reelection as a director after the expiration of his current term, or the
Director is removed from the board of directors, in either case because of the Directors
(a) gross negligence or gross neglect of duties, or
(b) commission of a felony or commission of a misdemeanor involving moral turpitude, or
(c) fraud, disloyalty, dishonesty, or willful violation of any law or significant policy of the
Company committed in the Directors service and resulting in an adverse effect on the Company,
or
(d) removal from service or permanent prohibition from participating in the Companys or The
Cortland Savings and Banking Companys affairs by an order issued under section 8(e)(4) or
(g)(1) of the Federal Deposit Insurance Act [12 U.S.C. 1818(e)(4) or (g)(1)].
Article 2
Lifetime Benefits
2.1 Normal Retirement
. For Separation from Service after attaining Normal Retirement Age, the
Company shall pay to the Director the benefit described in this section 2.1 instead of any other
benefit under this Agreement. However, no benefits shall be payable if this Agreement terminates
under Article 5.
2.1.1
Amount of benefit
. The annual benefit under this section 2.1 is $10,000.
2.1.2
Payment of benefit
. Beginning with the month immediately after the month in which the
Directors Separation from Service occurs, the Company shall pay the annual benefit to the
Director in 12 equal monthly installments on the first day of each month. The annual benefit
shall be paid to the Director for ten years.
2.2 Early Termination
. After Early Termination, the Company shall pay to the Director the
benefit described in this section 2.2 instead of any other benefit under this Agreement. However,
no benefits shall be payable if this Agreement terminates under Article 5. Neither the Director
nor the Company shall be entitled to elect in the 12-month period after a Change in Control between
the benefit under this section 2.2 versus the benefit under section 2.4. If the Directors
Separation from Service occurs within 12 months after a Change in Control, no benefit shall be
payable under this section 2.2 and the Director shall instead be entitled to the benefit under
section 2.4 or, if the Director first attained Normal Retirement Age, section 2.1.
2.2.1
Amount of benefit
. The annual benefit under this section 2.2 is calculated as the amount
that fully amortizes the Accrual Balance existing at the end of the month immediately before the
month in which Separation from Service occurs, amortizing that Accrual Balance over ten years
and taking into account interest at the discount rate or rates established by the Plan
Administrator.
2.2.2
Payment of benefit
. Beginning with the month immediately after the month in which the
Director attains Normal Retirement Age, the Company shall pay the annual benefit to the Director
in 12 equal monthly installments on the first day of each month. The annual benefit shall be paid
to the Director for ten years.
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2.3 Disability Benefit
. If the Directors Separation from Service occurs because of
Disability before Normal Retirement Age, the Company shall pay to the Director the benefit
described in this section 2.3 instead of any other benefit under this Agreement.
2.3.1
Amount of benefit
. The annual benefit under this section 2.3 is calculated as the amount
that fully amortizes the Accrual Balance existing at the end of the month immediately before the
month in which Separation from Service occurs, amortizing that Accrual Balance over ten years
and taking into account interest at the discount rate or rates established by the Plan
Administrator.
2.3.2
Payment of benefit
. Beginning with the month immediately after the month in which the
Director attains Normal Retirement Age, the Company shall pay the annual benefit to the Director
in 12 equal monthly installments on the first day of each month. The annual benefit shall be
paid to the Director for ten years.
2.4 Change in Control
. If the Directors Separation from Service occurs within 12 months
after a Change in Control, the Company shall pay to the Director the benefit described in this
section 2.4 instead of any other benefit under this Agreement. However, no benefits shall be
payable under this Agreement if this Agreement terminates under Article 5. Neither the Director
nor the Company shall be entitled to elect in the 12-month period after a Change in Control between
the benefit under this section 2.4 versus the Early Termination benefit under section 2.2. If the
Directors Separation from Service occurs within 12 months after a Change in Control, no benefit
shall be payable under section 2.2 and the Director shall instead be entitled to the benefit under
this section 2.4. But if the Director shall have attained Normal Retirement Age when Separation
from Service within 12 months after a Change in Control occurs, the Director shall be entitled
solely to the benefit provided by section 2.1, not this section 2.4.
2.4.1
Amount of benefit
. The benefit under this section 2.4 is the Accrual Balance on the date
of the Directors Separation from Service.
2.4.2
Payment of benefit
. The Company shall pay this benefit to the Director in a single lump
sum three days after the Directors Separation from Service.
2.5 Lump-Sum Payout of Remaining Normal Retirement Benefit, Early Termination Benefit, or
Disability Benefit When a Change in Control Occurs
. If a Change in Control occurs while the
Director is receiving the Normal Retirement Age benefit under section 2.1, the Company shall pay
the remaining salary continuation benefits to the Director in a single lump sum three days after
the Change in Control. If a Change in Control occurs after Separation from Service but while the
Director is receiving or is entitled at Normal Retirement Age to receive the Early Termination
benefit under section 2.2 or the Disability benefit under section 2.3, the Company shall pay the
remaining benefits to the Director in a single lump sum three days after the Change in Control.
The lump-sum payment due to the Director as a result of a Change in Control shall be an amount
equal to the Accrual Balance amount corresponding to the particular benefit when the Change in
Control occurs.
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2.6 Annual Benefit Statement
. Within 120 days after the end of each Plan Year, the Plan
Administrator shall provide or cause to be provided to the Director an annual benefit statement
showing benefits payable or potentially payable to the Director under this Agreement. Each annual
benefit statement shall supersede the previous years annual benefit statement. If there is a
contradiction between this Agreement and the annual benefit statement concerning the amount of a
particular benefit payable or potentially payable to the Director under sections 2.2, 2.3, or 2.4
hereof, the amount of the benefit determined under the Agreement shall control.
2.7 Savings Clause Relating to Compliance with Code Section 409A
. If any provision of this
Agreement would subject the Director to additional tax or interest under Code section 409A, the
Company shall reform the provision. However, the Company shall maintain to the maximum extent
practicable the original intent of the applicable provision without subjecting the Director to
additional tax or interest, and the Company shall not be required to incur any additional
compensation expense as a result of the reformed provision.
2.8 One Benefit Only
. Despite anything to the contrary in this Agreement, the Director and
Beneficiary are entitled to one benefit only under this Agreement, which shall be determined by the
first event to occur that is dealt with by this Agreement. Except as provided in section 2.5 or
Article 3, subsequent occurrence of events dealt with by this Agreement shall not entitle the
Director or Beneficiary to other or additional benefits under this Agreement.
Article 3
Death Benefits
3.1 Death Before Normal Retirement Age and Before Separation from Service
. If the Director
dies before Normal Retirement Age and before Separation from Service, 30 days after the Directors
death the Company shall pay to the Directors Beneficiary in a single lump sum an amount equal to
the Accrual Balance on the date of the Directors death.
3.2 Death After Normal Retirement Age but Before Separation from Service
. If the Director
dies after Normal Retirement Age but before Separation from Service, the Company shall for a period
of ten years pay to the Directors Beneficiary the Normal Retirement Benefit specified in section
2.1.
3.3 Death Before Normal Retirement Age but After Separation from Service
. (a)
After payments
begin
. If, a Separation from Service before Normal Retirement Age having previously occurred, the
Director dies after Early Termination benefits under section 2.2 or Disability benefits under
section 2.3 begin but before receiving all such payments, the Company shall pay the remaining
benefits to the Directors Beneficiary at the same time and in the same amounts the payments would
have been made to the Director had the Director survived.
(b)
Before payments begin
. If, a Separation from Service before Normal Retirement Age having
previously occurred, the Director is entitled at Normal Retirement Age to the Early Termination
benefit under section 2.2 or the Disability benefit under section 2.3 but dies before the benefit
payments begin, the Company shall pay to the Directors Beneficiary the Early Termination benefit
under section 2.2 or the Disability benefit under section 2.3, as the case may be, but the benefit
payments shall begin on the first day of the month immediately after the month in which the
Directors death occurs.
3.4 Death After Separation from Service After Normal Retirement Age
. (a)
After payments
begin
. If, a Separation from Service on or after Normal Retirement Age having previously occurred,
the Director dies after benefit payments under section 2.1 begin but before receiving all such
payments, the Company shall pay the remaining benefits to the Directors Beneficiary at the same
time and in the same amounts the payments would have been made to the Director had the Director
survived.
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(b)
Before payments begin
. If, a Separation from Service on or after Normal Retirement Age
having previously occurred, the Director is entitled to the benefit under section Article 2.1 but
dies before the benefit payments begin, beginning with the month immediately after the month in
which the Directors death occurs the Company shall pay to the Directors Beneficiary the Normal
Retirement benefit under section 2.1.
Article 4
Beneficiaries
4.1 Beneficiary Designations
. The Director shall have the right to designate at any time a
Beneficiary to receive any benefits payable under this Agreement after the Directors death. The
Beneficiary designated under this Agreement may be the same as or different from the beneficiary
designation under any other benefit plan of the Company in which the Director participates.
4.2 Beneficiary Designation: Change
. The Director shall designate a Beneficiary by completing
and signing the Beneficiary Designation Form and delivering it to the Plan Administrator or its
designated agent. The Directors Beneficiary designation shall be deemed automatically revoked if
the Beneficiary predeceases the Director or if the Executive names a spouse as Beneficiary and the
marriage is subsequently dissolved. The Director shall have the right to change a Beneficiary by
completing, signing, and otherwise complying with the terms of the Beneficiary Designation Form and
the Plan Administrators rules and procedures, as in effect from time to time. Upon the acceptance
by the Plan Administrator of a new Beneficiary Designation Form, all Beneficiary designations
previously filed shall be cancelled. The Plan Administrator shall be entitled to rely on the last
Beneficiary Designation Form filed by the Executive and accepted by the Plan Administrator before
the Directors death.
4.3 Acknowledgment
. No designation or change in designation of a Beneficiary shall be
effective until received, accepted, and acknowledged in writing by the Plan Administrator or its
designated agent.
4.4 No Beneficiary Designation
. If the Director dies without a valid beneficiary designation
or if all designated Beneficiaries predecease the Director, the Directors spouse shall be the
designated Beneficiary. If the Director has no surviving spouse, the benefit payments shall be
made to the personal representative of the Directors estate.
4.5 Facility of Payment
. If a benefit is payable to a minor, to a person declared
incapacitated, or to a person incapable of handling the disposition of his or her property, the
Company may pay the benefit to the guardian, legal representative, or person having the care or
custody of the minor, incapacitated person, or incapable person. The Company may require proof of
incapacity, minority, or guardianship as it may deem appropriate before distribution of the
benefit. Distribution shall completely discharge the Company from all liability for the benefit.
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Article 5
General Limitations
5.1 Termination with Cause
. Despite any contrary provision of this Agreement, the Company
shall not pay any benefit under this Agreement and this Agreement shall terminate if the
Directors Separation from Service is the result of Termination with Cause. Likewise, no benefits
shall be paid under the Split Dollar Agreement and Endorsement, as amended, between the Company and
the Director and the Split Dollar Agreement and Endorsement, as amended, also shall terminate if
Separation from Service is a Termination with Cause. The board of directors or a duly authorized
committee of the board shall have the sole and absolute right to determine whether the bases for
denial of benefits for cause exist. Benefits may be denied for cause regardless of whether the
Director continued to serve as a director after the board or committee made its determination not
to nominate the Director for reelection.
5.2 Misstatement
. The Company shall not pay any benefit under this Agreement if the Director
has made any material misstatement of fact on any application for life insurance purchased by the
Company.
5.3 Removal
. If the Director is removed or permanently prohibited from participating in the
Companys or The Cortland Savings and Banking Companys affairs by an order issued under section
8(e)(4) or (g)(1) of the Federal Deposit Insurance Act, 12 U.S.C. 1818(e)(4) or (g)(1), all
obligations of the Company under this Agreement shall terminate as of the effective date of the
order, and the Split Dollar Agreement and Endorsement, as amended, also shall terminate.
5.4 Default
. Despite any contrary provision of this Agreement, if the Company or The Cortland
Savings and Banking Company is in default or in danger of default, as those terms are defined
in section 3(x) of the Federal Deposit Insurance Act, 12 U.S.C. 1813(x), all obligations under this
Agreement shall terminate.
5.5 FDIC Open-Bank Assistance
. All obligations under this Agreement shall terminate, except
to the extent determined that continuation of the contract is necessary for the continued operation
of The Cortland Savings and Banking Company, when the Federal Deposit Insurance Corporation enters
into an agreement to provide assistance to or on behalf of The Cortland Savings and Banking Company
under the authority contained in section 13(c) of the Federal Deposit Insurance Act. 12 U.S.C.
1823(c). Any rights of the parties that have already vested shall not be affected by such action,
however.
Article 6
Claims and Review Procedures
6.1 Claims Procedure
. The Company shall notify any person or entity that makes a claim for
benefits under this Agreement (the Claimant) in writing, within 90 days after receiving
Claimants written application for benefits, of his or her eligibility or noneligibility for
benefits under the Agreement. If the Company determines that the Claimant is not eligible for
benefits or full benefits, the notice shall set forth (
w
) the specific reasons for such denial, (
x
)
a specific reference to the provisions of the Agreement on which the denial is based, (
y
) a
description of any additional information or material necessary for the Claimant to perfect his or
her claim, and a description of why it is needed, and (
z
) an explanation of the Agreements claims
review procedure and other appropriate information as to the steps to be taken if the Claimant
wishes to have the claim reviewed. If the Company determines that there are special circumstances
requiring additional time to make a decision, the Company shall notify the Claimant of the special
circumstances and the date by which a decision is expected to be made, and may extend the time for
up to an additional 90 days.
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6.2 Review Procedure
. If the Claimant is determined by the Company not to be eligible for
benefits, or if the Claimant believes that he or she is entitled to greater or different benefits,
the Claimant shall have the opportunity to have such claim reviewed by the Company by filing a
petition for review with the Company within 60 days after receipt of the notice issued by the
Company. Said petition shall
state the specific reasons, which the Claimant believes entitle him or her to benefits or to
greater or different benefits. Within 60 days after receipt by the Company of the petition, the
Company shall afford the Claimant (and counsel, if any) an opportunity to present his or her
position to the Company verbally or in writing, and the Claimant (or counsel) shall have the right
to review the pertinent documents. The Company shall notify the Claimant of its decision in
writing within the 60-day period, stating specifically the basis of its decision, written in a
manner to be understood by the Claimant and the specific provisions of the Agreement on which the
decision is based. If, because of the need for a hearing, the 60-day period is not sufficient, the
decision may be deferred for up to another 60 days at the election of the Company, but notice of
this deferral shall be given to the Claimant.
Article 7
Administration of Agreement
7.1 Plan Administrator Duties
. This Agreement shall be administered by a Plan Administrator
consisting of the Companys board of directors or such committee or person as the board shall
appoint. The Plan Administrator shall have the discretion and authority to (
x
) make, amend,
interpret, and enforce all appropriate rules and regulations for the administration of this
Agreement and (
y
) decide or resolve any and all questions that may arise, including interpretations
of this Agreement.
7.2 Agents
. In the administration of this Agreement, the Plan Administrator may employ agents
and delegate to them such administrative duties as it sees fit (including acting through a duly
appointed representative) and may from time to time consult with counsel, who may be counsel to the
Company.
7.3 Binding Effect of Decisions
. The decision or action of the Plan Administrator about any
question arising out of the administration, interpretation, and application of the Agreement and
the rules and regulations promulgated hereunder shall be final and conclusive and binding upon all
persons having any interest in the Agreement. No Director or Beneficiary shall be deemed to have
any right, vested or nonvested, regarding the continued use of any previously adopted assumptions,
including but not limited to the discount rate and calculation method employed in the determination
of the Accrual Balance.
7.4 Indemnity of Plan Administrator
. The Company shall indemnify and hold harmless the
members of the Plan Administrator against any and all claims, losses, damages, expenses, or
liabilities arising from any action or failure to act with respect to this Agreement, except in the
case of willful misconduct by the Plan Administrator or any of its members.
7.5 Company Information
. To enable the Plan Administrator to perform its functions, the
Company shall supply full and timely information to the Plan Administrator on all matters relating
to the date and circumstances of the retirement, Disability, death, or Separation from Service of
the Director, and such other pertinent information as the Plan Administrator may reasonably
require.
Article 8
Miscellaneous
8.1 Amendment and Termination
. This Agreement may be amended solely by a written agreement
signed by the Company and by the Director. Except as provided in Article 5 this Agreement may be
terminated solely by a written agreement signed by the Company and by the Director.
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8.2 Binding Effect
. This Agreement shall bind the Director and the Company and their
beneficiaries, survivors, executors, successors, administrators, and transferees.
8.3 No Guarantee of Service
. This Agreement is not a contract for services. It does not give
the Director the right to remain a Director of the Company nor does it interfere with the right of
the Companys shareholders not to re-elect the Director or the right of shareholders or the Board
to remove an individual as a director of the Company. The Agreement also does not require the
Director to remain a director or interfere with the Directors right to terminate service at any
time.
8.4 Non-Transferability
. Benefits under this Agreement may not be sold, transferred,
assigned, pledged, attached, or encumbered.
8.5 Successors
;
Binding Agreement
. By an assumption agreement in form and substance
satisfactory to the Director, the Company shall require any successor (whether direct or indirect,
by purchase, merger, consolidation or otherwise) to all or substantially all of the business or
assets of the Company to expressly assume and agree to perform this Agreement in the same manner
and to the same extent that the Company would be required to perform this Agreement had no
succession occurred.
8.6 Tax Withholding
. The Company shall withhold any taxes that are required to be withheld
from the benefits provided under this Agreement.
8.7 Applicable Law
. The Agreement and all rights hereunder shall be governed by the laws of
the State of Ohio, except to the extent preempted by the laws of the United States of America.
8.8 Unfunded Arrangement
. The Director and Beneficiary are general unsecured creditors of the
Company for the payment of benefits under this Agreement. The benefits represent the mere promise
by the Company to pay benefits. The rights to benefits are not subject to anticipation,
alienation, sale, transfer, assignment, pledge, encumbrance, attachment, or garnishment by
creditors. Any insurance on the Directors life is a general asset of the Company to which the
Director and Beneficiary have no preferred or secured claim.
8.9 Entire Agreement
. This Agreement and the Split Dollar Agreement and Endorsement, as
amended, constitute the entire agreement between the Company and the Director concerning the
subject matter. No rights are granted to the Director under this Agreement other than those
specifically set forth.
8.10 Severability
. If any provision of this Agreement is held invalid, such invalidity shall
not affect any other provision of this Agreement not held invalid and each such other provision
shall continue in full force and effect to the full extent consistent with law. If any provision
of this Agreement is held invalid in part, such invalidity shall not affect the remainder of such
provision and the remainder of such provision, together with all other provisions of this
Agreement, shall continue in full force and effect to the full extent consistent with law.
8.11 Captions and Counterparts
. Captions and section headings in this Agreement are included
solely for convenience of reference and shall not affect the meaning or interpretation of any
provision of this Agreement. This Agreement may be executed in two or more counterparts, each of
which shall be deemed an original but all of which together shall constitute one and the same
instrument.
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8.12 Notices
. All notices, requests, demands and other communications hereunder shall be in
writing and shall be deemed to have been duly given if delivered by hand or mailed, certified or
registered mail, return receipt requested, with postage prepaid, to the following addresses or to such other
address as either party may designate by like notice. If to the Company, notice shall be given to
the board of directors, Cortland Bancorp, 194 W. Main Street, P.O. Box 98, Cortland, Ohio
44410-1466, or to such other or additional person or persons as the Company shall have designated
to the Director in writing. If to the Director, notice shall be given to the Director at the
address of the Director appearing on the Companys records, or to such other or additional person
or persons as the Director shall have designated to the Company in writing.
In Witness Whereof
, the Director and a duly authorized Company officer have executed
this Director Retirement Agreement as of the date first written above.
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Director
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Cortland Bancorp
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By:
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Title:
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10
Beneficiary Designation
Cortland Bancorp
Director Retirement Agreement
I, Joseph E. Koch, designate the following as beneficiary of any death benefits under this
Director Retirement Agreement:
Primary:
.
Contingent:
.
Note:
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To name a trust as beneficiary, please provide the name of the trustee(s) and the
exact
name and date of the trust agreement.
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I understand that I may change these beneficiary designations by filing a new written
designation with the Company. 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.
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Signature:
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Joseph E. Koch
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Date:
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, 20__
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Received by the Company this
day of
, 20_____.
11
Exhibit 10.14
Cortland Bancorp
Split Dollar Agreement and Endorsement
This
Split Dollar Agreement and Endorsement
(this Split Dollar Agreement) is
entered into as of
, 2011, by and between Cortland
Bancorp, an Ohio corporation (the Company), and Joseph E. Koch, a director of the Company (the
Director). This Split Dollar Agreement shall append the Split Dollar Endorsement entered into on
even date herewith, or as subsequently amended, by and between the Company and the Director.
Whereas
, to encourage the Director to remain a director of the Company, the Company
is willing to grant to the Director the right to designate the beneficiary of a portion of the
death proceeds of an insurance policy on the Directors life. The Company will pay life insurance
premiums from its general assets.
Now Therefore
, in consideration of the foregoing premises and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto
agree as follows.
Article 1
General Definitions
Capitalized terms not otherwise defined in this Split Dollar Agreement shall have the same
meaning as defined in the Director Retirement Agreement between the Company and the Director dated
as of the date hereof, as the same may be amended. The following terms shall have the meanings
specified.
1.1
Administrator
means the administrator described in Article 7.
1.2
Directors Interest
means the benefit set forth in section 2.2.
1.3
Insured
means the Director.
1.4
Insurer
means each life insurance carrier for which there is a Split Dollar Policy
Endorsement attached to this Agreement.
1.5
Policy
means the specific life insurance policy or policies issued by the Insurer.
1.6
Split Dollar Policy Endorsement
means the form required by the Administrator or the
Insurer to indicate the Directors interest, if any, in a Policy on the Directors life.
Article 2
Policy Ownership/Interests
2.1 Company Ownership
. The Company is the sole owner of the Policy and shall have the right
to exercise all incidents of ownership. The Company shall be the beneficiary of any death proceeds
remaining after the Directors interest is paid under section 2.2 below.
2.2 Death Benefit
. Provided the Policy is not cancelled, surrendered, terminated, or allowed
to lapse, at the Directors death the Directors beneficiary designated in accordance with the
Split Dollar Policy Endorsement shall be entitled to death proceeds in the amount of $100,000 (the
Directors Interest). The Director shall have the right to designate the beneficiary of the
Directors Interest.
2.3 Option to Purchase
. The Company shall not sell, surrender, or transfer ownership of the
Policy while this Split Dollar Agreement is in effect unless the Company first gives the Director
or the Directors transferee a right of first refusal to purchase the Policy. The option to
purchase the Policy shall lapse if not exercised within 60 days after the date the Company gives
written notice of the Companys intention to sell, surrender, or transfer ownership of the Policy.
The purchase price shall be an amount equal to the Policy cash surrender value. This provision
shall not impair the Companys right to terminate this Split Dollar Agreement.
2.4 Comparable Coverage
. The Company shall maintain the Policy in full force and effect. The
Company may not amend, terminate, or otherwise abrogate the Directors interest in the Policy
unless the Company replaces the Policy with a comparable insurance policy to cover the benefit
provided under this Split Dollar Agreement and executes a new split dollar agreement and
endorsement for the comparable insurance policy. The Policy or any comparable policy shall be
subject to claims of the Companys creditors.
2.5 Internal Revenue Code Section 1035 Exchanges
. The Director recognizes and agrees that the
Company may after this Split Dollar Agreement is adopted wish to exchange the Policy of life
insurance on the Directors life for another contract of life insurance insuring the Directors
life. Provided that the Policy is replaced or intended to be replaced with a comparable policy of
life insurance, the Director agrees to provide medical information and cooperate with medical
insurance-related testing required by a prospective insurer for implementing the Policy or, if
necessary, for modifying or updating to a comparable insurer.
Article 3
Premiums
3.1 Premium Payment
. The Company shall pay any premiums due on the Policy.
3.2 Economic Benefit
. The Company shall determine the economic benefit attributable to the
Director based on the life insurance premium factor for the Directors age multiplied by the
aggregate death benefit payable to the Directors Beneficiary. The life insurance premium factor
is the minimum amount required to be imputed under Internal Revenue Service Regulations, section
1.61-22(d)(3)(ii), or any subsequent applicable authority. The Company shall impute the economic
benefit to the Director annually by adding the economic benefit to the Directors Form W-2 or, if
applicable, Form 1099.
Article 4
Assignment
The Director may assign without consideration all interests in the Policy and in this Split
Dollar Agreement to any person, entity, or trust. If the Director transfers all of the Directors
interest in the Policy, all of the Directors interest in the Policy and in the Split Dollar
Agreement shall be vested in the Directors transferee, who shall be substituted as a party
hereunder, and the Director shall have no further interest in the Policy or in this Split Dollar
Agreement.
2
Article 5
Insurer
The Insurer shall be bound only by the terms of the Policy. Any payments the Insurer makes or
actions it takes in accordance with the Policy shall fully discharge it from all claims, suits, and
demands of all entities or persons. The Insurer shall not be bound by or be deemed to have notice
of the provisions of this Split Dollar Agreement.
Article 6
Claims Procedure
6.1 Claims Procedure
. The Company shall notify any person or entity making a claim under this
Split Dollar Agreement (the Claimant) in writing, within 90 days after receiving Claimants
written application for benefits, of his or her eligibility or ineligibility for benefits under
this Split Dollar Agreement. If the Company determines that the Claimant is not eligible for
benefits or full benefits, the notice shall set forth (
w
) the specific reasons for denial, (
x
) a
specific reference to the provisions of this Split Dollar Agreement on which the denial is based,
(
y
) a description of any additional information or material necessary for the Claimant to perfect
his or her claim, and a description of why it is needed, and (
z
) an explanation of this Split
Dollar Agreements claims review procedure and other appropriate information concerning the steps
to be taken if the Claimant wishes to have the claim reviewed. If the Company determines that
there are special circumstances requiring additional time to make a decision, the Company shall
notify the Claimant of the special circumstances and the date by which a decision is expected to be
made, and may extend the time for up to an additional 90 days.
6.2 Review Procedure
. If the Claimant is determined by the Company not to be eligible for
benefits, or if the Claimant believes that he or she is entitled to greater or different benefits,
the Claimant shall have the opportunity to have its claim reviewed by the Company by filing a
petition for review with the Company within 60 days after receipt of the notice issued by the
Company. The petition shall state the specific reasons the Claimant believes it is entitled to
benefits or to greater or different benefits. Within 60 days after receipt by the Company of the
petition, the Company shall afford the Claimant (and counsel, if any) an opportunity to present its
position to the Company verbally or in writing, and the Claimant (or counsel) shall have the right
to review the pertinent documents. The Company shall notify the Claimant of the Companys decision
in writing within the 60-day period, stating specifically the basis of its decision, written in a
manner to be understood by the Claimant, and the specific provisions of this Split Dollar Agreement
on which the decision is based. If, because of the need for a hearing, the 60-day period is not
sufficient, the decision may be deferred for up to another 60-day period at the election of the
Company, but notice of this deferral shall be given to the Claimant.
Article 7
Administration of Agreement
7.1 Plan Administrator Duties
. This Split Dollar Agreement shall be administered by a Plan
Administrator consisting of the Companys board of directors or such committee or person as the
board shall appoint. The Plan Administrator shall have the discretion and authority to (
x
) make,
amend, interpret, and enforce all appropriate rules and regulations for the administration of this
Agreement and (
y
) decide or resolve any and all questions that may arise, including interpretations
of this Split Dollar Agreement.
3
7.2 Agents
. In the administration of this Split Dollar Agreement, the Plan Administrator may
employ agents and delegate to them such administrative duties as it sees fit (including acting
through a duly appointed representative) and may from time to time consult with counsel, who may be
counsel to the Company.
7.3 Binding Effect of Decisions
. The decision or action of the Plan Administrator about any
question arising out of the administration, interpretation, and application of the Agreement and
the rules and regulations promulgated hereunder shall be final and conclusive and binding upon all
persons having any interest in this Split Dollar Agreement.
7.4 Indemnity of Plan Administrator
. The Company shall indemnify and hold harmless the
members of the Plan Administrator against any and all claims, losses, damages, expenses, or
liabilities arising from any action or failure to act with respect to this Split Dollar Agreement,
except in the case of willful misconduct by the Plan Administrator or any of its members.
7.5 Company Information
. To enable the Plan Administrator to perform its functions, the
Company shall supply full and timely information to the Plan Administrator on all matters relating
to the date and circumstances of the retirement, Disability, death, or Termination of Service of
the Director, and such other pertinent information as the Plan Administrator may reasonably
require.
Article 8
Miscellaneous
8.1 Amendment and Termination
. This Split Dollar Agreement may be amended solely by a written
agreement signed by the Company and by the Director. This Split Dollar Agreement shall terminate
if the Director Retirement Agreement terminates under Article 5 of the Director Retirement
Agreement.
8.2 Binding Effect
. This Split Dollar Agreement shall bind the Director and the Company and
their beneficiaries, survivors, executors, administrators and transferees, and any Policy
beneficiary.
8.3 No Guarantee of Service
. This Split Dollar Agreement is not a service policy or contract.
It does not give the Director the right to remain a director of the Company nor does it interfere
with the right of the Companys stockholders not to re-elect the Director or the right of
stockholders or the board to remove an individual as a director of the Company. This Split Dollar
Agreement also does not require the Director to remain a director or interfere with the Directors
right to terminate service at any time.
8.4 Applicable Law
. The Split Dollar Agreement and all rights hereunder shall be governed by
and construed according to the laws of the State of Ohio, except to the extent preempted by the
laws of the United States of America.
8.5 Entire Agreement
. This Split Dollar Agreement constitutes the entire agreement between
the Company and the Director concerning the subject matter. No rights are granted to the Director
under this Split Dollar Agreement other than those specifically set forth.
8.6 Severability
. If any provision of this Split Dollar Agreement is held invalid, such
invalidity shall not affect any other provision of this Split Dollar Agreement not held invalid and
each such other provision shall continue in full force and effect to the full extent consistent
with law. If any provision of this Split Dollar Agreement is held invalid in part, such invalidity
shall not affect the
remainder of such provision not held invalid and the remainder of such provision, together with all
other provisions of this Split Dollar Agreement, shall continue in full force and effect to the
full extent consistent with law.
4
8.7 Captions and Counterparts
. Captions and section headings in this Split Dollar Agreement
are included solely for convenience of reference and shall not affect the meaning or interpretation
of any provision of this Split Dollar Agreement. This Split Dollar Agreement may be executed in
two or more counterparts, each of which shall be deemed an original but all of which together shall
constitute one and the same instrument.
8.8 Notices
. All notices, requests, demands and other communications hereunder shall be in
writing and shall be deemed to have been duly given if delivered by hand or mailed, certified or
registered mail, return receipt requested, with postage prepaid, to the following addresses or to
such other address as either party may designate by like notice. If to the Company, notice shall
be given to the board of directors, Cortland Bancorp, 194 W. Main Street, P.O. Box 98, Cortland,
Ohio 44410-1466, or to such other or additional person or persons as the Company shall have
designated to the Director in writing. If to the Director, notice shall be given to the Director
at the address of the Director appearing on the Companys records, or to such other or additional
person or persons as the Director shall have designated to the Company in writing.
In Witness Whereof
, the Director and a duly authorized Company officer have executed
this Split Dollar Agreement and Endorsement as of the date first written above.
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Director
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Cortland Bancorp
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By:
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Title:
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Agreement to Cooperate with Insurance Underwriting Incident to Internal Revenue Code section 1035 Exchange
I acknowledge that I have read the Split Dollar Agreement and Endorsement and agree to be
bound by its terms, particularly the covenant on my part set forth in section 2.5 of the Split
Dollar Agreement and Endorsement to provide medical information and cooperate with medical
insurance-related testing required by an insurer to issue a comparable insurance policy to cover
the benefit provided under this Split Dollar Agreement and Endorsement.
5
Split Dollar Policy Endorsement
Insured: Joseph E. Koch
Insurer:
Policy No.:
Pursuant to the terms of the Cortland Bancorp Split Dollar Agreement and Endorsement dated as
of
, 2011, the undersigned Owner requests that the above-referenced policy issued by
the Insurer provides for the following beneficiary designation and limited contract ownership
rights to the Insured:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its
successors or assigns, to the extent of its interest in the policy. It is hereby provided that the
Insurer may rely solely upon a statement from the Owner as to the amount of proceeds it is entitled
to receive under this paragraph.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions
of the preceding paragraph shall be paid in one sum to:
Primary Beneficiary, Relationship/Social Security Number
Contingent Beneficiary, Relationship/Social Security Number
The exclusive rights to change the beneficiary for the proceeds payable under this paragraph and to
assign all rights and interests granted under this paragraph are hereby granted to the Insured.
The sole signature of the Insured shall be sufficient to exercise the rights. The Owner retains
all contract rights not granted to the Insured under this paragraph.
3. It is agreed by the undersigned that this designation and limited assignment of rights
shall be subject in all respects to the contractual terms of the policy.
4. Any payment directed by the Owner under this endorsement shall be a full discharge of the
Insurer, and such discharge shall be binding on all parties claiming any interest under the policy.
The undersigned for the Owner is signing in a representative capacity and warrants that he or
she has the authority to bind the entity on whose behalf this document is executed.
Signed at
, Ohio this
day of
, 2011.
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Insured
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Owner
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Cortland Bancorp
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Joseph E. Koch
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By:
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Its:
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Exhibit 10.24
Addendum A
The Cortland Savings and Banking Company
Fourth Amended Split Dollar Agreement and Endorsement
This
Fourth Amended Split Dollar Agreement and Endorsement
(this Agreement) is
entered into as of this
_____
day of
, 2011, by and between The Cortland Savings and
Banking Company, an Ohio-chartered commercial bank (the Bank), and Timothy Carney, Executive Vice
President and Chief Operating Officer of the Bank (the Executive). This Agreement shall append
the Split Dollar Policy Endorsement entered into on even date herewith or as subsequently amended,
by and between the aforementioned parties.
Whereas
, to encourage the Executive to remain a Bank employee, the Bank and the
Executive entered into a Third Amended Split Dollar Agreement and Endorsement dated as of December
3, 2008, providing for division of the death proceeds of a life insurance policy or policies on the
Executives life,
Whereas
, the Bank and the Executive entered into a Fourth Amended Salary Continuation
Agreement dated as of June 1, 2010, providing for specified retirement benefits and amending and
restating in its entirety the Third Amended Salary Continuation Agreement, which also was dated as
of December 3, 2008, and
Whereas
, the Bank and the Executive intend that this Fourth Amended Split Dollar
Agreement and Endorsement shall be attached as Addendum A to the Fourth Amended Salary Continuation
Agreement, amending and restating in its entirety the Third Amended Split Dollar Agreement and
Endorsement.
Now Therefore
, in consideration of the foregoing premises and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto
agree as follows:
Article 1
Definitions
Capitalized terms not otherwise defined in this Agreement are used herein as defined in the
Fourth Amended Salary Continuation Agreement dated as of June 1, 2010, between the Bank and the
Executive. The following terms shall have the meanings specified.
1.1 Administrator
means the administrator described in Article 7.
1.2 Executives Interest
means the benefit set forth in section 2.2.
1.3 Insured
means the Executive.
1.4 Insurer
means each life insurance carrier for which there is a Split Dollar Policy
Endorsement attached to this Agreement.
1.5 Net Death Proceeds
means the total death proceeds of the Policy minus the cash surrender
value.
1.6 Policy
means the specific life insurance policy or policies issued by the Insurer(s).
1.7 Salary Continuation Agreement
means the Fourth Amended Salary Continuation Agreement dated
as of June 1, 2010, between the Bank and the Executive, as the same may hereafter be amended.
1.8 Split Dollar Policy Endorsement
means the form required by the Administrator or the
Insurer to indicate the Executives interest, if any, in a Policy on such Executives life.
Article 2
Policy Ownership/Interests
2.1 Bank Ownership
. The Bank is the sole owner of the Policy and shall have the right to
exercise all incidents of ownership. The Bank shall be the beneficiary of the remaining death
proceeds of the Policy after the Executives interest is paid according to section 2.2 below.
2.2 Death Benefit
. Provided the Executives death occurs both before the Executives
Separation from Service and before the Executive attains age 65, at the Executives death the
Executives beneficiary designated in accordance with the Split Dollar Policy Endorsement shall be
entitled to Policy proceeds in an amount equal to the lesser of (x) 100% of the Net Death Proceeds
or (y) $1,147,374 (the lesser of the amounts specified in clauses (x) and (y) being referred to in
this Agreement as the Executives Interest). The Executives Interest shall be extinguished at
the earliest of the date of the Executives Separation from Service, the date the Executive attains
age 65, or the date on which the Executive receives payment of the benefit provided under the
Salary Continuation Agreement for a Change in Control, and the Executives beneficiary shall be
entitled to no benefits under the Agreement of the Executives death occurring thereafter. The
Executive shall have the right to designate the beneficiary of the Executives Interest.
2.3 Option to Purchase
. Upon termination of this Agreement, the Bank shall not sell,
surrender, or transfer ownership of the Policy without first giving the Executive or the
Executives transferee the option to purchase the Policy for a period of 60 days from written
notice of such intention. The purchase price shall be an amount equal to the cash surrender value
of the Policy.
2.4 Comparable Coverage
. The Bank may replace the Policy with a comparable insurance policy
to cover the benefit provided under this Agreement, in which case the Bank and the Executive shall
execute a new Split Dollar Policy Endorsement for the comparable insurance policy.
2.5 Internal Revenue Code Section 1035 Exchanges
. The Executive recognizes and agrees that
the Bank may after this Agreement is adopted wish to exchange the Policy of life insurance on the
Executives life for another contract of life insurance insuring the Executives life. Provided
that the Policy is replaced (or intended to be replaced) with a comparable policy of life
insurance, the Executive agrees to provide medical information and cooperate with medical
insurance-related testing required by
a prospective insurer for implementing the Policy or, if necessary, for modifying or updating
to a comparable insurer.
2
Article 3
Premiums
3.1 Premium Payment
. The Bank shall pay any premiums due on the Policy.
3.2 Economic Benefit
. The Administrator shall annually determine the economic benefit
attributable to the Executive based on the life insurance premium factor for the Executives age
multiplied by the aggregate death benefit payable to the Executives beneficiary. The life
insurance premium factor is the minimum factor applicable under guidance published pursuant to
Treasury Reg. section 1.61-22(d)(3)(ii) or any subsequent authority.
3.3 Imputed Income
. The Bank shall impute the economic benefit to the Executive on an annual
basis by adding the economic benefit to the Executives W-2, or if applicable, Form 1099.
Article 4
Assignment
The Executive may irrevocably assign without consideration all of the Executives interest in
the Policy and in this Agreement to any person, entity, or trust established by the Executive or
the Executives spouse. If the Executive transfers all of the Executives interest in the Policy,
all of the Executives interest in the Policy and in the Agreement shall be vested in the
Executives transferee, who shall be substituted as a party hereunder and the Executive shall have
no further interest in this Agreement.
Article 5
Insurer
The Insurer shall be bound by the terms of the Policy only. Any payments the Insurer makes or
actions it takes in accordance with the Policy shall fully discharge it from all claims, suits, and
demands of all entities or persons. The Insurer shall not be bound by or be deemed to have notice
of the provisions of this Agreement.
Article 6
Claims and Review Procedures
6.1 Claims Procedure
. Any person or entity who has not received benefits under this Agreement
that he or she believes should be paid (the claimant) shall make a claim for benefits as follows
6.1.1
Initiation written claim
. The claimant initiates a claim by submitting to the
Administrator a written claim for benefits. If the claim relates to the contents of a
notice received by the claimant, the claim must be made within 60 days after the notice was
received by the claimant. All other claims must be made within 180 days after the date of
the event that
caused the claim to arise. The claim must state with particularity the determination
desired by the claimant.
3
6.1.2
Timing of Administrator response
. The Administrator shall respond to the claimant
within 90 days after receiving the claim. If the Administrator determines that special
circumstances require additional time for processing the claim, the Administrator can extend
the response period by an additional 90 days by notifying the claimant in writing, before
the end of the initial 90-day period, that an additional period is required. The notice of
extension must set forth the special circumstances and the date by which the Administrator
expects to render its decision.
6.1.3
Notice of decision
. If the Administrator denies part or all of the claim, the
Administrator shall notify the claimant in writing of the denial. The Administrator shall
write the notification in a manner calculated to be understood by the claimant. The
notification shall set forth
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(a)
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The specific reasons for the denial,
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(b)
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A reference to the specific provisions of this Agreement on which
the denial is based,
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(c)
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A description of any additional information or material necessary
for the claimant to perfect the claim and an explanation of why it is needed,
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(d)
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An explanation of the Agreements review procedures and the time
limits applicable to such procedures, and
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(e)
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A statement of the claimants right to bring a civil action under
ERISA section 502(a) after an adverse benefit determination on review.
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6.2 Review Procedure
. If the Administrator denies part or all of the claim, the claimant
shall have the opportunity for a full and fair review by the Administrator of the denial, as
follows
6.2.1
Initiation written request
. To initiate the review, the claimant must file with
the Administrator a written request for review within 60 days after receiving the
Administrators notice of denial.
6.2.2
Additional submissions information access
. The claimant shall then have the
opportunity to submit written comments, documents, records, and other information relating
to the claim. Upon request and free of charge, the Administrator shall also provide the
claimant reasonable access to and copies of all documents, records, and other information
relevant (as defined in applicable ERISA regulations) to the claimants claim for benefits.
6.2.3
Considerations on review
. In considering the review, the Administrator shall take
into account all materials and information the claimant submits relating to the claim,
without regard to whether the information was submitted or considered in the initial benefit
determination.
6.2.4
Timing of Administrator response
. The Administrator shall respond in writing to the
claimant within 60 days after receiving the request for review. If the Administrator
determines that special circumstances require additional time for processing the claim, the
Administrator can extend the response period by an additional 60 days by notifying the
claimant in writing before
the end of the initial 60-day period that an additional period is required. The notice of
extension must set forth the special circumstances and the date by which the Administrator
expects to render its decision.
4
6.2.5
Notice of decision
. The Administrator shall notify the claimant in writing of its
decision on review. The Administrator shall write the notification in a manner calculated
to be understood by the claimant. The notification shall set forth
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(a)
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The specific reasons for the denial,
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(b)
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A reference to the specific provisions of the Agreement on which
the denial is based,
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(c)
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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 claimants claim for benefits, and
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(d)
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A statement of the claimants right to bring a civil action under
ERISA section 502(a).
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Article 7
Administration of Agreement
7.1 Administrator Duties
. This Agreement shall be administered by an Administrator, which
shall consist of the Board or such committee as the Board shall appoint. The Executive may not be
a member of the Administrator. The Administrator shall have the discretion and authority to (
x
)
make, amend, interpret, and enforce all appropriate rules and regulations for the administration of
this Agreement and (
y
) decide or resolve any and all questions that may arise, including
interpretations of this Agreement.
7.2 Agents
. In the administration of this Agreement, the Administrator may employ agents and
delegate to them such administrative duties as the Administrator sees fit (including acting through
a duly appointed representative) and may from time to time consult with counsel, who may be counsel
to the Bank.
7.3 Binding Effect of Decisions
. The decision or action of the Administrator concerning any
question arising out of the administration, interpretation, and application of this Agreement and
the rules and regulations promulgated hereunder shall be final and conclusive and binding upon all
persons having any interest in the Agreement.
7.4 Indemnity of Administrator
. The Bank shall indemnify and hold harmless the members of the
Administrator against any and all claims, losses, damages, expenses, or liabilities arising from
any action or failure to act with respect to this Agreement, except in the case of willful
misconduct by the Administrator or any of its members.
7.5 Information
. To enable the Administrator to perform its functions, the Bank shall supply
full and timely information to the Administrator on all matters relating to the date and
circumstances of the retirement, death, or Separation from Service of the Executive, and such
other pertinent information as the Administrator may reasonably require.
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Article 8
Miscellaneous
8.1 Amendment and Termination of Agreement
. This Agreement may be amended or terminated
solely by a written agreement signed by the Bank and the Executive. However, this Agreement shall
terminate upon the first to occur of (
u
) payment to the Executive of the benefit provided under the
Salary Continuation Agreement for a Change in Control, or (
v
) surrender, lapse, or other
termination of the Policy by the Bank, or (
w
) distribution of the death benefit proceeds in
accordance with section 2.2 above, or (
x
) termination of the Salary Continuation Agreement under
Article 5 of the Salary Continuation Agreement, or (
y
) the Executives Separation from Service, or
(
z
) the date the Executive attains age 65.
8.2 Binding Effect
. This Agreement shall bind the Executive and the Bank and their
beneficiaries, survivors, executors, administrators, and transferees, and any Policy beneficiary.
8.3 No Guarantee of Employment
. This Agreement is not an employment policy or contract. This
Agreement does not give the Executive the right to remain an employee of the Bank nor does it
interfere with the Banks right to discharge the Executive. This Agreement also does not require
the Executive to remain an employee or interfere with the Executives right to terminate employment
at any time.
8.4 Successors
;
Binding Agreement
. By an assumption agreement in form and substance
satisfactory to the Executive, the Bank shall require any successor (whether direct or indirect, by
purchase, merger, consolidation, or otherwise) to all or substantially all of the business or
assets of the Bank to expressly assume and agree to perform this Agreement in the same manner and
to the same extent that the Bank would be required to perform this Agreement had no succession
occurred.
8.5 Applicable Law
. This Agreement and all rights hereunder shall be governed by and
construed according to the laws of the State of Ohio, except to the extent preempted by the laws of
the United States of America.
8.6 Entire Agreement
. This Agreement and the Salary Continuation Agreement constitute the
entire agreement between the Bank and the Executive concerning the subject matter. No rights are
granted to the Executive under this Agreement other than those specifically set forth. This
Agreement amends and restates in its entirety the December 3, 2008 Third Amended Split Dollar
Agreement and Endorsement.
8.7 Severability
. If any provision of this Agreement is held invalid, such invalidity shall
not affect any other provision of this Agreement not held invalid, and each such other provision
shall continue in full force and effect to the full extent consistent with law. If any provision
of this Agreement is held invalid in part, such invalidity shall not affect the remainder of the
provision not held invalid, and the remainder of the provision together with all other provisions
of this Agreement shall continue in full force and effect to the full extent consistent with law.
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8.8 Headings
. Caption headings and subheadings herein are included solely for convenience of
reference and shall not affect the meaning or interpretation of any provision of this Agreement.
8.9 Notices
. All notices, requests, demands and other communications hereunder shall be in
writing and shall be deemed to have been duly given if delivered by hand or mailed, certified or
registered mail, return receipt requested, with postage prepaid, to the following addresses or to
such other address as either party may designate by like notice. If to the Bank, notice shall be
given to the board of directors, The Cortland Savings and Banking Company, 194 W. Main Street, P.O.
Box 98, Cortland, Ohio 44410-1466, or to such other or additional person or persons as the Bank
shall have designated to the Executive in writing. If to the Executive, notice shall be given to
the Executive at the Executives address appearing on the Banks records, or to such other or
additional person or persons as the Executive shall have designated to the Bank in writing.
In Witness Whereof
, the Executive and a duly authorized representative of the Bank
have executed this Agreement as of the date first written above.
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Executive
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Bank
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The Cortland Savings and Banking Company
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By:
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Timothy Carney
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James M. Gasior
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Title:
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President and Chief Executive Officer
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Agreement to Cooperate with Insurance Underwriting Incident to Internal Revenue
Code section 1035 Exchange
I acknowledge that I have read the Fourth Amended Split Dollar Agreement and Endorsement and
agree to be bound by its terms, particularly the covenant on my part set forth in section 2.5 of
the Fourth Amended Split Dollar Agreement and Endorsement to provide medical information and
cooperate with medical insurance-related testing required by an insurer to issue a comparable
insurance policy to cover the benefit provided under this Fourth Amended Split Dollar Agreement and
Endorsement.
7
Split Dollar Policy Endorsement
Insured: Timothy Carney
Insurer: New York Life Insurance and Annuity Corporation
Policy No. 77251005
According to the terms of The Cortland Savings and Banking Company Fourth Amended Split Dollar
Agreement and Endorsement dated as of
, 2011,
the undersigned Owner requests that the above-referenced policy issued by the Insurer provide for
the following beneficiary designation and limited contract ownership rights to the Insured:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its
successors or assigns, to the extent of the Owners interest in the policy. It is hereby provided
that the Insurer may rely solely upon a statement from the Owner concerning the amount of proceeds
the Owner is entitled to receive under this paragraph.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions
of the preceding paragraph shall be paid in one sum to:
Primary Beneficiary, Relationship/Social Security Number
Contingent Beneficiary, Relationship/Social Security Number
The exclusive rights to change the beneficiary for the proceeds payable under this paragraph and to
assign all rights and interests granted under this paragraph are hereby granted to the Insured.
The sole signature of the Insured shall be sufficient to exercise the rights. The Owner retains
all contract rights not granted to the Insured under this paragraph.
3. It is agreed by the undersigned that this designation and limited assignment of rights
shall be subject in all respects to the contractual terms of the policy.
4. Any payment directed by the Owner under this endorsement shall be a full discharge of the
Insurer, and such discharge shall be binding on all parties claiming any interest under the policy.
The undersigned for the Owner is signing in a representative capacity and warrants that he or
she has the authority to bind the entity on whose behalf this document is executed.
Signed at
, Ohio this
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day of
, 2011.
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Insured
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Owner
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The Cortland Savings and Banking Company
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By:
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Timothy Carney
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Split Dollar Policy Endorsement
Insured: Timothy Carney
Insurer: Midland National Life Insurance Company
Policy No. 00690213
According to the terms of The Cortland Savings and Banking Company Fourth Amended Split Dollar
Agreement and Endorsement dated as of
, 2011,
the undersigned Owner requests that the above-referenced policy issued by the Insurer provide for
the following beneficiary designation and limited contract ownership rights to the Insured:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its
successors or assigns, to the extent of the Owners interest in the policy. It is hereby provided
that the Insurer may rely solely upon a statement from the Owner concerning the amount of proceeds
the Owner is entitled to receive under this paragraph.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions
of the preceding paragraph shall be paid in one sum to:
Primary Beneficiary, Relationship/Social Security Number
Contingent Beneficiary, Relationship/Social Security Number
The exclusive rights to change the beneficiary for the proceeds payable under this paragraph and to
assign all rights and interests granted under this paragraph are hereby granted to the Insured.
The sole signature of the Insured shall be sufficient to exercise the rights. The Owner retains
all contract rights not granted to the Insured under this paragraph.
3. It is agreed by the undersigned that this designation and limited assignment of rights
shall be subject in all respects to the contractual terms of the policy.
4. Any payment directed by the Owner under this endorsement shall be a full discharge of the
Insurer, and such discharge shall be binding on all parties claiming any interest under the policy.
The undersigned for the Owner is signing in a representative capacity and warrants that he or
she has the authority to bind the entity on whose behalf this document is executed.
Signed at
, Ohio this
day of
, 2011.
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Insured
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Owner
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The Cortland Savings and Banking Company
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By:
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Its:
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Exhibit 10.26
Addendum A
The Cortland Savings and Banking Company
Fourth Amended Split Dollar Agreement and Endorsement
This
Fourth Amended Split Dollar Agreement and Endorsement
(this Agreement) is
entered into as of this
_____
day of
, 2011, by and between The Cortland Savings and
Banking Company, an Ohio-chartered commercial bank (the Bank), and James M. Gasior, President and
Chief Executive Officer of the Bank (the Executive). This Agreement shall append the Split
Dollar Policy Endorsement entered into on even date herewith or as subsequently amended, by and
between the aforementioned parties.
Whereas
, to encourage the Executive to remain a Bank employee, the Bank and the
Executive entered into a Third Amended Split Dollar Agreement and Endorsement dated as of December
3, 2008, providing for division of the death proceeds of a life insurance policy or policies on the
Executives life,
Whereas
, the Bank and the Executive entered into a Fourth Amended Salary Continuation
Agreement dated as of June 1, 2010, providing for specified retirement benefits and amending and
restating in its entirety the Third Amended Salary Continuation Agreement, which also was dated as
of December 3, 2008, and
Whereas
, the Bank and the Executive intend that this Fourth Amended Split Dollar
Agreement and Endorsement shall be attached as Addendum A to the Fourth Amended Salary Continuation
Agreement, amending and restating in its entirety the Third Amended Split Dollar Agreement and
Endorsement.
Now Therefore
, in consideration of the foregoing premises and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto
agree as follows:
Article 1
Definitions
Capitalized terms not otherwise defined in this Agreement are used herein as defined in the
Fourth Amended Salary Continuation Agreement dated as of June 1, 2010, between the Bank and the
Executive. The following terms shall have the meanings specified.
1.1 Administrator
means the administrator described in Article 7.
1.2 Executives Interest
means the benefit set forth in section 2.2.
1.3 Insured
means the Executive.
1.4 Insurer
means each life insurance carrier for which there is a Split Dollar Policy
Endorsement attached to this Agreement.
1.5 Net Death Proceeds
means the total death proceeds of the Policy minus the cash surrender
value.
1.6 Policy
means the specific life insurance policy or policies issued by the Insurer(s).
1.7 Salary Continuation Agreement
means the Fourth Amended Salary Continuation Agreement dated
as of June 1, 2010, between the Bank and the Executive, as the same may hereafter be amended.
1.8 Split Dollar Policy Endorsement
means the form required by the Administrator or the
Insurer to indicate the Executives interest, if any, in a Policy on such Executives life.
Article 2
Policy Ownership/Interests
2.1 Bank Ownership
. The Bank is the sole owner of the Policy and shall have the right to
exercise all incidents of ownership. The Bank shall be the beneficiary of the remaining death
proceeds of the Policy after the Executives interest is paid according to section 2.2 below.
2.2 Death Benefit
. Provided the Executives death occurs both before the Executives
Separation from Service and before the Executive attains age 65, at the Executives death the
Executives beneficiary designated in accordance with the Split Dollar Policy Endorsement shall be
entitled to Policy proceeds in an amount equal to the lesser of (x) 100% of the Net Death Proceeds
or (y) $1,118,817 (the lesser of the amounts specified in clauses (x) and (y) being referred to in
this Agreement as the Executives Interest). The Executives Interest shall be extinguished at
the earliest of the date of the Executives Separation from Service, the date the Executive attains
age 65, or the date on which the Executive receives payment of the benefit provided under the
Salary Continuation Agreement for a Change in Control, and the Executives beneficiary shall be
entitled to no benefits under the Agreement of the Executives death occurring thereafter. The
Executive shall have the right to designate the beneficiary of the Executives Interest.
2.3 Option to Purchase
. Upon termination of this Agreement, the Bank shall not sell,
surrender, or transfer ownership of the Policy without first giving the Executive or the
Executives transferee the option to purchase the Policy for a period of 60 days from written
notice of such intention. The purchase price shall be an amount equal to the cash surrender value
of the Policy.
2.4 Comparable Coverage
. The Bank may replace the Policy with a comparable insurance policy
to cover the benefit provided under this Agreement, in which case the Bank and the Executive shall
execute a new Split Dollar Policy Endorsement for the comparable insurance policy.
2.5 Internal Revenue Code Section 1035 Exchanges
. The Executive recognizes and agrees that
the Bank may after this Agreement is adopted wish to exchange the Policy of life insurance on the
Executives life for another contract of life insurance insuring the Executives life. Provided
that the Policy is replaced (or intended to be replaced) with a comparable policy of life
insurance, the Executive agrees to provide medical information and cooperate with medical
insurance-related testing required by
a prospective insurer for implementing the Policy or, if necessary, for modifying or updating
to a comparable insurer.
2
Article 3
Premiums
3.1 Premium Payment
. The Bank shall pay any premiums due on the Policy.
3.2 Economic Benefit
. The Administrator shall annually determine the economic benefit
attributable to the Executive based on the life insurance premium factor for the Executives age
multiplied by the aggregate death benefit payable to the Executives beneficiary. The life
insurance premium factor is the minimum factor applicable under guidance published pursuant to
Treasury Reg. section 1.61-22(d)(3)(ii) or any subsequent authority.
3.3 Imputed Income
. The Bank shall impute the economic benefit to the Executive on an annual
basis by adding the economic benefit to the Executives W-2, or if applicable, Form 1099.
Article 4
Assignment
The Executive may irrevocably assign without consideration all of the Executives interest in
the Policy and in this Agreement to any person, entity, or trust established by the Executive or
the Executives spouse. If the Executive transfers all of the Executives interest in the Policy,
all of the Executives interest in the Policy and in the Agreement shall be vested in the
Executives transferee, who shall be substituted as a party hereunder and the Executive shall have
no further interest in this Agreement.
Article 5
Insurer
The Insurer shall be bound by the terms of the Policy only. Any payments the Insurer makes or
actions it takes in accordance with the Policy shall fully discharge it from all claims, suits, and
demands of all entities or persons. The Insurer shall not be bound by or be deemed to have notice
of the provisions of this Agreement.
Article 6
Claims and Review Procedures
6.1 Claims Procedure
. Any person or entity who has not received benefits under this Agreement
that he or she believes should be paid (the claimant) shall make a claim for benefits as follows
6.1.1
Initiation written claim
. The claimant initiates a claim by submitting to the
Administrator a written claim for benefits. If the claim relates to the contents of a
notice received by the claimant, the claim must be made within 60 days after the notice was
received by the claimant. All other claims must be made within 180 days after the date of
the event that
caused the claim to arise. The claim must state with particularity the determination
desired by the claimant.
3
6.1.2
Timing of Administrator response
. The Administrator shall respond to the claimant
within 90 days after receiving the claim. If the Administrator determines that special
circumstances require additional time for processing the claim, the Administrator can extend
the response period by an additional 90 days by notifying the claimant in writing, before
the end of the initial 90-day period, that an additional period is required. The notice of
extension must set forth the special circumstances and the date by which the Administrator
expects to render its decision.
6.1.3
Notice of decision
. If the Administrator denies part or all of the claim, the
Administrator shall notify the claimant in writing of the denial. The Administrator shall
write the notification in a manner calculated to be understood by the claimant. The
notification shall set forth
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(a)
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The specific reasons for the denial,
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(b)
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A reference to the specific provisions of this Agreement on which
the denial is based,
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(c)
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A description of any additional information or material necessary
for the claimant to perfect the claim and an explanation of why it is needed,
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(d)
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An explanation of the Agreements review procedures and the time
limits applicable to such procedures, and
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(e)
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A statement of the claimants right to bring a civil action under
ERISA section 502(a) after an adverse benefit determination on review.
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6.2 Review Procedure
. If the Administrator denies part or all of the claim, the claimant
shall have the opportunity for a full and fair review by the Administrator of the denial, as
follows
6.2.1
Initiation written request
. To initiate the review, the claimant must file with
the Administrator a written request for review within 60 days after receiving the
Administrators notice of denial.
6.2.2
Additional submissions information access
. The claimant shall then have the
opportunity to submit written comments, documents, records, and other information relating
to the claim. Upon request and free of charge, the Administrator shall also provide the
claimant reasonable access to and copies of all documents, records, and other information
relevant (as defined in applicable ERISA regulations) to the claimants claim for benefits.
6.2.3
Considerations on review
. In considering the review, the Administrator shall take
into account all materials and information the claimant submits relating to the claim,
without regard to whether the information was submitted or considered in the initial benefit
determination.
6.2.4
Timing of Administrator response
. The Administrator shall respond in writing to the
claimant within 60 days after receiving the request for review. If the Administrator
determines that special circumstances require additional time for processing the claim, the
Administrator can extend the response period by an additional 60 days by notifying the
claimant in writing before
the end of the initial 60-day period that an additional period is required. The notice of
extension must set forth the special circumstances and the date by which the Administrator
expects to render its decision.
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6.2.5
Notice of decision
. The Administrator shall notify the claimant in writing of its
decision on review. The Administrator shall write the notification in a manner calculated
to be understood by the claimant. The notification shall set forth
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(a)
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The specific reasons for the denial,
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(b)
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A reference to the specific provisions of the Agreement on which
the denial is based,
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(c)
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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 claimants claim for benefits, and
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(d)
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A statement of the claimants right to bring a civil action under
ERISA section 502(a).
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Article 7
Administration of Agreement
7.1 Administrator Duties
. This Agreement shall be administered by an Administrator, which
shall consist of the Board or such committee as the Board shall appoint. The Executive may not be
a member of the Administrator. The Administrator shall have the discretion and authority to (
x
)
make, amend, interpret, and enforce all appropriate rules and regulations for the administration of
this Agreement and (
y
) decide or resolve any and all questions that may arise, including
interpretations of this Agreement.
7.2 Agents
. In the administration of this Agreement, the Administrator may employ agents and
delegate to them such administrative duties as the Administrator sees fit (including acting through
a duly appointed representative) and may from time to time consult with counsel, who may be counsel
to the Bank.
7.3 Binding Effect of Decisions
. The decision or action of the Administrator concerning any
question arising out of the administration, interpretation, and application of this Agreement and
the rules and regulations promulgated hereunder shall be final and conclusive and binding upon all
persons having any interest in the Agreement.
7.4 Indemnity of Administrator
. The Bank shall indemnify and hold harmless the members of the
Administrator against any and all claims, losses, damages, expenses, or liabilities arising from
any action or failure to act with respect to this Agreement, except in the case of willful
misconduct by the Administrator or any of its members.
7.5 Information
. To enable the Administrator to perform its functions, the Bank shall supply
full and timely information to the Administrator on all matters relating to the date and
circumstances of the retirement, death, or Separation from Service of the Executive, and such
other pertinent information as the Administrator may reasonably require.
5
Article 8
Miscellaneous
8.1 Amendment and Termination of Agreement
. This Agreement may be amended or terminated
solely by a written agreement signed by the Bank and the Executive. However, this Agreement shall
terminate upon the first to occur of (
u
) payment to the Executive of the benefit provided under the
Salary Continuation Agreement for a Change in Control, or (
v
) surrender, lapse, or other
termination of the Policy by the Bank, or (
w
) distribution of the death benefit proceeds in
accordance with section 2.2 above, or (
x
) termination of the Salary Continuation Agreement under
Article 5 of the Salary Continuation Agreement, or (
y
) the Executives Separation from Service, or
(
z
) the date the Executive attains age 65.
8.2 Binding Effect
. This Agreement shall bind the Executive and the Bank and their
beneficiaries, survivors, executors, administrators, and transferees, and any Policy beneficiary.
8.3 No Guarantee of Employment
. This Agreement is not an employment policy or contract. This
Agreement does not give the Executive the right to remain an employee of the Bank nor does it
interfere with the Banks right to discharge the Executive. This Agreement also does not require
the Executive to remain an employee or interfere with the Executives right to terminate employment
at any time.
8.4 Successors
;
Binding Agreement
. By an assumption agreement in form and substance
satisfactory to the Executive, the Bank shall require any successor (whether direct or indirect, by
purchase, merger, consolidation, or otherwise) to all or substantially all of the business or
assets of the Bank to expressly assume and agree to perform this Agreement in the same manner and
to the same extent that the Bank would be required to perform this Agreement had no succession
occurred.
8.5 Applicable Law
. This Agreement and all rights hereunder shall be governed by and
construed according to the laws of the State of Ohio, except to the extent preempted by the laws of
the United States of America.
8.6 Entire Agreement
. This Agreement and the Salary Continuation Agreement constitute the
entire agreement between the Bank and the Executive concerning the subject matter. No rights are
granted to the Executive under this Agreement other than those specifically set forth. This
Agreement amends and restates in its entirety the December 3, 2008 Third Amended Split Dollar
Agreement and Endorsement.
8.7 Severability
. If any provision of this Agreement is held invalid, such invalidity shall
not affect any other provision of this Agreement not held invalid, and each such other provision
shall continue in full force and effect to the full extent consistent with law. If any provision
of this Agreement is held invalid in part, such invalidity shall not affect the remainder of the
provision not held invalid, and the remainder of the provision together with all other provisions
of this Agreement shall continue in full force and effect to the full extent consistent with law.
6
8.8 Headings
. Caption headings and subheadings herein are included solely for convenience of
reference and shall not affect the meaning or interpretation of any provision of this Agreement.
8.9 Notices
. All notices, requests, demands and other communications hereunder shall be in
writing and shall be deemed to have been duly given if delivered by hand or mailed, certified or
registered mail, return receipt requested, with postage prepaid, to the following addresses or to
such other address as either party may designate by like notice. If to the Bank, notice shall be
given to the board of directors, The Cortland Savings and Banking Company, 194 W. Main Street, P.O.
Box 98, Cortland, Ohio 44410-1466, or to such other or additional person or persons as the Bank
shall have designated to the Executive in writing. If to the Executive, notice shall be given to
the Executive at the Executives address appearing on the Banks records, or to such other or
additional person or persons as the Executive shall have designated to the Bank in writing.
In Witness Whereof
, the Executive and a duly authorized representative of the Bank
have executed this Agreement as of the date first written above.
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Executive
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Bank
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The Cortland Savings and Banking Company
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By:
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Title:
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Agreement to Cooperate with Insurance Underwriting Incident to Internal Revenue
Code section 1035 Exchange
I acknowledge that I have read the Fourth Amended Split Dollar Agreement and Endorsement and
agree to be bound by its terms, particularly the covenant on my part set forth in section 2.5 of
the Fourth Amended Split Dollar Agreement and Endorsement to provide medical information and
cooperate with medical insurance-related testing required by an insurer to issue a comparable
insurance policy to cover the benefit provided under this Fourth Amended Split Dollar Agreement and
Endorsement.
7
Split Dollar Policy Endorsement
Insured: James M. Gasior
Insurer: New York Life Insurance and Annuity Corporation
Policy No. 77251006
According to the terms of The Cortland Savings and Banking Company Fourth Amended Split Dollar
Agreement and Endorsement dated as of
, 2011,
the undersigned Owner requests that the above-referenced policy issued by the Insurer provide for
the following beneficiary designation and limited contract ownership rights to the Insured:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its
successors or assigns, to the extent of the Owners interest in the policy. It is hereby provided
that the Insurer may rely solely upon a statement from the Owner concerning the amount of proceeds
the Owner is entitled to receive under this paragraph.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions
of the preceding paragraph shall be paid in one sum to:
Primary Beneficiary, Relationship/Social Security Number
Contingent Beneficiary, Relationship/Social Security Number
The exclusive rights to change the beneficiary for the proceeds payable under this paragraph and to
assign all rights and interests granted under this paragraph are hereby granted to the Insured.
The sole signature of the Insured shall be sufficient to exercise the rights. The Owner retains
all contract rights not granted to the Insured under this paragraph.
3. It is agreed by the undersigned that this designation and limited assignment of rights
shall be subject in all respects to the contractual terms of the policy.
4. Any payment directed by the Owner under this endorsement shall be a full discharge of the
Insurer, and such discharge shall be binding on all parties claiming any interest under the policy.
The undersigned for the Owner is signing in a representative capacity and warrants that he or
she has the authority to bind the entity on whose behalf this document is executed.
Signed at
, Ohio this
day of
, 2011.
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Insured
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Owner
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The Cortland Savings and Banking Company
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By:
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Its:
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Split Dollar Policy Endorsement
Insured: James M. Gasior
Insurer: Midland National Life Insurance Company
Policy No. 690216
According to the terms of The Cortland Savings and Banking Company Fourth Amended Split Dollar
Agreement and Endorsement dated as of
, 2011,
the undersigned Owner requests that the above-referenced policy issued by the Insurer provide for
the following beneficiary designation and limited contract ownership rights to the Insured:
1. Upon the death of the Insured, proceeds shall be paid in one sum to the Owner, its
successors or assigns, to the extent of the Owners interest in the policy. It is hereby provided
that the Insurer may rely solely upon a statement from the Owner concerning the amount of proceeds
the Owner is entitled to receive under this paragraph.
2. Any proceeds at the death of the Insured in excess of the amount paid under the provisions
of the preceding paragraph shall be paid in one sum to:
Primary Beneficiary, Relationship/Social Security Number
Contingent Beneficiary, Relationship/Social Security Number
The exclusive rights to change the beneficiary for the proceeds payable under this paragraph and to
assign all rights and interests granted under this paragraph are hereby granted to the Insured.
The sole signature of the Insured shall be sufficient to exercise the rights. The Owner retains
all contract rights not granted to the Insured under this paragraph.
3. It is agreed by the undersigned that this designation and limited assignment of rights
shall be subject in all respects to the contractual terms of the policy.
4. Any payment directed by the Owner under this endorsement shall be a full discharge of the
Insurer, and such discharge shall be binding on all parties claiming any interest under the policy.
The undersigned for the Owner is signing in a representative capacity and warrants that he or
she has the authority to bind the entity on whose behalf this document is executed.
Signed at
, Ohio this
day of
, 2011.
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Insured
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Owner
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The Cortland Savings and Banking Company
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By:
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Its:
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