Form of Executive Supplemental Retirement Plan Agreement.



 EXHIBIT 10.21 
  
 EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN 
  
 AGREEMENT 
  
 This Agreement, made and entered into this      day of
            , 200    , by and between Crescent Bank and Trust Company, a Bank organized and existing under the laws of the State of Georgia, hereinafter
referred to as “the Bank”, and                     , a Key Employee and the Executive of the Bank, hereinafter referred to as
“the Executive”. 
  
 The Executive has been in the
employ of the Bank for several years and has now and for years past faithfully served the Bank. It is the consensus of the Board of Directors of the Bank (the Board) that the Executive’s services have been of exceptional merit, in excess of the
compensation paid and an invaluable contribution to the profits and position of the Bank in its field of activity. The Board further believes that the Executive’s experience, knowledge of corporate affairs, reputation and industry contacts are
of such value and his continued services are so essential to the Bank’s future growth and profits that it would suffer severe financial loss should the Executive terminate his services. 
  
 Accordingly, it is the desire of the Bank and the Executive to enter into
this Agreement under which the Bank will agree to make certain payments to the Executive upon the Executive’s retirement and, alternatively, to the Executive’s beneficiary(ies) in the event of the Executive’s premature death while
employed by the Bank. 
  
 It is the intent of the parties hereto
that this Agreement be considered an arrangement maintained primarily to provide supplemental retirement benefits for the Executive, as a member of a select group of management or highly-compensated employees of the Bank for purposes of the Employee
Retirement Income Security Act of 1974 (ERISA). The Executive is fully advised of the Bank’s financial status and has had substantial input in the design and operation of this benefit plan. 
  
 Therefore, in consideration of the Executive’s services performed in the
past and those to be performed in the future and based upon the mutual promises and covenants herein contained, the Bank and the Executive, agree as follows: 
  

	I.	DEFINITIONS 

  

	 	A.	Effective Date: 

  
 The Effective Date of this Agreement shall be
                    , 200    . 








	 	B.	Plan Year: 

  
 Any reference to “Plan Year” shall mean a calendar year from January 1 to December 31. In the year of implementation, the term “Plan
Year” shall mean the period from the effective date to December 31 of the year of the effective date. 
  

	 	C.	Retirement Date: 

  
 Retirement Date shall mean retirement from service with the Bank which becomes effective on the first day of the calendar month following the month in
which the Executive reaches the Executive’s sixty-fifth (65th) birthday or such later date as the Executive may actually retire. 
  

	 	D.	Termination of Service: 

  
 Termination of Service shall mean voluntary resignation of service by the Executive or the Bank’s discharge of the Executive without cause
(“cause” defined in Subparagraph III (D) hereinafter), prior to the Normal Retirement Age [described in Subparagraph I (J) hereinafter]. 
  

	 	E.	Pre-Retirement Account: 

  
 A Pre-Retirement Account shall be established as a liability reserve account on the books of the Bank for the benefit of the Executive. Prior to
termination of service or the Executive’s retirement, whichever shall first occur, such liability reserve account shall be increased or decreased each Plan Year (including the Plan Year in which the Executive ceases to be employed by the Bank)
by an amount equal to the annual earnings or loss for that Plan Year determined by the Index [described in Subparagraph I (G) hereinafter], less the Cost of Funds Expense for that Plan Year [described in Subparagraph I (H) hereinafter], divided by a
factor equal to 1.09 minus the marginal tax rate. 
  

	 	F.	Index Retirement Benefit: 

  
 The Index Retirement Benefit for the Executive for any year shall be equal to the excess of the annual earnings (if any) determined by the Index
[Subparagraph I (G)] for that Plan Year less the Cost of Funds Expense [Subparagraph I (H)] for that Plan Year, divided by a factor equal to 1.09 minus the marginal tax rate. 
  

	 	G.	Index: 

  
 The Index for any Plan Year shall be the aggregate annual after-tax income from the life insurance contracts described hereinafter as defined by FASB

  

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 Technical Bulletin 85-4. This Index shall be applied as if such insurance contracts were purchased on
the effective date hereof. 
  

	
	Insurance Company:
	Policy Form:
	Policy Name:
	Insured’s Age and Sex:
	Riders:
	Ratings:
	Option:
	Face
Amount:                                $
	Premiums
Paid:                              $
	Number of Premium Payments:
	Assumed Purchase Date:
	
	Insurance Company:
	Policy Form:
	Policy Name:
	Insured’s Age and Sex:
	Riders:
	Ratings:
	Option:
	Face
Amount:                                $
	Premiums
Paid:                              $
	Number of Premium Payments:
	Assumed Purchase Date:

  
 If such contracts of
life insurance are actually purchased by the Bank then the actual policies as of the dates they were purchased shall be used in calculations under this Agreement. If such contracts of life insurance are not purchased or are subsequently surrendered
or lapsed, then the Bank shall receive annual policy illustrations that assume the above-described policies were purchased from the above named insurance company(ies) on the Effective Date from which the increase in policy value will be used to
calculate the amount of the Index. 
  
 In either case,
references to the life insurance contract are merely for purposes of calculating a benefit. The Bank has no obligation to purchase such life insurance and, if purchased, the Executive and the Executive’s beneficiary(ies) shall have no ownership
interest in such policy and shall always have no greater interest in the benefits under this Agreement than that of an unsecured general creditor of the Bank. 
  

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	 	H.	Cost of Funds Expense: 

  
 The Cost of Funds Expense for any Plan Year shall be calculated by taking the sum of the amount of premiums set forth in the Indexed policies described
above plus the amount of any after-tax benefits paid to the Executive pursuant to this Agreement (Paragraph III hereinafter) plus the amount of all previous years after-tax Costs of Funds Expense, and multiplying that sum by the average Federal
Funds for the Plan Year as quoted in the Wall Street Journal. 
  

	 	I.	Change of Control: 

  
 Change of Control shall be deemed to be the cumulative transfer of more than fifty percent (50%) of the voting stock of the Bank Holding Company from the
Effective Date of this Agreement. For the purposes of this Agreement, transfers on account of deaths or gifts, transfers between family members or transfers to a qualified retirement plan maintained by the Bank shall not be considered in determining
whether there has been a change in control. 
  

	 	J.	Normal Retirement Age: 

  
 Normal Retirement Age shall mean the date on which the Executive attains age sixty-five (65). 
  

	II.	EMPLOYMENT 

  
 No provision of this Agreement shall be deemed to restrict or limit any existing employment agreement by and between the Bank and the Executive, nor shall
any conditions herein create specific employment rights to the Executive nor limit the right of the Employer to discharge the Executive with or without cause. In a similar fashion, no provision shall limit the Executive’s rights to voluntarily
sever his employment at any time. 
  

	III.	INDEX BENEFITS 

  
 The following benefits provided by the Bank to the Executive are in the nature of a fringe benefit and shall in no event be construed to effect nor limit
the Executive’s current or prospective salary increases, cash bonuses or profit-sharing distributions or credits. 
  

	 	A.	Retirement Benefits: 

  
 Should the Executive continue to be employed by the Bank until “Normal Retirement Age” defined in Subparagraph I (J), the Executive shall be
entitled to receive the balance in his Pre-Retirement Account [as defined 
  

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 in Subparagraph I (E)] in fifteen (15) equal annual installments commencing thirty (30) days following
the Executive’s Retirement Date. In addition to these payments, commencing with the Plan Year in which the Executive attains the Executive’s Retirement Date, the Index Retirement Benefit [as defined in Subparagraph I (F) above] for each
year shall be paid to the Executive until the Executive’s death. 
  

	 	B.	Termination of Service: 

  
 Subject to Subparagraph III (D) hereinafter, should the Executive suffer a Termination of Service [defined in Subparagraph I (D)], the Executive shall be
entitled to receive six and sixty-seven hundredths percent (6.67%) times the number of full years the Executive has served the Bank from the date of first service (to a maximum of 100%), times the balance in the Pre-Retirement Account paid over
fifteen (15) years in equal installments commencing at the Normal Retirement Age [Subparagraph I (J)]. In addition to these payments and commencing in the Plan Year in which the Executive attains Normal Retirement Age, six and sixty-seven hundredths
percent (6.67%) times the number of full years the Executive has served the Bank from the date of first service (to a maximum of 100%), times the Index Retirement Benefit for each year shall be paid to the Executive until the Executives death.

  

	 	C.	Death: 

  
 Should the Executive die prior to having received the full balance of the Pre-Retirement Account, the unpaid balance of the Pre-Retirement Account shall
be paid in a lump sum to the beneficiary selected by the Executive and filed with the Bank. In the absence of or a failure to designate a beneficiary, the unpaid balance shall be paid in a lump sum to the personal representative of the
Executive’s estate. The death benefit shall be paid on the first day of the second month following the decease of the participant. 
  

	 	D.	Discharge for Cause: 

  
 Should the Executive be discharged for cause at any time, all Benefits under this Agreement shall be forfeited. The term “for cause” shall mean
gross negligence or gross neglect or the conviction of a felony or gross misdemeanor involving moral turpitude, fraud, dishonesty or willful violation of any law that results in any adverse effect on the Bank. If a dispute arises as to discharge
“for cause,” such dispute shall be resolved by arbitration as set forth in this Agreement. 
  

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	 	E.	Disability Benefit: 

  
 In the event the Executive becomes disabled prior to Termination of Service, and the Executive’s employment is terminated because of such
disability, he shall immediately begin receiving the benefits in Subparagraph III (A) above. Such benefit shall begin without regard to the Executive’s Normal Retirement Age and the Executive shall be one hundred percent (100%) vested in the
entire benefit amount. If there is a dispute regarding whether the Executive is disabled, such dispute shall be resolved by a physician selected by the Bank and such resolution shall be binding upon all parties to this Agreement. 
  

	 	F.	Death Benefit: 

  
 Except as set forth above, there is no death benefit provided under this Agreement. 
  

	IV.	RESTRICTIONS UPON FUNDING 

  
 The Bank shall have no obligation to set aside, earmark or entrust any fund or money with which to pay its obligations under this Agreement. The
Executive, the Executive’s beneficiary(ies) or any successor in interest to the Executive shall be and remain simply a general creditor of the Bank in the same manner as any other creditor having a general claim for matured and unpaid
compensation. 
  
 The Bank reserves the absolute right, at its
sole discretion, to either fund the obligations undertaken by this Agreement or to refrain from funding the same and to determine the exact nature and method of such funding. Should the Bank elect to fund this Agreement, in whole or in part, through
the purchase of life insurance, mutual funds, disability policies or annuities, the Bank reserves the absolute right, in its sole discretion, to terminate such funding at any time, in whole or in part. At no time shall the Executive be deemed to
have any lien or right, title or interest in or to any specific funding investment or to any assets of the Bank. 
  
 If the Bank elects to invest in a life insurance, disability or annuity policy upon the life of the Executive, then the Executive shall assist the Bank by
freely submitting to a physical exam and supplying such additional information necessary to obtain such insurance or annuities. 
  

	V.	CHANGE OF CONTROL 

  
 Upon a Change of Control [as defined in Subparagraph I (I) herein], if the Executive’s employment is subsequently terminated, except for cause, then
the Executive shall receive the benefits promised in this Agreement upon attaining Normal Retirement Age, as if the Executive had been continuously employed by the Bank until the Executive’s Normal Retirement Age. The Executive will also

  

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 remain eligible for all promised death benefits in this Agreement. In addition, no sale, merger or
consolidation of the Bank shall take place unless the new or surviving entity expressly acknowledges the obligations under this Agreement and agrees to abide by its terms. 
  

	VI.	MISCELLANEOUS 

  

	 	A.	Alienability and Assignment Prohibition: 

  
 Neither the Executive, his/her surviving spouse nor any other beneficiary under this Agreement shall have any power or right to transfer, assign,
anticipate, hypothecate, mortgage, commute, modify or otherwise encumber in advance any of the benefits payable hereunder nor shall any of said benefits be subject to seizure for the payment of any debts, judgments, alimony or separate maintenance
owed by the Executive or the Executive’s beneficiary(ies), nor be transferable by operation of law in the event of bankruptcy, insolvency or otherwise. In the event the Executive or any beneficiary attempts assignment, commutation,
hypothecation, transfer or disposal of the benefits hereunder, the Bank’s liabilities shall forthwith cease and terminate. 
  

	 	B.	Binding Obligation of Bank and any Successor in Interest: 

  
 The Bank expressly agrees that it shall not merge or consolidate into or with another bank or sell substantially all of its assets to another bank, firm
or person until such bank, firm or person expressly agrees, in writing, to assume and discharge the duties and obligations of the Bank under this Agreement. This Agreement shall be binding upon the parties hereto, their successors, beneficiary(ies),
heirs and personal representatives. 
  

	 	C.	Revocation: 

  
 It is agreed by and between the parties hereto that, during the lifetime of the Executive, this Agreement may be amended or revoked at any time or times,
in whole or in part, by the mutual written assent of the Executive and the Bank. 
  

	 	D.	Gender: 

  
 Whenever in this Agreement words are used in the masculine or neuter gender, they shall be read and construed as in the masculine, feminine or neuter
gender, whenever they should so apply. 
  

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	 	E.	Effect on Other Bank Benefit Plans: 

  
 Nothing contained in this Agreement shall affect the right of the Executive to participate in or be covered by any qualified or non-qualified pension,
profit-sharing, group, bonus or other supplemental compensation or fringe benefit plan constituting a part of the Bank’s existing or future compensation structure. 
  

	 	F.	Headings: 

  
 Headings and subheadings in this Agreement are inserted for reference and convenience only and shall not be deemed a part of this Agreement. 

 

	 	G.	Applicable Law: 

  
 The validity and interpretation of this Agreement shall be governed by the laws of the State of Georgia. 
  

	VII.	ERISA PROVISION 

  

	 	A.	Named Fiduciary and Plan Administrator: 

  
 The “Named Fiduciary and Plan Administrator” of this Plan shall be Crescent Bank and Trust Company until its removal by the Board. As Named
Fiduciary and Administrator, the Bank shall be responsible for the management, control and administration of the Salary Continuation Agreement as established herein. The Named Fiduciary may delegate to others certain aspects of the management and
operation responsibilities of the plan including the employment of advisors and the delegation of ministerial duties to qualified individuals. 
  

	 	B.	Claims Procedure and Arbitration: 

  
 In the event a dispute arises over benefits under this Agreement and benefits are not paid to the Executive (or to his beneficiary in the case of the
Executive’s death) and such claimants feel they are entitled to receive such benefits, then a written claim must be made to the Plan Administrator named above within ninety (90) days from the date payments are refused. The Plan Administrator
shall review the written claim and if the claim is denied, in whole or in part, they shall provide in writing within ninety (90) days of receipt of such claim their specific reasons for such denial, reference to the provisions of this Agreement upon
which the denial is based and any additional material or information necessary to perfect the claim. Such written notice shall further indicate the additional steps to be taken by claimants if a further review of the claim denial is desired. A claim
shall be deemed denied if the Plan Administrator fails to take any action within the aforesaid ninety-day period. 
  

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 If claimants desire a second review they shall notify the Plan Administrator in writing within ninety
(90) days of the first claim denial. Claimants may review this Agreement or any documents relating thereto and submit any written issues and comments they may feel appropriate. In its sole discretion, the Plan Administrator shall then review the
second claim and provide a written decision within ninety (90) days of receipt of such claim. This decision shall likewise state the specific reasons for the decision and shall include reference to specific provisions of this Agreement upon which
the decision is based. 
  
 If claimants continue to dispute the
benefit denial based upon completed performance of this Agreement or the meaning and effect of the terms and conditions thereof, then claimants may submit the dispute to a Board of Arbitration for final arbitration. Said Board shall consist of one
member selected by the claimant, one member selected by the Bank, and the third member selected by the first two members. The Board shall operate under any generally recognized set of arbitration rules. The parties hereto agree that they and their
heirs, personal representatives, successors and assigns shall be bound by the decision of such Board with respect to any controversy properly submitted to it for determination. 
  
 Where a dispute arises as to the Bank’s discharge of the Executive “for cause,” such dispute shall likewise
be submitted to arbitration as above described and the parties hereto agree to be bound by the decision thereunder. 
  

	VIII.	TERMINATION OR MODIFICATION OF AGREEMENT BY REASON OF CHANGES IN THE LAW, RULES OR REGULATIONS 

  
 The Bank is entering into this Agreement upon the assumption that certain existing tax laws, rules and regulations will
continue in effect in their current form. If any said assumptions should change and said change has a detrimental effect on this Executive Plan, then the Bank reserves the right to terminate or modify this Agreement accordingly. Upon a Change of
Control [Subparagraph I (I) and Paragraph V], this paragraph shall become null and void effective immediately upon said Change of Control. 
  

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 IN WITNESS WHEREOF, the parties hereto acknowledge that each has carefully read this Agreement and
executed the original thereof on the first day set forth hereinabove, and that, upon execution; each has received a conforming copy. 
  

					
	 	 	 CRESCENT BANK AND TRUST COMPANY
 Jasper, Georgia

			
	
	 	By:	 	  


	Witness	 	 	 	            Title
		
	
	 	

	Witness	 	[Executive]

  

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 BENEFICIARY DESIGNATION FORM 
 FOR THE EXECUTIVE SUPPLEMENTAL RETIREMENT PLAN 
 AGREEMENT 
  

	I.	PRIMARY DESIGNATION 

                         (You may refer to the beneficiary designation information prior to completion.)

  

	 	A.	Person(s) as a Primary Designation: 

          (Please indicate the percentage for each beneficiary.) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  

	 	B.	Estate as a Primary Designation: 

  
 My Primary Beneficiary is The Estate of
                                        
                                        
                                        
             as set forth in the last will and testament dated the      day of
                    ,                  and any codicils
thereto. 
  

	 	C.	Trust as a Primary Designation: 

  
 Name of the Trust:
                                        
                                        
                                        
                                        
         
  
 Execution
Date of the Trust:              /              /
                 
  
 Name of the Trustee:
                                        
                                        
                                        
                                        
     
  

	
	 Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary):

	 ____________________________________________________________________________________________________________

	
	 ____________________________________________________________________________________________________________


  
 Is this an Irrevocable
Life Insurance Trust?                  Yes                  No 

(If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.) 
  

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	II.	SECONDARY (CONTINGENT) DESIGNATION 

  

	 	A.	Person(s) as a Secondary (Contingent) Designation: 

          (Please indicate the percentage for each beneficiary.) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  
 Name
                                        
                                        
       Relationship
                                        
                      /             % 
  
 Address:                                     
                                        
                                        
                                        
                            
                                 (Street)
                                        
                (City)
                                    (State)
                        (Zip) 
  

	 	B.	Estate as a Secondary (Contingent) Designation: 

  
 My Secondary Beneficiary is The Estate of
                                        
as set forth in my last will and testament dated the      day of                         ,
                 and any codicils thereto. 
  

	 	C.	Trust as a Secondary (Contingent) Designation: 

  
 Name of the Trust:
                                        
                                        
                                        
                                        
             
  
 Execution Date of the Trust:              /              /
                 
  
 Name of the Trustee:
                                        
                                        
                                        
                                        
         
  

	
	 Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary):

	 _______________________________________________________________________________________________________________

	
	 _______________________________________________________________________________________________________________


  
 All sums payable under
the Executive Supplemental Retirement Plan Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent)
Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing. 
  

					
	 	  	
	  	

	 	  	[Executive]	  	Date

  

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