Form of Executive Life Insurance Endorsement Method Split Dollar Plan Agreement.



 EXHIBIT 10.22 
  
 LIFE INSURANCE 
  
 ENDORSEMENT METHOD SPLIT DOLLAR PLAN 
  
 AGREEMENT 
  

			
	Insurer:	  	 
		
	Policy Number:	  	 
		
	Bank:	  	Crescent Bank and Trust Company
		
	Insured:	  	 
		
	Relationship of Insured to Bank:	  	Executive

  
 The respective rights and duties of
the Bank and the Insured in the above-referenced policy shall be pursuant to the terms set forth below: 
  

	I.	DEFINITIONS 

  
 Refer to the policy contract for the definition of all terms in this Agreement. 
  

	II.	POLICY TITLE AND OWNERSHIP 

  
 Title and ownership shall reside in the Bank for its use and for the use of the Insured all in accordance with this Agreement. The Bank alone may, to the
extent of its interest, exercise the right to borrow or withdraw on the policy cash values. Where the Bank and the Insured (or assignee, with the consent of the Insured) mutually agree to exercise the right to increase the coverage under the subject
Split Dollar policy, then, in such event, the rights, duties and benefits of the parties to such increased coverage shall continue to be subject to the terms of this Agreement. 
  

	III.	BENEFICIARY DESIGNATION RIGHTS 

  
 The Insured (or assignee) shall have the right and power to designate a beneficiary or beneficiaries to receive the Insured’s share of the proceeds
payable upon the death of the Insured, and to elect and change a payment option for such beneficiary, subject to any right or interest the Bank may have in such proceeds, as provided in this Agreement. 








	IV.	PREMIUM PAYMENT METHOD 

  
 The Bank shall pay an amount equal to the planned premiums and any other premium payments that might become necessary to keep the policy in force.

  

	V.	TAXABLE BENEFIT 

  
 Annually the Insured will receive a taxable benefit equal to the assumed cost of insurance as required by the Internal Revenue Service. The Bank (or its
administrator) will report to the Insured the amount of imputed income each year on Form W-2 or its equivalent. 
  

	VI.	DIVISION OF DEATH PROCEEDS 

  
 Subject to Paragraphs VII and IX herein, the division of the death proceeds of the policy is as follows: 
  

	 	A.	Should the Insured be employed by the Bank at the time of his or her death, the Insured’s beneficiary(ies), designated in accordance with Paragraph III, shall be entitled to an
amount equal to eighty percent (80%) of the net at risk insurance portion of the proceeds. The net at risk insurance portion is the total proceeds less the cash value of the policy. 

  

	 	B.	Should the Insured not be employed by the Bank at the time of his or her death, the Insured’s beneficiary(ies), designated in accordance with Paragraph III, shall be entitled
to the following percentage of the proceeds described in Subparagraph VI (A) hereinabove that corresponds to the number of full years the Insured has been employed with the Bank since the date of first employment. 

  

			
	 Total Years
 of Employment
 with the Bank

	 	 Vested


	 <1
	 	0%
	 1 or more
	 	6.67% per year to a maximum of 100%

  

	 	C.	The Bank shall be entitled to the remainder of such proceeds. 

  

	 	D.	The Bank and the Insured (or assignees) shall share in any interest due on the death proceeds on a pro rata basis as the proceeds due each respectively bears to the total proceeds,
excluding any such interest. 

  

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	VII.	DIVISION OF THE CASH SURRENDER VALUE OF THE POLICY 

  
 The Bank shall at all times be entitled to an amount equal to the policy’s cash value, as that term is defined in the policy contract, less any
policy loans and unpaid interest or cash withdrawals previously incurred by the Bank and any applicable surrender charges. Such cash value shall be determined as of the date of surrender or death as the case may be. 
  

	VIII.	RIGHTS OF PARTIES WHERE POLICY ENDOWMENT OR ANNUITY ELECTION EXISTS 

  
 In the event the policy involves an endowment or annuity element, the Bank’s right and interest in any endowment proceeds or annuity benefits, on
expiration of the deferment period, shall be determined under the provisions of this Agreement by regarding such endowment proceeds or the commuted value of such annuity benefits as the policy’s cash value. Such endowment proceeds or annuity
benefits shall be considered to be like death proceeds for the purposes of division under this Agreement. 
  

	IX.	TERMINATION OF AGREEMENT 

  
 This Agreement shall terminate if the Insured shall be discharged from employment with the Bank for cause. The term “for cause” shall mean gross
negligence or gross neglect or the commission 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. 
  
 Upon such termination, the Insured (or assignee) shall have a forty-five
(45) day option to receive from the Bank an absolute assignment of the policy in consideration of a cash payment to the Bank, whereupon this Agreement shall terminate. Such cash payment referred to hereinabove shall be the greater of: 
  

	 	1.	The Bank’s share of the cash value of the policy on the date of such assignment, as defined in this Agreement; or 

  

	 	2.	The amount of the premiums which have been paid by the Bank prior to the date of such assignment. 

  
 If, within said forty-five (45) day period, the Insured fails to exercise said option, fails to procure the entire
aforestated cash payment, or dies, then the option shall terminate, and the Insured (or assignee) agrees that all of the Insured’s rights, interest and claims in the policy shall terminate as of the date of the termination of this Agreement.

  
 Except as provided above, this Agreement shall terminate upon
distribution of the death benefit proceeds in accordance with Paragraph VI above. 
  

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	X.	INSURED’S OR ASSIGNEE’S ASSIGNMENT RIGHTS 

  
 The Insured may not, without the written consent of the Bank, assign to any individual, trust or other organization, any right, title or interest in the
subject policy nor any rights, options, privileges or duties created under this Agreement. 
  

	XI.	AGREEMENT BINDING UPON THE PARTIES 

  
 This Agreement shall bind the Insured and the Bank, their heirs, successors, personal representatives and assigns. 
  

	XII.	NAMED FIDUCIARY AND PLAN ADMINISTRATOR 

  
 Crescent Bank and Trust Company is hereby designated the “Named Fiduciary” until resignation or removal by the Board of Directors. As Named
Fiduciary, the Bank shall be responsible for the management, control, and administration of this Split Dollar Plan as established herein. The Named Fiduciary may allocate to others certain aspects of the management and operation responsibilities of
the Plan, including the employment of advisors and the delegation of any ministerial duties to qualified individuals. 
  

	XIII.	FUNDING POLICY 

  
 The funding policy for this Split Dollar Plan shall be to maintain the subject policy in force by paying, when due, all premiums required. 
  

	XIV.	CLAIM PROCEDURES FOR LIFE INSURANCE POLICY AND SPLIT DOLLAR PLAN 

  
 Claim forms or claim information as to the subject policy can be obtained by contacting Benmark, Inc. (800-544-6079). If the Named Fiduciary has a claim
which may be covered under the provisions described in the insurance policy, they should contact the office named above, and they will either complete a claim form and forward it to an authorized representative of the Insurer or advise the named
Fiduciary what further requirements are necessary. The Insurer will evaluate and make a decision as to payment. If the claim is payable, a benefit check will be issued to the Named Fiduciary. 
  
 In the event that a claim is not eligible under the policy, the Insurer will
notify the Named Fiduciary of the denial pursuant to the requirements under the terms of the policy. If the Named Fiduciary is dissatisfied with the denial of the claim and wishes to contest such claim denial, they should contact the office named
above and they will assist in making inquiry to the Insurer. All objections to the Insurer’s actions should be in writing and submitted to the office named above for transmittal to the Insurer. 
  

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	XV.	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. 
  

	XVI.	INSURANCE COMPANY NOT A PARTY TO THIS AGREEMENT 

  
 The Insurer shall not be deemed a party to this Agreement, but will respect the rights of the parties as herein developed upon receiving an executed copy
of this Agreement. Payment or other performance in accordance with the policy provisions shall fully discharge the Insurer for any and all liability. 
  
 Executed at Jasper, Georgia this      day of
                    , 200_. 
  

					
	 	 	CRESCENT BANK AND TRUST COMPANY
	 	 	Jasper, Georgia
			
	  

	 	By:	 	  


	Witness	 	Title	 	 
		
	  

	 	  


	Witness	 	[Executive]

  

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 BENEFICIARY DESIGNATION FORM 
 FOR THE LIFE INSURANCE ENDORSEMENT METHOD SPLIT 
 DOLLAR 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 Life Insurance Endorsement Method Split Dollar 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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