EXHIBIT 10.7


 


HOME FEDERAL BANK


 


AMENDED AND RESTATED

DEFERRED COMPENSATION AGREEMENT

FOR

CURTIS L. HAGE


 

















 


HOME FEDERAL BANK


 


AMENDED AND RESTATED

DEFERRED COMPENSATION AGREEMENT

FOR

CURTIS L. HAGE


 


THIS AGREEMENT is made this 31st day of
December, 2008, by and between Home Federal Bank, located in Sioux Falls, South
Dakota (the “Company”), and Curtis L. Hage (the “Executive”), amending and
restating the Deferred Compensation Agreement, by and between the Company and
the Executive initially dated April 2, 1996, and later amended July 15,
1998 (the “Agreement”). The Agreement is being restated to comply with Section 409A
of the Internal Revenue Code of 1986, as amended, and is effective January 1,
2009.


 


INTRODUCTION


 


To encourage
the Executive to remain an employee of the Company, the Company is willing to
provide to the Executive a deferred compensation opportunity. The Company will
pay the Executive’s benefits from the Company’s general assets. The benefit
provided hereunder is intended to be a benefit to an employee who is a member
of a select group of management or highly compensated employees of the Company
and is intended to be paid from the Company’s general assets.


 


AGREEMENT


 


The Executive and the Company agree as
follows:


 


Article 1

Definitions


 


1.1.                              Definitions. Whenever used in this Agreement, the
following words and phrases shall have the meanings specified:


 


1.1.1                        “Change in
Control”


 


(a)                                Change in
Control means that any one person or more than one person acting as a group
acquires ownership of stock of the corporation that, together with the stock
held by such person or group, constitutes more than 50 percent of the total
fair market value or total voting power of the stock of such corporation.
However, if any one person or more than one person acting as a group, is
considered to own more than 50 percent of the total fair market value or total
voting power of the stock of a corporation, the acquisition of additional stock
by the same person or persons is not considered to cause a change in the ownership
of the corporation or to cause a change in the effective control of the
corporation. or


 

















 


(b)                               any one
person, or more than one person acting as a group acquires (or has acquired
during the 12-month period ending on the date of the most recent acquisition by
such person or persons) ownership of stock of the corporation possessing 35
percent or more of the total voting power of the stock of such corporation; or


 


(c)                                any one
person, or more than one person acting as a group acquires (or has acquired during
the 12-month period ending on the date of the most recent acquisition by such
person or persons) assets from the corporation that have a total gross fair
market value equal to or more than 40 percent of the total gross fair market
value of all of the assets of the corporation immediately prior to such
acquisition or acquisitions; or


 


(d)                               A majority
of the members of the Company’s Board of Directors is replaced during any
12-month period by directors whose appointment or election is not endorsed by a
majority of the members of the Company’s Board prior to the date of the
appointment or election.


 


(e)                                This
definition shall be interpreted in a manner consistent with Section 409A
of the Code.


 


1.1.2                        “Code” means
the Internal Revenue Code of 1986, as amended. References to a Code section
shall be deemed to be to that section as it now exists and to any successor
provision.


 


1.1.3                        “Compensation”
means the total annual base salary payable to the Executive.


 


1.1.4                        “Disability”


 


(a)                                Disability
means the Executive’s inability to perform substantially all normal duties of
the Executive’s position, as determined by the Company’s Board of Directors in
its sole discretion. As a condition to any benefits, the Company may require
the Executive to submit to such physical or mental evaluations and tests as the
Board of Directors deems appropriate.


 


1.1.5                        “Election
Form” means the Form attached as Exhibit 1.


 


1.1.6                        “Normal
Retirement Date” means the Executive attaining age 65.


 


1.1.7                        “Plan Year”
means twelve (12) months ending on each December 31.


 


1.1.8                        “Unforeseen
Emergency” shall mean the Executive’s severe financial hardship resulting from
an unforeseeable emergency such as (1) an illness or accident of the
Executive or the Executive’s spouse, dependent or beneficiary, (2) the
loss of the 


 


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Executive’s property because of casualty, or (3) other
similar extraordinary and unforeseeable circumstances arising as a result of
events beyond the control of the Executive, as determined by the Administrator.


 


1.1.9                        “Termination
of Employment” means the Executive’s separation from service within the meaning
of Section 409A of the Code for any reason whatsoever, voluntary or
involuntary, other than by reason of an approved leave of absence, to the
extent set forth in Section 409A of the Code.


 


Article 2

Deferral Election


 


2.1.                              Initial Election. The Executive was permitted to make an
initial deferral election under this Agreement by filing with the Company a
signed Election Form within 30 days after the initial effective date of
this Agreement. The Election Form set forth the amount of Compensation to
be deferred. The Election Form was effective to defer only Compensation
earned after the date the Election Form was received by the Company The
Election Form continues in effect until changed under Section 2.2
below.


 


2.2.                              Election Changes.


 


2.2.1                        Generally. The Executive may modify the amount of
Compensation to be deferred by filing a subsequent signed Election Form with
the Company. The modified deferral shall not be effective until the beginning
of the calendar year following the calendar year in which the subsequent
Election Form is received by the Company.


 


2.2.2                        Unforeseeable Emergency. If an Unforeseeable Emergency as
described in Section 1.1.10 occurs, the Executive, by written instructions
to the Company may request the Company to cease deferrals under the Agreement
for the remainder of the calendar year, but only to the extent that such
reduction shall permit the Executive to meet the Unforeseeable Emergency and
only to the extent permitted by Section 409A of the Code. Once deferrals
are ceased, they cannot begin again until the beginning of the calendar year
following the year in which the cessation of deferrals occurred and only if the
Executive files a subsequent signed Election Form with the Company before
the beginning of that calendar year.


 


Article 3

Deferral Account


 


3.1.                              Establishing and Crediting. The Company shall establish a Deferral
Account on its books for the Executive, and shall credit to the Deferral
Account the following amounts:


 


3.1.1                        Deferrals. The Compensation deferred by the
Executive shall be credited as of the time such amounts would have otherwise
been paid to the Executive, after subtraction of FICA and Medicare tax.


 


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3.1.2                        Interest. Interest shall be credited on a monthly
basis and compounded on a monthly basis to the Deferral Account. The annual
rate of such interest shall become effective on the first day of each Plan
Year, and shall equal the Wall Street Journal Prime Rate plus one percent on
the first business day of the Plan Year.


 


3.2.                              Statement of Accounts. The Company shall provide to the
Executive, within one hundred twenty (120) days after each anniversary of this
Agreement, a statement setting forth the Deferral Account balance.


 


3.3.                              Accounting Device Only. The Deferral Account is solely a device
for measuring amounts to be paid under this Agreement. The Deferral Account is
not a trust fund of any kind. The Executive is a general unsecured creditor of
the Company for the payment of benefits. The benefits represent the mere
Company promise to pay such benefits. The Executive’s rights are not subject in
any manner to anticipation, alienation, sale, transfer, assignment, pledge,
encumbrance, attachment, or garnishment by the Executive’s creditors.


 


Article 4

Lifetime Benefits


 


4.1.                              Normal Retirement Benefit. If the Executive terminates employment
on or after the Normal Retirement Date for reasons other than death, the
Company shall pay to the Executive the benefit described in this Section 4.1
in lieu of any other benefit under this Agreement.


 


4.1.1                        Amount of Benefit. The benefit under this Section 4.1
is the Deferral Account balance at the Executive’s Termination of Employment.


 


4.1.2                        Payment of Benefit. The Company shall pay the Deferral
Account to the Executive in a lump sum on the first day of the month following
the six month anniversary of the Executive’s Termination of Employment,
increased by interest during the period of deferral at the appropriate interest
rate (as determined under Section 3.1.2).


 


4.2.                              Early Retirement Benefit. If the Executive terminates employment
before the Normal Retirement Date, and for reasons other than death, Change in
Control or Disability, the Company shall pay to the Executive the benefit
described in this Section 4.2 in lieu of any other benefit under this
Agreement.


 


4.2.1                        Amount of Benefit. The benefit under this Section 4.2
is the Deferral Account balance at the Executive’s Termination of Employment.


 


4.2.2                        Payment of Benefit. The Company shall pay the Deferral
Account to the Executive in a lump sum on the first day of the month following
the six month anniversary of the Executive’s Termination of Employment, increased
by interest during the period of deferral at the appropriate interest rate (as
determined under Section 3.1.2).


 


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4.3.                              Disability Benefit. If the Executive terminates employment
for Disability prior to the Normal Retirement Date, the Company shall pay to
the Executive the benefit described in this Section 4.3 in lieu of any
other benefit under this Agreement.


 


4.3.1                        Amount of Benefit. The benefit under this Section 4.3
is the Deferral Account balance at the Executive’s Termination of Employment.


 


4.3.2                        Payment of Benefit. The Company shall pay the Deferral
Account to the Executive in a lump sum on the first day of the month following
the six month anniversary of the Executive’s Termination of Employment,
increased by interest during the period of deferral at the appropriate interest
rate (as determined under Section 3.1.2).


 


4.4.                              Change in Control Benefit. Upon a Change in Control while the
Executive is in the active service of the Company, the Company shall pay to the
Executive the benefit described in this Section 4.4 in lieu of any other
benefit under this Agreement.


 


4.4.1                        Amount of Benefit. The benefit under this Section 4.4
is the Deferral Account balance at the date of the Change in Control, as defined
in Section 1.1.1.


 


4.4.2                        Payment of Benefit. The Company shall pay this benefit to
the Executive in a lump sum on the 60th day after the Change in Control.


 


4.5.                              Unforeseen Emergency Distribution. Upon the
Company’s determination (following petition by the Executive) that the
Executive has suffered an Unforeseen Emergency as described in Section 1.1.8,
the Company shall distribute to the Executive all or a portion of the Deferral
Account balance as determined by the Company, but in no event shall the distribution
be greater than is necessary to relieve the hardship. If the Executive receives
a hardship distribution, his Elective Deferrals shall be terminated for the
remainder of the Plan Year and new deferrals shall be permitted only as of the
beginning of a calendar year following the calendar year in which the emergency
distribution was made. The Executive must make a new election to defer
compensation.


 


Article 5

Death Benefits


 


5.1.                              Death During Active Service. If the
Executive dies while in the active service of the Company, the Company shall
pay to the Executive’s beneficiary the benefit described in this Section 5.1
in lieu of any other benefit under this Agreement.


 


5.1.1                        Amount of Benefit. The benefit under Section 5.1 is
the greater of: a) the Deferral Account balance at the date of the Executive’s
death; or b) the Projected Benefit. The Projected Benefit shall mean the
balance that would have accumulated in the Executive’s Deferral Account at the
Normal Retirement Date if it is assumed that the Executive: (1) continued
to receive Compensation at the same rate that the Executive was receiving
Compensation on the date of the Executive’s death, (2) continued to defer
Compensation at the same rate that the Executive had been deferring 


 


5

















 


Compensation on the date of the Executive’s
death; and (3) survived to the Normal Retirement Date. The interest rate
shall be determined pursuant to Section 3.1.2.


 


5.1.2                        Payment of Benefit. The Company shall pay the death benefit
to the beneficiary in a lump sum on the 60th day after the date of the
Executive’s death.


 


Article 6

Beneficiaries


 


6.1.                              Beneficiary Designations. The Executive shall designate a
beneficiary by filing a written designation with the Company. The Executive may
revoke or modify the designation at any time by filing a new designation.
However, designations will only be effective if signed by the Executive and
accepted by the Company during the Executive’s lifetime. The Executive’s
beneficiary designation shall be deemed automatically revoked if the
beneficiary predeceases the Executive, or if the Executive names a spouse as
beneficiary and the marriage is subsequently dissolved. If the Executive dies
without a valid beneficiary designation, all payments shall be made to the
Executive’s surviving spouse, if any, and if none, to the Executive’s surviving
children and the descendants of any deceased child by right of representation,
and if no children or descendants survive, to the Executive’s estate.


 


6.2.                              Facility of Payment. If a benefit is payable to a minor, to
a person declared incompetent, or to a person incapable of handling the
disposition of his or her property, the Company may pay such benefit to the
guardian, legal representative or person having the care or custody of such
minor, incompetent person or incapable person. The Company may require proof of
incompetency, minority or guardianship as it may deem appropriate prior to
distribution of the benefit. Such distribution shall completely discharge the
Company from all liability with respect to such benefit.


 


Article 7

General Limitations


 


7.1.                              Notwithstanding
any provision of this Agreement to the contrary, the Company shall not pay any
benefit under this Agreement that is attributable to the interest credited to
the Deferral Account in the event of Termination for Cause, as defined in Section 7.2.


 


7.2.                              Termination for Cause means involuntary termination of the
Executive’s employment by the Company provided that the Board of Directors has
determined that the Executive’s employment should be terminated for “Cause” in
accordance with the provisions of the Executive’s employment contract.


 


Article 8

Claims and Review Procedures


 


8.1.                              Initial Claim for Benefits. The following shall apply with respect
to claims of the Executive for benefits, other than claims governed by Section 8.3
below. The Company shall give notice to the Executive within 90 days of the
Executive’s written application for benefits of the Executive’s eligibility or
noneligibility for benefits under the Agreement. If 


 


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the Company determines that the Executive is
not eligible for benefits or full benefits, the notice shall set forth (a) the
specific reasons for such denial, (b) a specific reference to the
provision of the Agreement on which the denial is based, (c) a description
of any additional information or material necessary for the Executive to
perfect the claim, and a description of why it is needed, and (d) an
explanation of the Agreement’s claims review procedure and other appropriate
information as to the steps to be taken if the Executive 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 give notice to
the Executive 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-day
period.


 


8.2.                              Appeal of Claim Denial. If the Executive is determined by the
Company under Section 8.1 above to be not eligible for benefits, or if the
Executive believes that the Executive is entitled to greater or different
benefits, the Executive shall have the opportunity to have the claim reviewed
by filing a petition for review within 60 days after the Executive has been
given the notice issued by the Company. The petition shall be filed with the
Company. A petition shall state the specific reasons the Executive believes
that the Executive is entitled to benefits or greater or different benefits.
Within 60 days after the petition has been filed, the Company shall afford the
Executive an opportunity to present the Executive’s position to the Company, in
writing, and the Executive shall have the right to review pertinent documents.
The Company shall give notice to the Executive of its decision in writing
within said 60-day period, stating specifically the basis of the decision
written in a manner calculated to be understood by the Executive and the
specific provisions of the Agreement on which the decision is based. If because
of special circumstances, 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 Executive.


 


8.3.                              Disability Claim for Benefits. If an
Executive makes a claim for benefits under the Agreement that is contingent on
the Company determining that the Executive has a disability, the Company will
give notice to the Executive within 45 days of the Executive’s written
application for benefits of the Executive’s eligibility or noneligibility for
benefits under the Agreement. If special circumstances require an extension,
the Company will notify the Executive within the 45-day processing period that
additional time is needed. The notice will specify the circumstances requiring
the extension and the date a decision can be expected. The extension notice
will also: (a) explain the standards for approving a Disability claim; (b) state
the unresolved issue(s) that prevent the Company from reaching a decision;
and (c) describe any additional information needed to resolve the
issue(s). If the Company requests the Executive to provide additional
information so it can process the claim, the Executive will be given at least
45 days in which to provide the information. Otherwise, the initial extension
cannot exceed 30 days. If circumstances require further extension, the Company
will notify the Executive before the end of the initial 30-day extension. The
notice will specify the circumstances requiring the further extension and the
date a decision can be expected. In no event will a decision be postponed
beyond an additional 30 days after the end of the first 30-day extension. If
the Disability claim is denied based on an internal rule, guideline, protocol,
or other similar provision, in addition to the notice provisions 


 


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described in this section, the Company’s
notice will provide that a copy of such rule, guideline, protocol or other
similar provision is available upon request and free of charge. The notice will
also identify any medical or vocational experts consulted on the claim. The
Executive may obtain reasonable access to, and copies of, all documents,
records, and other information relevant to the claim for benefits and may
request, in writing, a list of medical or vocational experts consulted.


 


8.4.                              Review of a Denied Disability Claim. The
Executive may request a review of the Company’s decision regarding a Disability
claim within 180 days after receipt of the denial of the Disability claim. This
request must be in writing and addressed to the Company. The Executive may, but
is not required to, submit written comments, documents, records and other
information relating to the claim for benefits. The review will take into
account any such comments, documents, records and other information submitted
by the Executive relating to the claim, without regard to whether such
information was submitted or considered in the initial benefit determination.
The review will be conducted by a Company official different from the Company
official who originally denied the claim. This Company official cannot be a
subordinate of the Company official who originally denied the claim. If the
original denial of the claim was based on a medical judgment, the reviewing
Company official will consult with an appropriate health care professional who
was not consulted on the original claim and who is not subordinate to someone
who was. The Executive will receive notice of the reviewing Company’s final
decision regarding the Disability claim within 45 days of the request for
review.


 


8.5.                              Deadline to File Claim. To be considered timely under the
claims procedures, a claim must be filed under Section 8.1 or 8.3 within
one year after the claimant knew or reasonably should have known of the
principal facts upon which the claim is based. Knowledge of all facts that the
Executive knew or reasonably should have known shall be imputed to the claimant
for the purpose of applying this deadline.


 


8.6.                              Exhaustion of Administrative Remedies. The
exhaustion of the claims procedures is mandatory for resolving every claim and
dispute arising under this Agreement. As to such claims and disputes: (a) No
claimant shall be permitted to commence any legal action to recover benefits or
to enforce or clarify rights under the Agreement under Section 502 or Section 510
of ERISA or under any other provision of law, whether or not statutory, until
the claims procedures have been exhausted in their entirety; and (b) In
any such legal action all explicit and all implicit determinations by the
Company and Company officials (including, but not limited to, determinations as
to whether the claim, or a request for a review of a denied claim, was timely
filed) shall be afforded the maximum deference permitted by law.


 


8.7.                              Deadline to File Legal Action. No legal
action to recover benefits or to enforce or clarify rights under the Agreement
under Section 502 or Section 510 of ERISA or under any other
provision of law, whether or not statutory, may be brought by any claimant on
any matter pertaining to this Agreement unless the legal action is commenced in
the proper forum before the earlier of: (a) 30 months after the claimant
knew or reasonably should have known of the principal facts on which the claim
is based, or (b) six months 


 


8

















 


after the claimant has exhausted the claims
procedure under this Agreement. Knowledge of all facts that the Executive knew
or reasonably should have known shall be imputed to every claimant who is or
claims to be a beneficiary of the Executive or otherwise claims to derive an
entitlement by reference to the Executive for the purpose of applying the
previously specified periods.


 


8.8.                              Company Discretion; Court Review. The
Company and all persons determining or reviewing claims have full discretion to
determine benefit claims under the Agreement. Any interpretation, determination
or other action of such persons shall be subject to review only if it is
arbitrary or capricious or otherwise an abuse of discretion. Any review of a
final decision or action of the persons reviewing a claim shall be based only
on such evidence presented to or considered by such persons at the time they
made the decision that is the subject of review.


 


Article 9

Amendments and Termination


 


The Company
may amend or terminate this Agreement at any time prior to the Executive’s
Termination of Employment by written notice to the Executive. In no event shall
this Agreement be terminated without payment to the Executive of the Deferral
Account balance attributable to the Executive’s deferrals and interest credited
on such amounts, except as provided in Section 7.1. To the extent
consistent with Section 409A of the Code, distribution shall be made in a
lump sum on the first day following the one year anniversary of the termination
of this Agreement.


 


Article 10

Miscellaneous


 


10.1.                        Binding Effect. This Agreement shall bind the Executive
and the Company, and their beneficiaries, survivors, executors, administrators
and transferees.


 


10.2.                        No Guarantee of Employment. This Agreement is not an employment
policy or contract. It does not give the Executive the right to remain an employee
of the Company, nor does it interfere with the Company’s right to discharge the
Executive. It also does not require the Executive to remain an employee nor
interfere with the Executive’s right to terminate employment at any time.


 


10.3.                        Non-Transferability. Benefits under this Agreement cannot be
sold, transferred, assigned, pledged, attached or encumbered in any manner.


 


10.4.                        Tax Withholding. The Company shall withhold any taxes
that are required to be withheld from the benefits provided under this Agreement.


 


10.5.                        Applicable Law. The Agreement and all rights hereunder
shall be governed by the laws of South Dakota, except to the extent preempted
by the laws of the United States of America. It is the intent of the parties
that this Agreement be construed to avoid the income inclusion and tax
penalties described in Section 409A of the Code. This Agreement shall be
interpreted in a manner consistent with that intent.


 


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10.6.   Unfunded Arrangement. The Executive 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
such benefits. The rights to benefits are not subject in any manner to
anticipation, alienation, sale, transfer, assignment, pledge, encumbrance,
attachment, or garnishment by creditors. Any insurance on the Executive’s life
is a general asset of the Company to which the Executive and beneficiary have
no preferred or secured claim.


 


10.7.   Reorganization. The Company shall not merge or consolidate
into or with another company, or reorganize, or sell substantially all of its
assets to another company, firm, or person unless such succeeding or continuing
company, firm, or person agrees to assume and discharge the obligations of the
Company under this Agreement.


 


10.8.   Entire Agreement. This Agreement constitutes the entire
agreement between the Company and the Executive as to the subject matter hereof.
No rights are granted to the Executive by virtue of this Agreement other than
those specifically set forth herein.


 


10.9.   Administration. The Company shall have powers which are
necessary to administer this Agreement, including but not limited to:


 


10.9.1           Interpreting the provisions of the
Agreement;


 


10.9.2           Establishing and revising the method of
accounting for the Agreement;


 


10.9.3           Maintaining a record of benefit payments;
and


 


10.9.4           Establishing rules and prescribing any
forms necessary or desirable to administer the Agreement.


 


10.10. Plan Administrator. For purposes of the Employee Retirement
Income Security Act of 1974, if applicable, the Company shall be the plan
administrator under the Agreement. The plan administrator may delegate to
others certain aspects of the management and operation responsibilities of the
plan including the employment of advisors and the delegation of ministerial
duties to qualified individuals.


 


IN WITNESS WHEREOF, the Executive and a duly
authorized Company officer have signed this Agreement.


 


	
  EXECUTIVE:

  	
  COMPANY:

  Home Federal Bank  

  
	
   

  	
   

  
	
   

  	
   

  
	
  /s/ Curtis L. Hage

  	
   

  	
  By 

  	
  /s/ Mary F. Hitzemann

  
	
   

  	
  Title

  	
  Senior Vice President/Human Resources

  
				



 


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EXHIBIT 1 -
DEFERRAL ELECTION


 


HOME FEDERAL
BANK


 


AMENDED AND
RESTATED

DEFERRED COMPENSATION AGREEMENT


 


I elect to
defer my Compensation received under the Amended and Restated Deferred
Compensation Agreement with the Company, as follows:


 


	
  Amount of Deferral

  	
   

  	
  Duration

  
	
  [Initial and Complete one]  

  	
   

  	
  [Initial One]  

  
	
   

  	
   

  	
   

  
	
  o

  	
  I elect to defer    % of Compensation per payroll
  period 

  	
   

  	
  o This Year only

  o For
       Years [Insert Number of Year]

  
	
  o

  	
  I elect to defer $   of all Compensation paid to me
  per payroll period.

  	
   

  	
  o Until the Normal Retirement
  Date

  o Until I separate
  from service

  
	
  o

  	
  I elect not to defer any of my Compensation.

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  



I understand
that I may change the amount and duration of my deferrals by filing a new
election form with the Company; provided, however, that any subsequent election
will not be effective until the calendar year following the calendar year in
which the new election is received by the Company, unless the subsequent
election is required or permitted under Code Section 409A.


 


	
  Signature Date

  	
   

  	
   

  
	
  Date

  	
   

  	
   

  



 


Accepted by
the Company this          day of
                                    ,
200    .


 


	
  By

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Title

  	
   

  	
   

  



 


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BENEFICIARY
DESIGNATION


 


HOME FEDERAL
BANK


 


AMENDED AND
RESTATED

DEFERRED COMPENSATION AGREEMENT


 


I designate
the following as beneficiary of benefits under the Deferred Compensation
Agreement payable following my death:


 


Primary:


 


Contingent:


 


Note:      To
name a trust as beneficiary, please provide the name of the trustee(s) and
the exact date of the trust agreement.


 


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.


 


	
  Signature Date

  	
   

  	
   

  
	
  Date

  	
   

  	
   

  



 


Accepted by
the Company this          day of
                                    ,
200    .


 


	
  By

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Title

  	
   

  	
   

  



 


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