Document:

ex_169872.htm

Exhibit 10.1

 

 

	Purpose	The STI plan provides an annual performance-based cash bonus opportunity for eligible employees. This is intended to achieve a number of goals including:
	 	 	 
	
			 

				●	
			Emphasizing the Company’s commitment to competitive compensation practices;

			
	 	 	 
	 	●	Driving a high performance culture;
	 	 	 
	 	●	Assuring accountability;
	 	 	 
	 	●	Focusing on results, not activity; and
	 	 	 
	 	●	Reinforcing the importance of measurable and aligned goals and objectives.
	 	 	 
	
			Eligibility

				
			These guidelines apply to Executive Officers.

			 

			To receive payment under the STI Plan, the participant must be actively employed as of November 30.

			
	 	 
	 	 
	Plan Design	The plan design is based on the following financial metrics.
	 	 	 
	 	●	EBITDA
	 	●	Net Revenue
	 	●	Earnings Per Share
	 	 	 
	 	 	 
	 	Each participant’s plan design will be based on the participant’s position. Details of the design are as follows:
	 	 	 
	 	●	Corporate/Global

 

	 	
			Weighting Per Metric

				 
	 	
			EPS

				
			HBF Net

			Revenue

				
			HBF EBITDA

				 
	 	
			30%

				
			35%

				
			35%

				 

 

	
			 

				●	
			Operating Segment 

			

 

	 	
			Weighting Per Metric

				 
	 	
			EPS

				
			Operating

			Segment Net

			Revenue

				
			Operating Segment

			EBITDA

				 
	 	
			30%

				
			35%

				
			35%

				 

 

Page 1 of 6

 

 

 

 

	 	Target
	
			 

				●	Each metric will have a target level of performance. Payout will be determined for each metric based on performance relative to target. The target levels of performance will be established at the beginning of each fiscal year.
	 	 	 	 
	 	Threshold
	 	●	Threshold performance levels will be established for each metric as follows:
	 	 	o	Net Revenue: 90% of target
	 	 	o	EBITDA: 80% of target
	 	 	o	EPS: 80% of target
	 	 	 	 
	 	●	Payout at the threshold level of performance will be 50% of the target allocated to that metric.
	 	 	 	 
	 	Superior
	 	●	Superior performance levels will be established for each metric as follows:
	 	 	o	Net Revenue: 110% of target
	 	 	o	EBITDA: 120% of target
	 	 	o	EPS: 120% of target
	 	 	 	 
	 	●	Payout at the superior level of performance will be 200% of the target allocated to that metric.
	 	 	 
	 	 	 
	 	See Appendix for payout schedule.
	 	 
	Payment	
			Payment will be made in cash, subject to taxes and deductions as applicable.

			Payment will be made as close as possible to January 31 following the conclusion of the relevant Plan Year, but will be made no later than March 15th of the calendar year following the Plan Year.

			
	 	 
	Participant Status Changes	
			If a participant begins employment with the company during the Plan Year, bonus potential will be pro-rated for the time the participant was employed during the Plan Year.

			 

			If a participant transfers jobs and changes plan design standards, potential bonus will be pro-rated for the time spent in each job.

			
	 	 
	Administration	
			Participants may direct questions about the STI Plan to their local management or human resources representatives.

			 

			The Compensation Committee of the Board of Directors shall make a certification decision with respect to performance of financial metrics and consider extraordinary circumstances that may have positively or negatively impacted the achievement of the objectives. The Board or management in their discretion, reserves the right at any time to enhance, diminish or terminate all or any portion of any compensation plan or program, on a collective or individual basis; provided.

			

 

Page 2 of 6

 

	 	 	 
	Relevant Terms	
			Actively Employed - A full-time or part-time employee on the Company payroll. It excludes any employee who has been terminated from employment with the Company – voluntarily or involuntarily –prior to November 30.

			 

			Company - H.B. Fuller Company and its wholly owned subsidiaries.

			 

			Eligible Earnings – To be determined by region/country.

			 

			Payment - The cash reward payable after conclusion of the Plan Year.

			 

			Plan Year – The relevant Company fiscal year.

			 

			Short Term Incentive (STI) Plan - The program described herein. May also be referred to as “STIP” or “STI Plan”.

			

 

Page 3 of 6

 

 

	Appendix

	
			STIP Payment Schedule for EPS,

				
			 

				
			STIP Payment schedule for 

			
	
			EBITDA

				
			 

				
			 

				
			Net Revenue

				
			 

			
	
			Metric Performance

				
			Payout (as % of target)

				
			 

				
			Metric Performance

				
			Payout (as % of target)

			
	
			120%

				
			200.0%

				
			 

				
			110%

				
			200%

			
	
			119%

				
			195.0%

				
			 

				
			109%

				
			190%

			
	
			118%

				
			190.0%

				
			 

				
			108%

				
			180%

			
	
			117%

				
			185.0%

				
			 

				
			107%

				
			170%

			
	
			116%

				
			180.0%

				
			 

				
			106%

				
			160%

			
	
			115%

				
			175.0%

				
			 

				
			105%

				
			150%

			
	
			114%

				
			170.0%

				
			 

				
			104%

				
			140%

			
	
			113%

				
			165.0%

				
			 

				
			103%

				
			130%

			
	
			112%

				
			160.0%

				
			 

				
			102%

				
			120%

			
	
			111%

				
			155.0%

				
			 

				
			101%

				
			110%

			
	
			110%

				
			150.0%

				
			 

				
			100%

				
			100%

			
	
			109%

				
			145.0%

				
			 

				
			99%

				
			95%

			
	
			108%

				
			140.0%

				
			 

				
			98%

				
			90%

			
	
			107%

				
			135.0%

				
			 

				
			97%

				
			85%

			
	
			106%

				
			130.0%

				
			 

				
			96%

				
			80%

			
	
			105%

				
			125.0%

				
			 

				
			95%

				
			75%

			
	
			104%

				
			120.0%

				
			 

				
			94%

				
			70%

			
	
			103%

				
			115.0%

				
			 

				
			93%

				
			65%

			
	
			102%

				
			110.0%

				
			 

				
			92%

				
			60%

			
	
			101%

				
			105.0%

				
			 

				
			91%

				
			55%

			
	
			100%

				
			100.0%

				
			 

				
			90%

				
			50%

			
	
			99%

				
			97.5%

				
			 

				
			 

				
			 

			
	
			98%

				
			95.0%

				
			 

				
			 

				
			 

			
	
			97%

				
			92.5%

				
			 

				
			 

				
			 

			
	
			96%

				
			90.0%

				
			 

				
			 

				
			 

			
	
			95%

				
			87.5%

				
			 

				
			 

				
			 

			
	
			94%

				
			85.0%

				
			 

				
			 

				
			 

			
	
			93%

				
			82.5%

				
			 

				
			 

				
			 

			
	
			92%

				
			80.0%

				
			 

				
			 

				
			 

			
	
			91%

				
			77.5%

				
			 

				
			 

				
			 

			
	
			90%

				
			75.0%

				
			 

				
			 

				
			 

			
	
			89%

				
			72.5%

				
			 

				
			 

				
			 

			
	
			88%

				
			70.0%

				
			 

				
			 

			
	
			87%

				
			67.5%

				
			 

				
			 

			
	
			86%

				
			65.0%

				
			 

				
			 

			
	
			85%

				
			62.5%

				
			 

				
			 

			
	
			84%

				
			60.0%

				
			 

				
			 

			
	
			83%

				
			57.5%

				
			 

				
			 

				
			 

			
	
			82%

				
			55.0%

				
			 

				
			 

				
			 

			
	
			81%

				
			52.5%

				
			 

				
			 

				
			 

			
	
			80%

				
			50.0%

				
			 

				
			 

				
			 

			

 

 

	 	●	Payout is calculated for each incremental increase in performance (straight line interpolation).

 

Page 4 of 6

 

 

Calculation Guidelines

 

	 	
			Total Company Metrics

			Company EPS   

			The adjusted EPS as disclosed in the Company’s quarterly earnings release.

			 

			HBF Net Revenue

			
	 	
			 

				●	
			The adjusted reported revenue as disclosed in the Company’s quarterly earnings release is adjusted for currency impact compared to budgeted exchange rates.

			
	 	 	 	 
	 	
			 

				●	
			Unbudgeted acquisitions and divestitures are excluded from the calculation.

			
	 	 	 	 
	 	HBF EBITDA (Consolidated)
	 	
			 

				●	
			Adjusted Net Income plus Income Tax Expense plus Interest Expense, net, plus Depreciation Expense plus Amortization Expense

			
	 	 	 	 
	 	 	●	Unbudgeted acquisitions and divestitures are excluded from the calculation.
	 	 	 	 
	 	
			Operating Segment Metrics

			Net Revenue

			
	 	
			 

				●	
			Total company adjustments are transferred down to the region/operating segment revenue which is impacted by the adjustments, unless not approved by the CEO.

			
	 	 	 	 
	 	
			 

				●	
			Basis of targets is US dollars. The budgeted exchange rates will be used to assess performance.

			
	 	 	 	 
	 	
			 

				●	
			Unbudgeted acquisitions and divestitures are excluded from the calculation.

			
	 	 	 	 
	 	Fully allocated EBITDA
	 	
			 

				●	
			Adjusted Gross Profit minus Adjusted SG&A expenses plus Depreciation Expense and Amortization Expense

			
	 	 	 	 
	 	
			 

				●	
			EBITDA targets include corporate governance allocation at budget. In determining performance, actual corporate governance allocations will be used.

			
	 	 	 	 
	 	
			 

				●	
			Total company adjustments are transferred down to the region/operating segment EBITDA which is impacted by the adjustments, unless not approved by the CEO.

			
	 	 	 	 
	 	
			 

				●	
			Basis of targets is US dollars. The budgeted exchange rates will be used to assess performance.

			
	 	 	 	 
	 	
			 

				●	
			Unbudgeted acquisitions and divestitures are excluded from the calculation.

			

 

Page 5 of 6

 

 

 

 

	 	
			Adjustments

			In calculating the results, the following adjustments will be made:

			
	 	 	a.	Individual legal settlements (payments or receipts) with a value (net of insurance) of $3 million or greater will not be included in metric calculations.
	 	 	b.	Any unbudgeted reorganization or restructuring-related items which cannot be offset by related benefits in the fiscal year will not be included in metric calculations.
	 	 	c.	Any unbudgeted asset write-downs in excess of $2 million will not be included in metric calculations.
	 	 	d.	Adjustments needed to (1) correct any inadvertent errors or miscalculations made in setting a performance target for our key markets (such as Hygiene, Packaging, or Durable Assembly) or (2) account for changes resulting from new accounting definitions, requirements or pronouncements.
	 	 	e.	Other items as publicly disclosed in the Company’s quarterly earnings release. However, the above adjustments (a-d) will not be made to the extent they are inconsistent with publicly disclosed earnings.
	 	 	 	 
	 	Any discretion related to total company adjustments transferred to the operating segment exercised by the CEO requires approval by the Compensation Committee of the Board of Directors.

 

Page 6 of 6Index Options Contract Schedule

          

    

    

    Owner: [John Doe] Contract Number:                                                                   
        [??687456]

    [Joint Owner:                                      [Jane Doe]] Issue Date: [04/15/10]

    Annuitant:                                           [John Doe] Scheduled Annuity Date:                                                    [04/15/65]

    

    

    

    

    Allocation Guidelines:

    [1. Currently, you can select up to [5] of the Index Protection Strategy Index Options.

    2. Currently, you can select up to [5] of the Index Performance Strategy Index Options.

    3. Currently, you can select up to [5] of the Index Guard Strategy Index Options.

    4. Currently, you can select up to [5] of the Index Precision Strategy Index Options.

    5. Currently, you can select up to a maximum of [15] Index Options.

    6. Allocations must be made in whole percentages.]

    

    

    Index Options:

    [Index Protection Strategy Index Options

    	
            Index

          	
            Minimum Declared Protection Strategy Credit for all Index Years

          	
            Term

          
	
            [S&P 500® Index

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Nasdaq-100® Index

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Russell 2000® Index

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [EURO STOXX 50®

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [iShares® MSCI Emerging Markets ETF

          	
            [1.50]%

          	
            [1 Index Year]]]

          

    

    

    [Index Performance Strategy Index Options

    	
            Index

          	
            Buffer for all Terms

          	
            Minimum Cap for all Terms

          	
            Term

          
	
            [S&P 500® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Nasdaq-100® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Russell 2000® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [EURO STOXX 50®

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [iShares® MSCI Emerging Markets ETF

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [S&P 500® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [3 Index Years]]

          
	
            [Nasdaq-100® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [3 Index Years]]

          
	
            [Russell 2000® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [3 Index Years]]

          
	
            [EURO STOXX 50®

          	
            [10.00]%

          	
            [1.50]%

          	
            [3 Index Years]]

          
	
            [iShares® MSCI Emerging Markets ETF

          	
            [10.00]%

          	
            [1.50]%

          	
            [3 Index Years]]]

          

    
      
        S40877-ADV-04                                                                               [Admin. Tracking Number]

      

      
        

      

    

    

    

    	
            Index Options Contract
                Schedule continued from the
                previous page

          

    [Index Guard Strategy Index Options

    	
            Index

          	
            Floor for all Index Years

          	
            Minimum Cap for all Index Years

          	
            Term

          
	
            [S&P 500® Index

          	
            [-10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Nasdaq-100® Index

          	
            [-10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Russell 2000® Index

          	
            [-10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [EURO STOXX 50®

          	
            [-10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [iShares® MSCI Emerging Markets ETF

          	
            [-10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]]

          

    

    

    

    

    

    

    

    

    [Index Precision Strategy Index Options

    	
            Index

          	
            Buffer for all Index Years

          	
            Minimum Precision Rate for all Index Years

          	
            Term

          
	
            [S&P 500® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Nasdaq-100® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [Russell 2000® Index

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [EURO STOXX 50®

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]

          
	
            [iShares® MSCI Emerging Markets ETF

          	
            [10.00]%

          	
            [1.50]%

          	
            [1 Index Year]]]

          

    

    

    The indexes do not reflect the dividends paid on the stocks underlying the market indexes.

    
      
        S40877-ADV-04                                                                           [Admin. Tracking Identifier]

      

      
        

      

    

    

    

    	
            Index Options Contract
                Schedule continued from the
                previous page

          

    

    

    Changes to an Index

    We will send notice to you and any assignee of record at your last known address if we add an Index. We will send notice to you
      and any assignee of record at your last known address if we substitute an Index, and any portion of your Contract Value is allocated to the Index being substituted. An Index may be substituted with a new Index because:

    • the Index is discontinued;

    
      	
              •

            	
              we are unable to use the Index because changes to the Index make it impractical or expensive to purchase derivative
                securities to hedge the Index;

            

    

    • we are not licensed to use the Index; or

    
      	
              •

            	
              if the method of calculation of the Index values changes substantially resulting in significantly different
                performance results.

            

    

    We will seek regulatory approval prior to substituting an Index. If an Index is renamed, we will send notice of the new name to you and any
      assignee of record at your last known address.

    

    

    [The S&P 500® Index is comprised of 500 stocks representing major U.S. industrial sectors.

    

    

    S&P® is a registered trademark of Standard & Poor’s Financial Services LLC (“S&P”). This trademark has been licensed for use by
      S&P Dow Jones Indices LLC. S&P marks are trademarks of S&P. These trademarks have been sublicensed for certain purposes by Allianz Life Insurance Company of North America (“Allianz”). The S&P 500® Index (“the Index”) is a product of
      S&P Dow Jones Indices LLC and/or its affiliates and have been licensed for use by Allianz.

    

    

    Allianz products are not sponsored, endorsed, sold, or promoted by S&P Dow Jones Indices LLC, Dow Jones, S&P, or any of their
      respective affiliates (collectively, “S&P Dow Jones Indices”). S&P Dow Jones Indices make no representation or warranty, express or implied, to the owners of the Allianz products or any member of the public regarding the advisability of
      investments generally or in Allianz products particularly or the ability of the Index and Average to track general market performance. S&P Dow Jones Indices’ only relationship to Allianz with respect to the Index and Average is the licensing of
      the Index and Average and certain trademarks, service marks, and/or trade names of S&P Dow Jones Indices and/or its third-party licensors. The Index and Average are determined, composed, and calculated by S&P Dow Jones Indices without regard
      to Allianz or the products. S&P Dow Jones Indices have no obligation to take the needs of Allianz or the owners of the products into consideration in determining, composing, or calculating the Index and Average. S&P Dow Jones Indices are not
      responsible for and have not participated in the design, development, pricing, and operation of the products, including the calculation of any interest payments or any other values credited to the products. S&P Dow Jones Indices have no
      obligation or liability in connection with the administration, marketing, or trading of products. There is no assurance that investment products based on the Index and Average will accurately track index performance or provide positive investment
      returns. S&P Dow Jones Indices LLC and its subsidiaries are not investment advisors. Inclusion of a security or futures contract within an index is not a recommendation by S&P Dow Jones Indices to buy, sell, or hold such security or futures
      contract, nor is it considered to be investment advice. Notwithstanding the foregoing, CME Group Inc. and its affiliates may independently issue and/or sponsor financial products unrelated to products currently being issued by Allianz, but which may
      be similar to and competitive with Allianz products. In addition, CME Group Inc., an indirect minority owner of S&P Dow Jones Indices LLC, and its affiliates may trade financial products which are linked to the performance of the Index and
      Average. It is possible that this trading activity will affect the value of the products.

    

    

    S&P DOW JONES INDICES DO NOT GUARANTEE THE ADEQUACY, ACCURACY, TIMELINESS, AND/OR THE COMPLETENESS OF THE INDEX AND AVERAGE OR ANY DATA
      RELATED THERETO OR ANY COMMUNICATION, INCLUDING BUT NOT LIMITED TO, ORAL OR WRITTEN COMMUNICATION (INCLUDING ELECTRONIC COMMUNICATIONS) WITH RESPECT THERETO. S&P DOW JONES INDICES SHALL NOT BE SUBJECT TO ANY DAMAGES OR LIABILITY FOR ANY ERRORS,
      OMISSIONS, OR DELAYS THEREIN. S&P DOW JONES INDICES

    

    

    MAKE NO EXPRESS OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIM ALL WARRANTIES, OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE
      OR AS TO RESULTS TO BE OBTAINED BY ALLIANZ, OWNERS OF THE PRODUCTS, OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE INDEX AND AVERAGE OR WITH RESPECT TO ANY DATA RELATED THERETO. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT WHATSOEVER SHALL
      S&P DOW JONES INDICES BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE, OR CONSEQUENTIAL DAMAGES INCLUDING BUT NOT LIMITED TO, LOSS OF PROFITS, TRADING LOSSES, LOST TIME, OR GOODWILL, EVEN IF THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF
      SUCH DAMAGES, WHETHER IN CONTRACT, TORT, STRICT LIABILITY, OR OTHERWISE. THERE ARE NO THIRD-PARTY BENEFICIARIES OF ANY AGREEMENTS OR ARRANGEMENTS BETWEEN S&P DOW JONES INDICES AND ALLIANZ OTHER THAN THE LICENSORS OF S&P DOW JONES INDICES.]

    
      
        S40877-ADV-04                                                                           [Admin. Tracking Identifier]

      

      
        

      

    

    

    

    	
            Index Options Contract
                Schedule continued from the
                previous page

          

    

    

    [The NASDAQ-100 Index® includes 100 of the largest domestic and international non-financial securities listed on The NASDAQ Stock Market®
      based on market capitalization.

    

    

    The Product(s) is not sponsored, endorsed, sold or promoted by Nasdaq, Inc. or its affiliates (Nasdaq, with its affiliates, are referred to
      as the “Corporations”).  The Corporations have not passed on the legality or suitability of, or the accuracy or adequacy of descriptions and disclosures relating to, the Product(s).  The Corporations make no representation or warranty, express or
      implied to the owners of the Product(s) or any member of the public regarding the advisability of investing in securities generally or in the Product(s) particularly, or the ability of the Nasdaq-100 Index® to track general stock market performance. 
      The Corporations' only relationship to Allianz Life Insurance Company of North America (“Licensee”) is in the licensing of the NASDAQ®, and Nasdaq-100 Index® registered trademarks, and certain trade names of the Corporations and the use of the
      Nasdaq-100 Index® which is determined, composed and calculated by NASDAQ without regard to Licensee or the Product(s).  Nasdaq has no obligation to take the needs of the Licensee or the owners of the Product(s) into consideration in determining,
      composing or calculating the Nasdaq-100 Index®.  The Corporations are not responsible for and have not participated in the determination of the timing of, prices at, or quantities of the Product(s) to be issued or in the determination or calculation
      of the equation by which the Product(s) is to be converted into cash.  The Corporations have no liability in connection with the administration, marketing or trading of the Product(s).

    

    

    THE CORPORATIONS DO NOT GUARANTEE THE ACCURACY AND/OR UNINTERRUPTED CALCULATION OF THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  THE
      CORPORATIONS MAKE NO WARRANTY, EXPRESS OR IMPLIED, AS TO RESULTS TO BE OBTAINED BY LICENSEE, OWNERS OF THE PRODUCT(S), OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  THE CORPORATIONS MAKE NO EXPRESS
      OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIM ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE WITH RESPECT TO THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT SHALL
      THE CORPORATIONS HAVE ANY LIABILITY FOR ANY LOST PROFITS OR SPECIAL, INCIDENTAL, PUNITIVE, INDIRECT, OR CONSEQUENTIAL DAMAGES, EVEN IF NOTIFIED OF THE POSSIBILITY OF SUCH DAMAGES.]

    

    

    [The Russell 2000® Index is an equity index that measures the performance of the 2,000 smallest companies in the Russell 3000® Index, which
      is made up of 3, 000 of the biggest U.S. stocks.  The Russell 2000® Index is constructed to provide a comprehensive and unbiased small-cap barometer and is completely reconstituted annually to ensure larger stocks do not affect the performance and
      characteristics of the true small-cap index.

    

    

    The Russell 2000® Index (the “Index”) is a trademark of Frank Russell Company (“Russell”) and has been licensed for use by Allianz Life
      Insurance Company of North America (“Allianz”). Allianz products are not in any way sponsored, endorsed, sold or promoted by Russell or the London Stock Exchange Group companies (“LSEG”) (together the “Licensor Parties”) and none of the Licensor
      Parties make any claim, prediction, warranty or representation whatsoever, expressly or impliedly, either as to (i) the results to be obtained from the use of the Index (upon which the Allianz product is based), (ii) the figure at which the Index is
      said to stand at any particular time on any particular day or otherwise, or (iii) the suitability of the Index for the purpose to which it is being put in connection with the Allianz product. None of the Licensor Parties have provided or will provide
      any financial or investment advice or recommendation in relation to the Index to Allianz or to its clients. The Index is calculated by Russell or its agent. None of the Licensor Parties shall be (a) liable (whether in negligence or otherwise) to any
      person for any error in the Index or (b) under any obligation to advise any person of any error therein.]

    
      
        S40877-ADV-04                                                                           [Admin. Tracking Identifier]

      

      
        

      

    

    

    

    

    

    	
            Index Options Contract
                Schedule  continued from the previous page

          

    

    

    [The EURO STOXX 50®, Europe's leading Blue-chip index for the Eurozone, provides a blue-chip representation of supersector leaders in the
      Eurozone.  The index covers 50 stocks from 12 Eurozone countries: Austria, Belgium, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal and Spain.

    

    

    STOXX Limited, Deutsche Börse Group and their licensors, research partners or data providers have no relationship to Allianz Life Insurance
      Company of North America (“Allianz”), other than the licensing of the EURO STOXX 50® and the related trademarks for use in connection with Allianz products.

    STOXX, Deutsche Börse Group and their licensors, research partners or data providers do not:

    • sponsor, endorse, sell or promote Allianz products.

    • recommend that any person invest in Allianz products or any other securities.

    • have any responsibility or liability for or make any decisions about the timing, amount or pricing of Allianz products.

    • have any responsibility or liability for the administration, management or marketing of Allianz products.

    • consider the needs of Allianz products or the owners of Allianz products in determining, composing or calculating the EURO STOXX 50 or have
      any obligation to do so.

    STOXX, Deutsche Börse Group and their licensors, research partners or data providers give no warranty, and exclude any
      liability (whether in negligence or otherwise), in connection with the Allianz products or their performance.

    STOXX does not assume any contractual relationship with the purchasers of Allianz products or any other third parties.

    Specifically,

    • STOXX, Deutsche Börse Group and their licensors, research partners or data providers do not give any warranty, express or implied, and
      exclude any liability about:

    • The results to be obtained by Allianz products, the owner of Allianz products or any other person in connection with the use of the EURO
      STOXX 50 and the data included in the EURO STOXX 50;

    • The accuracy, timeliness, and completeness of the EURO STOXX 50 and its data;

    • The merchantability and the fitness for a particular purpose or use of the EURO STOXX 50 and its data;

    • The performance of Allianz products generally.

    • STOXX, Deutsche Börse Group and their licensors, research partners or data providers give no warranty and exclude any liability, for any
      errors, omissions or interruptions in the EURO STOXX 50 or its data;

    • Under no circumstances will STOXX, Deutsche Börse Group or their licensors, research partners or data providers be liable (whether in
      negligence or otherwise) for any lost profits or indirect, punitive, special or consequential damages or losses, arising as a result of such errors, omissions or interruptions in the [relevant index] or its data or generally in relation to Allianz
      products, even in

    circumstances where STOXX, Deutsche Börse Group or their licensors, research partners or data providers are aware that such loss or damage
      may occur.

    

    

    The licensing Agreement between Allianz and STOXX is solely for their benefit and not for the benefit of the owners of Allianz products or
      any other third parties.]

    

    

    [The iShares® MSCI Emerging Markets ETF distributed by BlackRock Investments, LLC. iShares®, BLACKROCK®, and the corresponding logos are
      registered trademarks of BlackRock, Inc. and its affiliates (“BlackRock”) and are used under license. These trademarks have been licensed for certain purposes by Allianz Life Insurance Company of North America ("Allianz") and its wholly-owned
      subsidiaries. Products offered by Allianz or its wholly-owned subsidiaries are not sponsored, endorsed, sold or promoted by BlackRock, and purchasers of such products do not acquire any interest in the iShares® MSCI Emerging Markets ETF  nor enter
      into any relationship of any kind with BlackRock. BlackRock makes no representations or warranties, express or implied, to the owners of any products offered by Allianz or its wholly-owned subsidiaries, or any member of the public regarding the
      advisability of purchasing a product from Allianz or its wholly-owned subsidiaries. BlackRock has no obligation or liability for any errors, omissions, interruptions or use of the iShares MSCI Emerging Markets ETF or any data related thereto, or with
      the operation, marketing, trading or sale of any products or services offered by Allianz  and its wholly-owned subsidiaries.]

    

    

    
      S40877-ADV-04                                                                           [Admin. Tracking Identifier]

       

        

       

        

       

      

    

      

      

      	
              Index Options Contract Schedule Addendum

            

      

      

      Owner: [John Doe] Contract Number: [??687456]

      [Joint Owner: [Jane Doe]] Issue Date: [04/15/10]

      Annuitant: [John Doe] Scheduled Annuity Date: [04/15/65]

      

      

      

      

      Allocation Guidelines:

      [1. Currently, you can select up to [5] of the Index Performance Strategy II Index Options.

      2. Currently, you can select up to a maximum of [15] Index Options.

      3. Allocations must be made in whole percentages.]

      

      

      The following is added to your Index Options shown on your Index Options Contract Schedule.

      

      

      Index Options:

      [Index Performance Strategy II Index Options

      	
              Index

            	
              Buffer for all Terms

            	
              Minimum Cap for all Terms

            	
              Term

            
	
              [S&P 500® Index

            	
              [10.00]%

            	
              [1.50]%

            	
              [3 Index Years]]

            
	
              [Nasdaq-100® Index

            	
              [10.00]%

            	
              [1.50]%

            	
              [3 Index Years]]

            
	
              [Russell 2000® Index

            	
              [10.00]%

            	
              [1.50]%

            	
              [3 Index Years]]

            
	
              [EURO STOXX 50®

            	
              [10.00]%

            	
              [1.50]%

            	
              [3 Index Years]]

            
	
              [iShares® MSCI Emerging Markets ETF

            	
              [10.00]%

            	
              [1.50]%

            	
              [3 Index Years]]]

            

      

      

      The indexes do not reflect the dividends paid on the stocks underlying the market indexes.

      
        
          S40877-ADD                                                                               [Admin. Tracking Number]

        

        
          

        

      

      

      

      	
              Index Options Contract
                  Schedule Addendum continued
                  from the previous page

            

      

      

      [The S&P 500® Index is comprised of 500 stocks representing major U.S. industrial sectors.

      

      

      S&P® is a registered trademark of Standard & Poor’s Financial Services LLC (“S&P”). This trademark has been licensed for use by
        S&P Dow Jones Indices LLC. S&P marks are trademarks of S&P. These trademarks have been sublicensed for certain purposes by Allianz Life Insurance Company of North America (“Allianz”). The S&P 500® Index (“the Index”) is a product of
        S&P Dow Jones Indices LLC and/or its affiliates and have been licensed for use by Allianz.

      

      

      Allianz products are not sponsored, endorsed, sold, or promoted by S&P Dow Jones Indices LLC, Dow Jones, S&P, or any of their
        respective affiliates (collectively, “S&P Dow Jones Indices”). S&P Dow Jones Indices make no representation or warranty, express or implied, to the owners of the Allianz products or any member of the public regarding the advisability of
        investments generally or in Allianz products particularly or the ability of the Index and Average to track general market performance. S&P Dow Jones Indices’ only relationship to Allianz with respect to the Index and Average is the licensing of
        the Index and Average and certain trademarks, service marks, and/or trade names of S&P Dow Jones Indices and/or its third-party licensors. The Index and Average are determined, composed, and calculated by S&P Dow Jones Indices without
        regard to Allianz or the products. S&P Dow Jones Indices have no obligation to take the needs of Allianz or the owners of the products into consideration in determining, composing, or calculating the Index and Average. S&P Dow Jones Indices
        are not responsible for and have not participated in the design, development, pricing, and operation of the products, including the calculation of any interest payments or any other values credited to the products. S&P Dow Jones Indices have no
        obligation or liability in connection with the administration, marketing, or trading of products. There is no assurance that investment products based on the Index and Average will accurately track index performance or provide positive investment
        returns. S&P Dow Jones Indices LLC and its subsidiaries are not investment advisors. Inclusion of a security or futures contract within an index is not a recommendation by S&P Dow Jones Indices to buy, sell, or hold such security or futures
        contract, nor is it considered to be investment advice. Notwithstanding the foregoing, CME Group Inc. and its affiliates may independently issue and/or sponsor financial products unrelated to products currently being issued by Allianz, but which
        may be similar to and competitive with Allianz products. In addition, CME Group Inc., an indirect minority owner of S&P Dow Jones Indices LLC, and its affiliates may trade financial products which are linked to the performance of the Index and
        Average. It is possible that this trading activity will affect the value of the products.

      

      

      S&P DOW JONES INDICES DO NOT GUARANTEE THE ADEQUACY, ACCURACY, TIMELINESS, AND/OR THE COMPLETENESS OF THE INDEX AND AVERAGE OR ANY DATA
        RELATED THERETO OR ANY COMMUNICATION, INCLUDING BUT NOT LIMITED TO, ORAL OR WRITTEN COMMUNICATION (INCLUDING ELECTRONIC COMMUNICATIONS) WITH RESPECT THERETO. S&P DOW JONES INDICES SHALL NOT BE SUBJECT TO ANY DAMAGES OR LIABILITY FOR ANY ERRORS,
        OMISSIONS, OR DELAYS THEREIN. S&P DOW JONES INDICES

      

      

      MAKE NO EXPRESS OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIM ALL WARRANTIES, OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE
        OR AS TO RESULTS TO BE OBTAINED BY ALLIANZ, OWNERS OF THE PRODUCTS, OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE INDEX AND AVERAGE OR WITH RESPECT TO ANY DATA RELATED THERETO. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT WHATSOEVER SHALL
        S&P DOW JONES INDICES BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE, OR CONSEQUENTIAL DAMAGES INCLUDING BUT NOT LIMITED TO, LOSS OF PROFITS, TRADING LOSSES, LOST TIME, OR GOODWILL, EVEN IF THEY HAVE BEEN ADVISED OF THE POSSIBILITY
        OF SUCH DAMAGES, WHETHER IN CONTRACT, TORT, STRICT LIABILITY, OR OTHERWISE. THERE ARE NO THIRD-PARTY BENEFICIARIES OF ANY AGREEMENTS OR ARRANGEMENTS BETWEEN S&P DOW JONES INDICES AND ALLIANZ OTHER THAN THE LICENSORS OF S&P DOW JONES
        INDICES.]

      
        
          S40877-ADD                                                                               [Admin. Tracking Number]

        

        
          

        

      

      

      

      	
              Index Options Contract
                  Schedule Addendum continued
                  from the previous page

            

      

      

      [The NASDAQ-100 Index® includes 100 of the largest domestic and international non-financial securities listed on The NASDAQ Stock Market®
        based on market capitalization.

      

      

      The Product(s) is not sponsored, endorsed, sold or promoted by Nasdaq, Inc. or its affiliates (Nasdaq, with its affiliates, are referred to
        as the “Corporations”).  The Corporations have not passed on the legality or suitability of, or the accuracy or adequacy of descriptions and disclosures relating to, the Product(s).  The Corporations make no representation or warranty, express or
        implied to the owners of the Product(s) or any member of the public regarding the advisability of investing in securities generally or in the Product(s) particularly, or the ability of the Nasdaq-100 Index® to track general stock market
        performance.  The Corporations' only relationship to Allianz Life Insurance Company of North America (“Licensee”) is in the licensing of the NASDAQ®, and Nasdaq-100 Index® registered trademarks, and certain trade names of the Corporations and the
        use of the Nasdaq-100 Index® which is determined, composed and calculated by NASDAQ without regard to Licensee or the Product(s).  Nasdaq has no obligation to take the needs of the Licensee or the owners of the Product(s) into consideration in
        determining, composing or calculating the Nasdaq-100 Index®.  The Corporations are not responsible for and have not participated in the determination of the timing of, prices at, or quantities of the Product(s) to be issued or in the determination
        or calculation of the equation by which the Product(s) is to be converted into cash.  The Corporations have no liability in connection with the administration, marketing or trading of the Product(s).

      

      

      THE CORPORATIONS DO NOT GUARANTEE THE ACCURACY AND/OR UNINTERRUPTED CALCULATION OF THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  THE
        CORPORATIONS MAKE NO WARRANTY, EXPRESS OR IMPLIED, AS TO RESULTS TO BE OBTAINED BY LICENSEE, OWNERS OF THE PRODUCT(S), OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  THE CORPORATIONS MAKE NO
        EXPRESS OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIM ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE WITH RESPECT TO THE NASDAQ-100 INDEX® OR ANY DATA INCLUDED THEREIN.  WITHOUT LIMITING ANY OF THE FOREGOING, IN NO
        EVENT SHALL THE CORPORATIONS HAVE ANY LIABILITY FOR ANY LOST PROFITS OR SPECIAL, INCIDENTAL, PUNITIVE, INDIRECT, OR CONSEQUENTIAL DAMAGES, EVEN IF NOTIFIED OF THE POSSIBILITY OF SUCH DAMAGES.]

      

      

      [The Russell 2000® Index is an equity index that measures the performance of the 2,000 smallest companies in the Russell 3000® Index, which
        is made up of 3, 000 of the biggest U.S. stocks.  The Russell 2000® Index is constructed to provide a comprehensive and unbiased small-cap barometer and is completely reconstituted annually to ensure larger stocks do not affect the performance and
        characteristics of the true small-cap index.

      

      

      The Russell 2000® Index (the “Index”) is a trademark of Frank Russell Company (“Russell”) and has been licensed for use by Allianz Life
        Insurance Company of North America (“Allianz”). Allianz products are not in any way sponsored, endorsed, sold or promoted by Russell or the London Stock Exchange Group companies (“LSEG”) (together the “Licensor Parties”) and none of the Licensor
        Parties make any claim, prediction, warranty or representation whatsoever, expressly or impliedly, either as to (i) the results to be obtained from the use of the Index (upon which the Allianz product is based), (ii) the figure at which the Index
        is said to stand at any particular time on any particular day or otherwise, or (iii) the suitability of the Index for the purpose to which it is being put in connection with the Allianz product. None of the Licensor Parties have provided or will
        provide any financial or investment advice or recommendation in relation to the Index to Allianz or to its clients. The Index is calculated by Russell or its agent. None of the Licensor Parties shall be (a) liable (whether in negligence or
        otherwise) to any person for any error in the Index or (b) under any obligation to advise any person of any error therein.]

      
        
          S40877-ADD                                                                               [Admin. Tracking Number]

        

        
          

        

      

      

      

      

      

      	
              Index Options Contract
                  Schedule Addendum  continued from the previous page

            

      

      

      [The EURO STOXX 50®, Europe's leading Blue-chip index for the Eurozone, provides a blue-chip representation of supersector leaders in the
        Eurozone.  The index covers 50 stocks from 12 Eurozone countries: Austria, Belgium, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal and Spain.

      

      

      STOXX Limited, Deutsche Börse Group and their licensors, research partners or data providers have no relationship to Allianz Life Insurance
        Company of North America (“Allianz”), other than the licensing of the EURO STOXX 50® and the related trademarks for use in connection with Allianz products.

      STOXX, Deutsche Börse Group and their licensors, research partners or data providers do not:

      • sponsor, endorse, sell or promote Allianz products.

      • recommend that any person invest in Allianz products or any other securities.

      • have any responsibility or liability for or make any decisions about the timing, amount or pricing of Allianz products.

      • have any responsibility or liability for the administration, management or marketing of Allianz products.

      • consider the needs of Allianz products or the owners of Allianz products in determining, composing or calculating the EURO STOXX 50 or
        have any obligation to do so.

      STOXX, Deutsche Börse Group and their licensors, research partners or data providers give no warranty, and exclude any
        liability (whether in negligence or otherwise), in connection with the Allianz products or their performance.

      STOXX does not assume any contractual relationship with the purchasers of Allianz products or any other third parties.

      Specifically,

      • STOXX, Deutsche Börse Group and their licensors, research partners or data providers do not give any warranty, express or implied, and
        exclude any liability about:

      • The results to be obtained by Allianz products, the owner of Allianz products or any other person in connection with the use of the EURO
        STOXX 50 and the data included in the EURO STOXX 50;

      • The accuracy, timeliness, and completeness of the EURO STOXX 50 and its data;

      • The merchantability and the fitness for a particular purpose or use of the EURO STOXX 50 and its data;

      • The performance of Allianz products generally.

      • STOXX, Deutsche Börse Group and their licensors, research partners or data providers give no warranty and exclude any liability, for any
        errors, omissions or interruptions in the EURO STOXX 50 or its data;

      • Under no circumstances will STOXX, Deutsche Börse Group or their licensors, research partners or data providers be liable (whether in
        negligence or otherwise) for any lost profits or indirect, punitive, special or consequential damages or losses, arising as a result of such errors, omissions or interruptions in the [relevant index] or its data or generally in relation to Allianz
        products, even in

      circumstances where STOXX, Deutsche Börse Group or their licensors, research partners or data providers are aware that such loss or damage
        may occur.

      

      

      The licensing Agreement between Allianz and STOXX is solely for their benefit and not for the benefit of the owners of Allianz products or
        any other third parties.]

      

      

      [The iShares® MSCI Emerging Markets ETF distributed by BlackRock Investments, LLC. iShares®, BLACKROCK®, and the corresponding logos are
        registered trademarks of BlackRock, Inc. and its affiliates (“BlackRock”) and are used under license. These trademarks have been licensed for certain purposes by Allianz Life Insurance Company of North America ("Allianz") and its wholly-owned
        subsidiaries. Products offered by Allianz or its wholly-owned subsidiaries are not sponsored, endorsed, sold or promoted by BlackRock, and purchasers of such products do not acquire any interest in the iShares® MSCI Emerging Markets ETF  nor enter
        into any relationship of any kind with BlackRock. BlackRock makes no representations or warranties, express or implied, to the owners of any products offered by Allianz or its wholly-owned subsidiaries, or any member of the public regarding the
        advisability of purchasing a product from Allianz or its wholly-owned subsidiaries. BlackRock has no obligation or liability for any errors, omissions, interruptions or use of the iShares MSCI Emerging Markets ETF or any data related thereto, or
        with the operation, marketing, trading or sale of any products or services offered by Allianz  and its wholly-owned subsidiaries.]

      

      

      
        S40877-ADD                                                                               [Admin. Tracking Number]

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00303-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00303-of-00352.parquet"}]]