Document:

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American
International Group, Inc.

  Annual
Short-Term Incentive Plan 

as Amended and Restated
Effective October 1, 2015 

 

 

 

1.           
 Purpose

American International Group,
Inc. (“AIG” and together with its consolidated subsidiaries, the
“Company”) has created this American International Group, Inc.
Annual Short-Term Incentive Plan (this “Plan”) to strengthen our
pay-for-performance culture by rewarding employees for business and individual
performance during the applicable Performance Year.  This Plan replaces the
American International Group, Inc. 2013 Short-Term Incentive Plan beginning
with the Performance Year from January 1, 2014 through December 31, 2014. 
Awards under this Plan (each, an “Incentive Award”) will be in
the form of cash.  Capitalized terms not otherwise defined herein will have the
meanings set forth in the Glossary of Terms in Appendix A. 

2.           
 Performance Periods

This Plan will operate for
successive one-year periods beginning on January 1 of each year (each, a “Performance
Year”) until this Plan is terminated by the Compensation and Management
Resources Committee of the Board of Directors of AIG (including any successor
thereto, the “Committee”).  The first Performance Year will be
January 1, 2014 through December 31, 2014.

3.           
 Eligibility

All full and part-time employees
of the Company, excluding external contractors, independent contractors,
temporary workers, and independent agents during the applicable Performance
Year (the “Participants”) are eligible to participate in this
Plan for such Performance Year, unless the employee is a participant in another
variable pay or sales plan that the applicable business has determined is in
lieu of this Plan during such Performance Year.  For the avoidance of doubt,
employees who are eligible to participate in a bonus plan that is required to
be provided under local law or who have an employment contract with AIG or its
subsidiaries for ongoing employment of unlimited duration that is not confined
to a specific, finite project will not be ineligible for the Plan (unless the
applicable business expressly elects to exclude such employee).  If an
individual is hired after the Performance Year commences, the individual may
become a Participant in the Plan, and the amount of his or her Incentive Award
may be Pro-Rated to reflect the portion of the Performance Year worked.

4.           
 Bonus Pool Funding

A.          
Determination.  As soon as practicable following a Performance
Year, the Committee will determine the aggregate bonus pool (the “Earned
Bonus Pool”) to ensure that the Plan rewards all Participants
appropriately and consistent with the purpose of this Plan.  Promptly following
this determination, the Compensation Center of Excellence (“Compensation
COE”) under the direction of the Operating Committee will allocate the
Earned Bonus Pool to each of the Business/Functional Segments.  Prior to March
31st of any Performance Year, the 

 

 

 

Committee
will have the discretion to establish a threshold goal (the “Threshold
Goal”) and determine that, if the Threshold Goal is not met, the Earned
Bonus Pool will be capped at a fixed amount (including $0) or the amount
resulting from a specified formula.

B.          
Exceptions to Earned Bonus Pool.  As soon as practicable
following a Performance Year, the Committee will determine whether the
Incentive Awards for any Participants will be excluded from, and not subject
to, the Earned Bonus Pool.

5.           
 Incentive Awards

A.          
Amount and Form.  Prior to or as soon as practicable following
the commencement of a Performance Year, a Participant’s target Incentive Award
(the “Individual Target Award”) will be established by the
Committee or the applicable Business/Functional Segment in which the
Participant is Employed.  The Individual Target Award will generally be
established after considering the Participant’s job grade, business, local
market, job scope, responsibilities and experience.

B.          
Performance Metrics.  Prior to or as soon as practicable
following the commencement of a Performance Year, the Committee will determine
the performance metric(s) (each, a “Performance Metric”) and the manner
in which each Participant’s actual Incentive Award (the “Earned
Individual Award”) will be calculated for such Performance Year. 
Unless otherwise determined by the Committee, there will be three categories of
Performance Metrics:  (1) Company-based Performance Metrics, (2)
Business/Functional Segment-based Performance Metrics and (3) Individual-based
Performance Metrics; provided that for any Performance Year there will
be at least one Company-based Performance Metric or Business/Functional
Segment-based Performance Metric (which could include the Threshold Goal).  The
Earned Individual Awards may be determined for any Performance Year on the
basis of one or any combination of the Performance Metrics, as determined by
the Committee in its sole discretion, and the Performance Metrics will be
documented in a written Administrative Guide prepared by management for the
Performance Year.  In determining the manner in which the Earned Individual
Award will be calculated, the Committee may establish minimum, target and
maximum achievement levels for any Performance Metric.

C.          
Earned Individual Award.  The Committee will assess performance
against (1) any Company-based Performance Metrics, (2) any Business/Functional
Segment-based Performance Metrics and (3) for Participants who are under the
purview of the Committee, any Individual-based Performance Metrics, in each
case, as soon as practicable following a Performance Year.  For any
Participants who are not under the purview of the Committee, such Participant’s
manager (in accordance with the then-current performance management process, if
any) will assess performance against his or her Individual-based Performance
Metrics, if applicable.  Each Participant’s Earned Individual Award will
be determined by the extent to which the Performance Metrics applicable to the
Plan Year have been attained.  The Committee may provide that an Earned
Individual Award may not exceed a certain percentage of the Individual Target
Award.  In addition, in no event will the aggregate Earned Individual Awards
for a Performance Year exceed the Earned Bonus Pool.

 

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D.          
Vesting; Payment.  Earned Individual Awards for a Performance
Year will be granted as the Committee determines in its sole discretion and
paid on such date or dates following the determination process described
in Section 5.C, but no later than April 30th following
the Performance Year (the “Award Date”).  A Participant must be
employed on the Award Date to be eligible to receive his or her Earned
Individual Award except to the extent provided in Section 6  and Appendix B. 
Prior to March 31st of a Performance Year, the Committee may
determine that all or a specified percentage of a Participant’s Earned
Incentive Award will be a “Deferred Award,” in which case such
Earned Incentive Award will be paid on the one-year anniversary of the Award
Date (the “Deferred Award Payment Date”). 

6.           
 Termination
in Service; Breaks in Service

A.          
Termination Generally.  In the event (i) a Participant’s
Employment is Terminated for any reason during the Performance Year or prior to
the Award Date or (ii) a Participant is Employed but not actively performing
services for the Company for a portion of the Performance Year or on the Award
Date for certain reasons specified in Appendix B, the amount and
payment of the Earned Individual Award, if any, that the Participant will
receive will be determined (and, if applicable, modified) in accordance with Appendix
B. 

B.          
Termination without Cause.  In the event that a Participant is
involuntarily Terminated without Cause, AIG will require the Participant to
execute a Release in order to impose restrictive covenants requiring
confidentiality of information, non-disparagement and non-solicitation of
Company employees for 12 months following the termination as a condition
to receiving payment of all or a portion of an Earned Individual Award for
which the Award Date has not occurred as of such termination.  The Release must
be executed by the Participant, submitted to the Company and become irrevocable
prior to the date on which any such Earned Individual Award shall be paid, but
in no event shall the Release be executed later than March 10th of
the year following the year in which the Termination without Cause occurred; provided
that if the Release is executed after such time, any payments with respect
to the Earned Individual Award will be forfeited.

7.           
 Clawback/Repayment.

Notwithstanding anything to the
contrary herein, in consideration of the grant of an Incentive Award, the award
and any payments under this Plan will be subject to forfeiture and/or repayment
to the extent provided for in the AIG Clawback Policy, as in effect from time
to time.

8.           
 Administration

A.          
General.  The Plan will be administered by the Committee, and any
person or persons designated by the Committee to administer the Plan from time
to time including, but not limited to, the Senior C&B Executive and the
Compensation COE.  The Compensation COE will conduct validation analyses to
determine that this Plan is generally operated in accordance with the terms of
this Plan and the applicable Administrative Guide.  Actions of the Committee
may be taken by the 

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vote of a majority of its members. 
The Committee may allocate among its members and delegate to any person who is
not a member of the Committee any of its powers, responsibilities or duties
under the Plan.  The Committee will have the power to construe, interpret and
implement this Plan, to make regulations for carrying out its purposes and to
make all other determinations in connection with its administration, all of
which will, unless otherwise determined by the Committee, be final, binding and
conclusive.  The Committee may, in its sole discretion, reinstate any Earned
Individual Awards made under this Plan that have been terminated and forfeited
because of a Participant’s Termination, if the Participant complies with any
covenants, agreements or conditions that the Committee may impose; provided, 
however, that payment under such reinstated awards will not be made until
the scheduled times set forth in this Plan.

B.          
Determination of Employment.  The Committee, with respect to any
Participant under the purview of the Committee, and the Senior C&B
Executive, with respect to any other Participant, will have the right to
determine the commencement or Termination date of a Participant’s Employment
with the Company solely for purposes of this Plan, separate and apart from any
determination as may be made by the Company with respect to the individual’s
employment.

C.          
No Liability.  No member of the Board of Directors of AIG (the “Board”)
or any employee of AIG performing services with respect to the Plan (each, a “Covered
Person”) will have any liability to any person (including any
Participant) for any action taken or omitted to be taken or any determination
made, in each case, in good faith with respect to this Plan or any
Participant’s participation in it.  Each Covered Person will be indemnified and
held harmless by AIG against and from any loss, cost, liability, or expense
(including attorneys’ fees) that may be imposed upon or incurred by such
Covered Person in connection with or resulting from any action, suit or
proceeding to which such Covered Person may be a party or in which such Covered
Person may be involved by reason of any action taken or omitted to be taken under
this Plan and against and from any and all amounts paid by such Covered Person,
with AIG’s approval, in settlement thereof, or paid by such Covered Person in
satisfaction of any judgment in any such action, suit or proceeding against
such Covered Person, provided  that  AIG will have the right, at
its own expense, to assume and defend any such action, suit or proceeding and,
once AIG gives notice of its intent to assume the defense, AIG will have sole
control over such defense with counsel of AIG’s choice.  To the extent any
taxable expense reimbursement under this paragraph is subject to Section 409A,
(1) the amount thereof eligible in one taxable year shall not affect the amount
eligible in any other taxable year; (2) in no event shall any expenses be reimbursed
after the last day of the taxable year following the taxable year in which the
Covered Person incurred such expenses; and (3) in no event shall any right to
reimbursement be subject to liquidation or exchange for another benefit.  The
foregoing right of indemnification will not be available to a Covered Person to
the extent that a court of competent jurisdiction in a final judgment or other
final adjudication, in either case, not subject to further appeal, determines
that the acts or omissions of such Covered Person giving rise to the
indemnification claim resulted from such Covered Person’s bad faith, fraud or
willful misconduct.  The foregoing right of indemnification will not be
exclusive of any other rights of indemnification to which Covered Persons may
be entitled under AIG’s Amended and Restated Certificate of Incorporation or 

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Bylaws, as a matter of law, or otherwise, or any other
power that AIG may have to indemnify such persons or hold them harmless.

D.          
Consent.  If the Committee at any time determines, in its sole
discretion, that any consent (as hereinafter defined) is necessary or desirable
as a condition of, or in connection with, the granting of any award or the
payment of any amount under this Plan or the taking of any other action thereunder
(each such action, a “plan action”), then such plan action will
not be taken, in whole or in part, unless and until such consent will have been
effected or obtained to the full satisfaction of the Committee; provided 
that  if such consent has not been so effected or obtained as of the
latest date provided by this Plan for payment of such amount and further delay
is not permitted in accordance with the requirements of Section 409A, such
amount will be forfeited and terminate notwithstanding any prior earning or
vesting.  

The term “consent” as used in this
paragraph with respect to any plan action includes (1) any and all listings,
registrations or qualifications in respect thereof upon any securities exchange
or under any federal, state, or local law, or law, rule or regulation of a
jurisdiction outside the United States, (2) any other matter, which the
Committee may deem necessary or desirable to comply with the terms of any such
listing, registration or qualification or to obtain an exemption from the requirement
that any such listing, qualification or registration be made, (3) any and all
other consents, clearances and approvals in respect of a plan action by any
governmental or other regulatory body or any stock exchange or self-regulatory
agency and (4) any and all consents required by the Committee.

9.           
 Other Provisions

A.          
No Funding.  The Company will be under no obligation to fund or
set aside amounts to pay obligations under this Plan. A Participant will have
no rights to awards or other amounts under this Plan other than as a general,
unsecured creditor of the Company.

B.          
Tax Withholding.  The Company will comply with all applicable tax
reporting, withholding and other requirements globally with respect to amounts
paid under this Plan, in amounts and in a manner determined in the sole
discretion of the Company.  As a condition to the payment of any amount under
this Plan, or in connection with any other event related to this Plan, that
gives rise to a federal or other governmental tax withholding obligation (1)
the Company may deduct or withhold (or cause to be deducted or withheld) from
any payment to a Participant whether or not pursuant to this Plan or (2) the
Committee will be entitled to require that the Participant remit cash to the
Company (through payroll deduction or otherwise), in each case, in an amount
sufficient in the opinion of the Company to satisfy such withholding
obligation.

C.          
No Rights to Other Payments.  The provisions of this Plan provide
no right or eligibility to a Participant to any other payouts from AIG or its
subsidiaries under any other alternative plans, schemes, arrangements or
contracts AIG may have with any employee or group of employees of AIG or its
subsidiaries.  Nothing contained in the Plan will be deemed in any way to limit
or restrict the Company from adopting or continuing in effect any compensation
arrangements or 

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making any award or payment to any
person under any other plan, arrangement or understanding, whether now existing
or hereafter in effect.

D.          
Effect on Benefit Plans.  The Incentive Award payment is deemed
compensation under certain of the Company’s compensation and benefit plans, but
it is not deemed compensation for other programs; provided, however, that for
purposes of the Company’s benefit programs, this Plan will be deemed a
short-term incentive, annual, year-end bonus program. The Summary Plan
Description and plan summaries of each of the Company’s compensation and
benefit plans will govern whether and the extent to which the Incentive Award
payment will affect the Participant’s benefits under such plans, and the
Company reserves the right to amend those compensation and benefit plans at any
time.

E.          
Section 409A.  Payments under this Plan are intended to be exempt
from Section 409A to the extent they satisfy the “short-term deferral
exception” in Treasury Regulation Section
1.409A-1(b)(4) and otherwise to be compliant with Section 409A, and this
Plan shall be interpreted, operated and administered accordingly.  For the avoidance of doubt, all Incentive Awards under the
Plan other than Deferred Awards are intended to satisfy the short-term deferral
exception and all Deferred Awards constitute “deferred compensation” subject to
Section 409A.  With respect to any Incentive Award that constitutes
“deferred compensation” subject to Section 409A, (1) references to termination
of the Participant’s employment will mean the Participant’s separation from
service with the Company within the meaning of Section 409A and (2) any payment
to be made with respect to such Incentive Award in connection with the
Participant’s separation from service with the Company within the meaning of
Section 409A that would be subject to the limitations in Section 409A(a)(2)(b)
of the Code will be delayed until six months after the Participant’s separation
from service (or earlier death) in accordance with the requirements of Section
409.  Each payment made under the Plan will be deemed
to be a separate payment for purposes of Section 409A.  The Committee
will have full authority to give effect to the intent of this Section 9.E. 

F.           
Section 4999.  In the event that any Incentive Award payment
received or to be received by any Participant under this Plan would be subject
to the excise tax imposed by Section 4999 of the Code or any similar or
successor provision to Section 4999 (the “Excise Tax”) then, at
the discretion of the Chief Human Resource Officer, such Incentive Award
payment shall be reduced up to the largest amount which would result in no
portion of the Incentive Award payment being subject to the Excise Tax.  The
determination of any such reduction pursuant to this Section 9.F will be
made by the Senior C&B Executive, and such determination will be conclusive
and binding upon the Company, the Participant, the Senior C&B Executive and
the Committee for all purposes.

G.          
Section Headings.  The section headings contained herein are for
convenience only, and in the event of any conflict, the text of the Plan,
rather than the headings will control.

H.          
Severability.  If any term or provision contained herein is
finally held to be, to any extent, invalid, illegal or unenforceable (whether
in whole or in part), such provision will be deemed modified only to the extent
of such invalidity, 

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illegality or unenforceability and
the remaining provisions will not be affected thereby.

I.            
No Third Party Beneficiaries.  Except as expressly provided
herein, this Plan will not confer on any person other than AIG and the
Participant any rights or remedies hereunder. The exculpation and
indemnification provisions of Section 8.C will inure to the benefit of a
Covered Person’s estate and beneficiaries and legatees.

J.           
Nonassignability.  No award (or any rights and obligations
thereunder) granted to any person under the Plan may be sold, exchanged,
transferred, assigned, pledged, hypothecated or otherwise disposed of or
hedged, in any manner (including through the use of any cash-settled
instrument), whether voluntarily or involuntarily and whether by operation of
law or otherwise, other than by will or by the laws of descent and distribution,
except as may be otherwise provided in the award agreement.  Any sale,
exchange, transfer, assignment, pledge, hypothecation, or other disposition in
violation of the provisions of this Section 9.J  will be null and
void and any award which is hedged in any manner will immediately be
forfeited.  All of the terms and conditions of this Plan and the award
agreements will be binding upon any permitted successors and assigns.

K.          
Entire Understanding.  The Plan and, with respect to a
Performance Year, the applicable Administrative Guide, contains the entire
understanding of the Company and the Participants with respect to the subject
matter thereof and supersedes all prior promises, covenants, arrangements,
agreements, communications, representations and understanding between the
Company and the Participant.

L.           
No Right of Employment.  Nothing in this Plan will be construed
as creating any contract of employment or conferring upon the Participant any
right to continue in the employ or other service of the Company, or any of its
subdivisions or subsidiaries, or limit in any way the right of the Company to
change such Participant’s compensation or benefits or to terminate the
employment or other service of such Participant with or without Cause.

M.         
Successor and Assigns.  The terms of this Plan will inure to the
benefit of AIG and any successor entity.

N.          
Subject to Any AIG Section 162(m) Plan.   AIG may, in any
year, propose a Section 162(m) compliant
performance incentive award plan (the “AIG Section 162(m) Plan”). 
If an AIG Section 162(m) Plan is proposed and approved by the AIG stockholders
in accordance with Section 162(m)(4)(C) of the Code and Treasury Regulation
Section 1.162‐27(e)(4), this Plan will function as a sub-plan under the
AIG Section 162(m) Plan, whereby performance compensation amounts payable under
the AIG Section 162(m) Plan can be paid in part by accruing awards with respect
to a Performance Year.

O.          
No Liability With Respect to Tax Qualification or Adverse Tax
Treatment.  Notwithstanding anything to the contrary contained herein, in
no event shall the Company be liable to a Participant on account of the failure
of any Incentive Award or amount payable under this Plan to (a) qualify
for favorable 

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United States or foreign tax treatment or
(b) avoid adverse tax treatment under United States or foreign law, including,
without limitation, Section 409A.

10.        
 Governing Law.

The Plan will be governed and
enforced in accordance with the appropriate country and local regulations. 
With respect to Participants working in the United States, this Plan will be
governed by and construed in accordance with the laws of the State of New York,
without regard to principles of conflict of laws.

The Plan shall also be subject to
all applicable non-U.S. laws as to Participants located outside of the United
States. In the event that any provision of this Plan is not permitted by the
local laws of a country or jurisdiction in which a Participant works, such
local law shall supersede that provision of this Plan with respect to that
Participant.  The  Senior HR Attorney and the Senior C&B Executive or their
designee(s) shall have the discretion to operate the Plan with respect to such
Participant in a manner that incorporates as much of the Plan’s current terms
as possible while also complying with such local laws.

11.        
 Plan Termination; Amendment

The Plan may be amended or
modified, with or without prior notification of the Participants, at any time
in the sole discretion of the Committee.  The Plan will continue until
suspended or terminated by the Committee in its sole discretion; provided
that all Incentive Awards made under the Plan before its suspension or
termination will remain in effect until such awards have been satisfied or
terminated in accordance with the terms and provisions of the Plan and the
applicable award.  Any termination of this Plan will be done in a manner that
the Committee determines complies with Section 409A. 

Notwithstanding the foregoing,
the Committee’s rights and powers to amend the Plan shall be delegated to the
Senior C&B Executive, who shall have the right to amend the Plan with
respect to (i) amendments required by relevant law, regulation or ruling, (ii)
amendments that are not expected to have a material financial impact on the
Company, (iii) amendments that can reasonably be characterized as technical or
ministerial in nature or (iv) amendments that have previously been approved in
concept by the Committee.  Notwithstanding the foregoing delegation, the Senior
C&B Executive shall not have the power to make an amendment to the Plan
that could reasonably be expected to result in a termination of the Plan or a
change in the structure or the powers, duties or responsibilities of the
Committee, unless such amendment is approved or ratified by the Committee.

12.        
 Effective Date

The Plan is effective as of the 2014 Performance Year,
and will continue thereafter until terminated by the Committee; provided,
however, that the existence of the Plan at any time or from time to time
does not guarantee or imply the payment of any Incentive Awards hereunder, or
the establishment of any future plans or the continuation of this Plan. 

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Appendix A

Glossary of Terms

“AIG” means American International Group, Inc.

“AIG Section 162(m) Plan” means a Section 162(m) compliant performance incentive award plan.

“Award Date” means the date, in accordance with Section
5.D, that the Incentive Award is granted to and becomes non-forfeitable
(other than with respect to the clawback provisions of Section 7 of the
Plan) to the Participant.  For point of clarity, for Participants with an
Incentive Award of which a portion is designated as a Deferred Award (with such
portion payable in a year later than the year following the Performance Year),
the Award Date is the date the entire Incentive Award becomes non-forfeitable
and that the portion of the Incentive Award not  designated as a Deferred
Award is paid.  For all others, the Award Date is the date that the entire
Incentive Award is paid.

“Board” means the Board of Directors of AIG.

“Breaks in Service” means the cessation of actively
performing services for the Company, either on a temporary or permanent basis
(including Resignation, Termination, Leaves of Absence, Retirement and Death). 
See Appendix B for more information.

“Business/Functional Segments” means the business unit
segments and functional unit segments established by the Committee for a
Performance Year.  

“Cause” has the meaning provided in the applicable
severance plan, program or other arrangement in which the Participant is
eligible to participate; provided  that, to the extent that the
Committee, with respect to any Participant under the purview of the Committee,
or the Senior C&B Executive, with respect to any other Participant, or
their delegate(s), in each case, in its or his or her sole discretion
determines that the Participant is not eligible to participate in a severance plan,
program or arrangement, “Termination without Cause” shall mean a Termination
due to a reduction in force, position elimination or office closing.

“Code” means the Internal Revenue Code of 1986, as amended
from time to time.

“Committee” means the Compensation and Management Resources
Committee of the Board of Directors of AIG (including any successor thereto).

“Company” means AIG together with its consolidated
subsidiaries.

“Compensation COE” means the Compensation Center of
Excellence.

“Covered Person” means any employee of AIG performing
services with respect to the Plan.

“Deferred Award” means all or a specified percentage of a
Participant’s Earned Incentive Award that the Committee determines, prior to
March 31st of a Performance Year, will be paid on the Deferred Award
Payment Date.

“Deferred Award Payment Date” means the one-year
anniversary of the Award Date.

 

 

 

“Earned Bonus Pool” means the
actual bonus pool approved by the Committee under this Plan for a Performance
Year.

“Earned Individual Award” means a Participant’s actual
Incentive Award.

“Employed” and “Employment” means (a)
actively performing services for the Company, (b) being on a Company-approved
leave of absence, whether paid or unpaid, or (c) receiving long term disability
benefits for up to three years from the date short term disability leave
commenced, in each case while in good standing with the Company.

“Excise Tax” means the excise tax imposed by Section 4999
of the Code or any similar or successor provision to Section 4999.

 “Incentive Award” means an award under this Plan.

“Individual Target Award” means a Participant’s target
Incentive Award.

“Normal Schedule” means the date specified in Section
5.D that an Incentive Award would otherwise have been paid if the
Participant had continued to remain Employed by the Company. 

“Operating Committee” means the group of senior executives
selected by the President and CEO to be a member of this deliberative group.

“Paid Leave of Absence” means an approved leave of absence
during which the Participant is receiving salary continuation from a Company
payroll.

“Participant” has the meaning provided in Section 3. 

“Performance Metric” means a performance metric determined
by the Committee prior to or as soon as practicable following the commencement
of a Performance Year in accordance with Section 5.B. 

“Performance Year” means each successive one-year periods
beginning on January 1 of each year.

“Plan” means this American International Group, Inc. Annual
Short-Term Incentive Plan (also referred to as “Compensation Plan 483”).

“Pro-Rated” means, for any amount under this Plan,
multiplying such amount by a fraction, the numerator of which is the number of
months (rounding up for partial months) during the Performance Year that the
Participant actively performed services for the Company (including any period
designated by the Company as “working notice”) or was on a Paid Leave of
Absence, and the denominator of which 12.

“Release” means the release required by the severance plan
or program applicable to the Participant’s Termination without Cause; provided
that, to the extent that no such established severance plan or program is
deemed applicable by the Committee, with respect to any Participant under the
purview of the Committee, or the Senior C&B Executive, with respect to any
other Participant, or their delegate(s), in each case, in its or his or her
sole discretion, then the release will be a release generally in the form set
forth in Appendix C, subject to any provisions that the Senior HR
Attorney and the Senior C&B 

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Executive or their
delegate(s) may amend or add to the release; provided, further, that if
the local laws of a country or non-U.S. jurisdiction in which the Participant
performs services would not permit all or a portion of the release in Appendix
C to be structured or executed in the applicable form attached hereto, the Senior
HR Attorney and the Senior C&B Executive or their designee(s) shall have
the discretion to create a release that incorporates as much of the release in
the form attached as Appendix C as possible while also complying with
such local laws.

“Retirement”
or “Retire” means, solely for purposes of this Plan, (i) in the
United States, voluntary Termination initiated by the Participant (while such
Participant is in good standing with the Company) (x) on or after age 60 with
five years of service or (y) on or after age 55 with 10 years of service, and
(ii) outside of the United States, effective as of April 1, 2014, a  voluntary
Termination initiated by the Participant (while such Participant is in good
standing with the Company) (x) on or after age 60 with five years of service or
(y) on or after age 55 with 10 years of service.

  

 “Section 409A” means Section 409A of the Code, including
any amendments or successor provisions to that section, and any regulations and
other administrative guidance relating thereto, in each case as they may be
from time to time amended or interpreted through further administrative
guidance.

“Senior C&B Executive”  means the Company’s most senior executive
whose responsibility it is to oversee both the Corporate Compensation
Department and the Corporate Benefits Department.  In
the event that no individual holds such position, “Senior C&B Executive”
will instead refer to the Company’s most senior executive whose responsibility
it is to oversee the global Human Resources Department.

“Senior HR Attorney”  means
the Company’s most senior attorney whose responsibility it is to oversee Human
Resource/employment matters.

“Termination” or “Terminate,” with respect to
a Participant, means the termination of the Participant’s Employment.

“Threshold Goal” has the meaning provided in Section 4. 

“Unpaid Leave of Absence” means an approved leave of
absence during which the Participant is not receiving salary continuation from
a Company payroll, including a period of long term disability leave during
which a Participant may be receiving long term disability insurance payments
from a long term disability insurer.

  

-11-

 

 

Appendix B

Treatment of Incentive
Awards Upon Various Types of Breaks in Service or

Terminations of Employment

	
   Type of Break
   in Service or Termination of Employment

   	
   Amount the
   Participant Receives

   
	
  Short-Term &
  Long-Term Medical Leaves of Absence 

  (STD & LTD)

  Family Medical
  & Domestic Partner Leave

  Non-Medical Leave
  of Absence

  (Personal Leave)

  Military Leave of
  Absence

  	
  If a Participant is on an approved leave
  of absence during which the Participant is receiving salary continuation from
  a Company payroll (a “Paid Leave of Absence”), such Paid Leave
  of Absence will not be deemed a break a service or a Termination for purposes
  of this Plan. Time on a Paid Leave of Absence will be treated the same as
  time during which the Participant performs services for the Company.

   

  If a Participant is on an approved leave
  of absence during which the Participant is NOT receiving salary continuation
  from a Company payroll, including a period of long term disability leave
  during which a Participant may be receiving long term disability insurance
  payments from a long term disability insurer (an “Unpaid Leave of
  Absence”), his or her Incentive Award will be Pro-Rated based on the
  number of months during the Performance Year that the Participant was
  actively employed (prior to the Participant’s last day worked) or on a Paid
  Leave of Absence with the Company, but will not include the number of months
  that the Participant was on an Unpaid Leave of Absence.

   

  Incentive Awards are paid on the Normal Schedule.

   

  
	
  Retirement

  	
  If a Participant Retires During the Performance
  Year, after March 31st and before the End of the
  Performance Year:  

  ·        
  The Incentive Award is Pro-Rated based on the number of months
  during the Performance Year that the Participant was actively employed (prior
  to the Participant’s last day worked) or on a Paid Leave of Absence with the
  Company and,

  ·        
  The amount of the Incentive Award is based on 100% of the
  Participant’s Individual Target Award for such Performance Year and, 

  ·        
  To the extent applicable for such Performance Year, actual
  performance against the Company-based Performance Metrics and the
  Business/Functional Segment-based Performance Metrics as determined by the
  Committee. 

  ·        
  Paid on the Normal Schedule. 

   

  If a Participant Retires on or before March 31st
  of the Performance Year:

  ·        
  Participant will not receive any Pro-Rated Incentive Award
  payment for the current Performance Year.

   

   

  If a Participant Retires After the End of the
  Performance Year but 

  

 

 

 

 

	
   Type of Break in Service or Termination of
   Employment

   	
   Amount the
   Participant Receives

   
	
   

  	
  prior to the Award Date:   

  ·        
  The Incentive Award is not Pro-Rated, but is paid in full based
  on, to the extent applicable for such Performance Year, actual performance
  against the Individual-based Performance Metrics, the Company-based
  Performance Metrics and the Business/Functional Segment-based Performance
  Metrics for such Performance Year. 

  ·        
  Paid on the Normal Schedule.

   

  
	
  Death

  	
  If a Participant Dies During the Performance Year,
  after March 31st and before the End of the Performance Year:  

  ·        
  The Incentive Award is Pro-Rated based on the number of months
  during the Performance Year that the Participant was actively employed (prior
  to the Participant’s last day worked) or on a Paid Leave of Absence with the
  Company and the amount of the Incentive Award is based on 100% of the
  Participant’s Individual Target Award for such Performance Year. 

  ·        
  Paid as soon as administratively possible after the date of
  death, but in no event later than March 15th following such
  Performance Year. 

   

  If a Participant Dies on or before March 31st
  of the Performance Year:

  ·        
  The Participant will not receive any Pro-Rated Incentive Award
  payment for the current Performance Year.

   

  If a Participant Dies After the End of the
  Performance Year but prior to the Award Date:

  ·        
  The Incentive Award is not Pro-Rated, but is paid 100% of the
  Individual Target Award in effect on the date of death. 

  ·        
  Paid as soon as administratively possible after the date of
  death, but in no event later than March 15th following the year in which the
  death occurred.

  
	
  Resignation, Voluntary
  Quit, Constructive Discharge

  	
  If the last day the Participant was actively performing
  services for the Company (the Participant’s last day worked) or on a Paid
  Leave of Absence is prior to the Award Date, the Incentive Award is
  forfeited.  

  
	
  Termination without
  Cause

   

  	
  If a Participant Experiences a Termination without
  Cause: 

  For Participants in the 2012 Executive Severance Plan or
  its successor plan, paid in accordance with such plan.  

   

  For all other Participants, payable pursuant to the AIG,
  Inc.

  Severance Plan, or other severance arrangement applicable
  to such Termination without Cause as follows:  

   

  Termination without Cause During the Performance
  Year

  

 

-13-

 

 

 

	
   Type of Break in Service or Termination of
   Employment

   	
   Amount the
   Participant Receives

   
	
   

  	
  ·        
  If the last day that the Participant was actively performing
  services for the Company (the Participant’s last day worked) or on a Paid
  Leave of Absence occurs after March 31st and before the end of the
  Performance Year, the Participant will receive 100% of the Participant’s
  Individual Target Award with respect to such Performance Year Pro-Rated based
  on the number of months during the Performance Year that the Participant was
  actively performing services for the Company (prior to the Participant’s last
  day worked) or on a Paid Leave of Absence. 

  ·        
  For the avoidance of doubt, if the last day that the
  Participant was actively performing services for the Company or on a Paid
  Leave of Absence occurs on or before March 31st of a Performance
  Year, the Participant will not receive any Incentive Award payment for such
  Performance Year.

  Termination without Cause After the End of the
  Performance Year but prior to the Award Date

  ·        
  If the last day that the Participant was actively performing
  services for the Company (the Participant’s last day worked) or on a Paid
  Leave of Absence occurs after the end of the Performance Year, but prior to
  the Award Date for such Performance Year, the Participant will receive 100%
  of the Participant’s Individual Target Award with respect to such Performance
  Year.

   

  Timing of Payments  

  ·        
  Paid as soon as administratively possible after the date of
  Termination without Cause, but no later than March 15th following
  the year in which the Termination without Cause occurs, and in no event later
  than when other actively employed Participants are
  paid similar Incentive Awards under the Plan; provided that any
  Deferred Award will be paid on the Normal Schedule.   

  To the extent there is an inconsistency between this Plan
  and the applicable severance program, the severance program will prevail. To
  the extent the Committee, with respect to any Participant under the purview
  of the Committee, or the Senior C&B Executive, with respect to any other
  Participant, or their delegate(s), in each case, in its or his or her sole
  discretion determines that no established severance program or arrangement is
  applicable to a Participant’s Termination without Cause, then, in accordance
  with Section 6.B, the Participant will need to execute a release
  generally in the form set forth in Appendix C, subject to any
  provisions that the Senior HR Attorney and the Senior C&B Executive  or
  their delegate(s) may amend or add to the release.

  

 

-14-

 

 

 

 

-15-

 

 

Appendix C

Form of Release Referred to in Section 6.B of the Plan

NOT
personalized to each Participant.

(1)          
[Employee Name] (“Employee”), for good and sufficient
consideration, the receipt of which is hereby acknowledged, hereby waives and
forever releases and discharges any and all claims of any kind Employee may
have against American International Group, Inc., its affiliate or subsidiary
companies, or any officer, director or employee of, or any benefit plan
sponsored by, any such company (collectively, the “Released Parties”)
which arise from Employee’s employment with any of the Released Parties or the
termination of Employee’s employment with any of the Released Parties. 
[Specifically, but without limiting that release, Employee hereby waives any rights
or claims Employee might have pursuant to the Age Discrimination in Employment
Act of 1967, as amended (the “Act”) and under the laws of any and
all jurisdictions, including, without limitation, the United States.  Employee
recognizes that Employee is not waiving any rights or claims under the Act that
may arise after the date that Employee executes this Release.] Nothing herein
modifies or affects any vested rights that Employee may have under the
[American International Group, Inc. Retirement Plan, or the American
International Group, Inc. Incentive Savings Plan] [and other plans
applicable to Employee]; nor does this Release confer any such rights,
which are governed by the terms of the respective plans (and any agreements
under such plans).

(2)          
Employee acknowledges that Employee has not filed any complaint, charge,
claim or proceeding, if any, against any of the Released Parties before any
local, state or federal agency, court or other body (each individually a “Proceeding”). 
Employee represents that Employee is not aware of any basis on which such a
Proceeding could reasonably be instituted.

(3)          
Confidentiality/Non-Disclosure.  During the term of Employee’s
employment, the Company permitted Employee to have access to and become
acquainted with trade secret information of a confidential, proprietary or
secret nature.  Subject to and in addition to any confidentiality or
non-disclosure requirements to which Employee was subject prior to the date the
Employee executes this Release, effective as of the date Employee executes this
Release, Employee acknowledges and agrees that (i) all confidential,
proprietary, trade secret information received, obtained or possessed at any
time by Employee concerning or relating to the business, financial,
operational, marketing, economic, accounting, tax or other affairs at the
Company or any client, customer, agent or supplier or prospective client,
customer, agent or supplier of the Company will be treated by Employee in the
strictest confidence and will not be disclosed or used by Employee in any
manner without the prior written consent of the Company or unless required by
law, and ii) Employee  has not during the term of Employee’s employment and
will not remove or destroy any such confidential information.

(4)          
Non-Solicitation.  Employee acknowledges and agrees that Employee’s
employment with the Company required exposure to and use of confidential trade
secret information (as set forth in Paragraph 3).  Subject to and in
addition to any non-solicitation requirements to which Employee was subject
prior to the date Employee executes this Release, effective as of the date
Employee executes this Release, Employee acknowledges and agrees that (i)
Employee will not, directly or 

 

 

 

indirectly,
on Employee’s own behalf or on behalf of any other person or entity solicit,
contact, call upon, communicate with or attempt to communicate with any
customer or client or prospective customer or client of the Company where to do
so would require the use or disclosure of trade secret information, and (ii)
for a period of one (1) year after employment terminates for any reason,
Employee will not solicit or in any manner encourage or provide assistance to
any employee, consultant or agent of the Company to terminate his or her
employment or other relationship with the Company or to leave its employ or
other relationship with the Company for any engagement in any capacity or any
other person or entity.

(5)          
Non-Disparagement.  Employee acknowledges and agrees that
Employee will not disparage AIG or any of its subsidiaries or affiliates or any
of their officers, directors or employees to any person or entity not
affiliated with AIG; provided, however, that nothing herein prohibits the
Employee from giving truthful testimony as required by law.

(6)          
Employee agrees that AIG’s remedies at law for a breach or threatened
breach of Section 3, 4 and 5 of this Release would be inadequate.  In
recognition of this fact, Employee agrees that, in the event of such a breach
or threatened breach, in addition to any remedies at law, AIG, without posting
any bond, shall be entitled to obtain equitable relief from a court of
competent jurisdiction the form of specific performance, temporary restraining
order, temporary or permanent injunction or any other equitable remedy which
may then be available in the event of a breach or threatened breach of such
provision. 

(7)          
[Employee acknowledges and understands that Employee is hereby being
advised to consult with an attorney prior to executing this Release.  Employee
also acknowledges and understands that Employee has twenty-one (21) days to
consider the terms of this Release before signing it.  However, in no event may
Employee sign this Release before Employee’s termination date.]

(8)          
[Upon the signing of this Release by Employee, Employee understands that
Employee shall have a period of seven (7) days following Employee’s signing of
this Release in which Employee may revoke this Release.  Employee understands
that this Release shall not become effective or enforceable until this seven
(7) day revocation period has expired, and that neither the Released Parties
nor any other person has any obligation [pursuant to the American International
Group, Inc. Annual Short-Term Incentive Plan] until eight (8) days have
passed since Employee’s signing of this Release without Employee having revoked
this Release.  If Employee revokes this Release, Employee will be deemed not to
have accepted the terms of this Release.]

 

-17-

 

 

 

 

(9)          
Any dispute arising under this Release shall be governed by the [law of
the State of New York], without reference to the choice of law rules that would
cause the application of the law of any other jurisdiction.

	
   

  	
   

  	
   

  
	
  
   

  

  	
   

  	

   

  

  
	
   

  	
   

  	
   

  
	
  DATE

  	
   

  	
  [Employee]

  

 

-18-EX-10.20

 Exhibit 10.20 
  

 
 [WITH EMPLOYMENT AGREEMENT] 

EFI 2015 Bonus Program 
  

 
 We are pleased to offer you
participation in the EFI 2015 Bonus Program (the “Program”) on the terms set forth below. 
 Each participant (the
“Participant”) in the Program will, provided that the Participant remains employed by EFI through the date of grant of such awards, be granted an award of restricted stock units that is subject to vesting requirements based on the
performance of Electronics For Imaging, Inc. (“EFI” or the “Company”) for 2015 and the Participant’s continued employment as set forth below. 

Performance Equity Bonus Terms 
  

	 	•	 	Per the approval by the Company’s Compensation Committee (the “Compensation Committee”) and subject to your continued employment with the Company through the date of grant, you will be granted two
performance-based restricted stock unit (“RSU”) awards with respect to the Program. The RSU awards will be subject to vesting based on the achievement of certain Company’s performance components for 2015 as set forth below, and
your continued employment as set forth below (“Program Components”). In addition, no portion of the RSU Awards will vest if the Company’s 2015 Non-GAAP operating income is less than $*** million. 

 

	 	•	 	The total number of RSUs that you will be granted will equal your “Equity Bonus Eligibility” amount (expressed in U.S. Dollars) set forth below, divided by the closing price of EFI’s common stock on
January 30, 2015. In each case your total RSUs under each Program Component will be rounded down to the nearest whole share. 

  

	 	•	 	The RSUs will be granted under and will be subject to the terms and conditions of EFI’s 2009 Equity Incentive Award Plan, as amended (the “2009 Equity Plan”) and the Restricted Stock Unit Award
Notice and Restricted Stock Unit Award Agreement used by EFI to evidence RSU awards granted under the 2009 Equity Plan, except as otherwise expressly set forth herein. Each RSU Award will have a grant date that is the grant date that the
Compensation Committee approves for such award (the “Grant Date”). The RSU awards are also subject to the individual and other share limits of the 2009 Plan. 

 

	 	•	 	During the first quarter of 2016, the Program Administrator will determine whether (and the extent to which) the performance conditions applicable to the RSUs were achieved for 2015, subject to approval by the
Compensation Committee (the date of the Compensation Committee’s approval is referred to as the “Determination Date”). Subject to your continued employment by the Company through the applicable Vesting Date, if the Program
Administrator determines that the applicable performance condition related to the RSUs was achieved for 2015, subject to the Compensation Committee’s approval, the related RSUs will vest (the “Vesting Date”) on the later
of (1) February 4, 2016 or (2) the Determination Date. Each RSU that vests in accordance with the terms of the Program will be paid in one share of the Company’s common stock as soon as practicable after (and in all events within two and
one-half months after) the Vesting Date. In the event any performance condition applicable to an RSU is not satisfied, the RSU will be deemed to have been forfeited. 

Performance Targets and Equity Bonus Target 
 Your Equity
Bonus Eligibility amount is set forth below. 
 Equity Bonus Eligibility: [$] 

The performance goals applicable to your equity bonus opportunity are set forth below. Vesting of each of your RSU awards is also conditioned on the
Company’s achievement of Non-GAAP 2015 operating income of at least $** million. 
  

									
	 Performance Metric
	  	Threshold	 	  	Target	 
	 Revenue (millions)
	  	$	            M	  	  	$	            M	  
	 Non-GAAP Operating Income (millions)
	  	$	            M	  	  	$	            M	  

  
 1 

 The number of Revenue RSUs that will vest will be determined based on the Company’s revenue for 2015 as
certified by the Compensation Committee. If the RSU revenue threshold level set forth above is achieved, the Revenue RSUs will vest on a pro-rata, straight-line basis between 0% and 100% vesting, starting at the RSU threshold revenue level up to the
RSU target revenue level. In other words, none of the Revenue RSUs will vest for Company 2015 revenue at or below the threshold level; from there, the percentage of Revenue RSUs that vest will increase on a straight-line basis up to 100% at the
target level and will be determined based on the actual level of Company revenue achieved for 2015. 
 The number of Operating Income RSUs that will vest
will be determined based on the Company’s Non-GAAP Operating Income for 2015 as certified by the Company’s Compensation Committee. If the RSU Non-GAAP Operating Income threshold level set forth above is satisfied, the Operating Income RSUs
will vest on a pro-rata, straight-line basis between 0% and 100% vesting, starting at the RSU threshold Non-GAAP Operating Income level up to the RSU target Non-GAAP Operating Income level. In other words, none of the Operating Income RSUs will vest
for Company 2015 Non-GAAP Operating Income at or below the threshold level; from there, the percentage of Operating Income RSUs that vest will increase on a straight-line basis up to 100% at the target level and will be determined based on the
actual level of Company Non-GAAP Operating Income achieved for 2015. 
 In each case, the number of RSUs that vest (if any) will be rounded down to the
nearest whole share, and is subject to your continued employment in good standing through the date of vesting. Any portion of the award that does not vest (including as a result of the failure to satisfy either or both of the Conditions or the
failure to achieve the target level of performance indicated above) will terminate as of the last day of 2015 and you will have no rights with respect thereto. 

Non-GAAP Operating Income is defined as operating income determined in accordance with GAAP, as adjusted to remove the impact of certain recurring and
non-recurring expenses and the tax effect of these adjustments, in each case consistent with the determination of non-GAAP operating income in the Company’s financial reporting. 

Maximum Award - In no event shall any RSU award vest with respect to more than 100% of the RSUs subject to such award. 

Adjustments - The results will be adjusted for certain non-recurring material items which are not included in the original calculation of the
performance targets such as results from a significant acquisitions, dispositions, and/or bookings. 
 Other Terms 

Program Participants 
 Participants in this Program are not
eligible for participation in other variable compensation arrangement, program or plan, such as commission-based plans or other similar plans, for 2015. 

Leaves of Absences 
 Periods of leave of absence will be
considered when determining the vesting of RSU award. Specifically, RSU vesting will (unless otherwise required by applicable law) be calculated on a pro-rata basis excluding any leave of absence period(s) during the applicable Program Year.

 Termination of Employment 
 Except as may otherwise
be expressly provided below, in the applicable Restricted Stock Unit Award Notice and Restricted Stock Unit Award Agreement (as to RSUs), or your written employment agreement (if any) with the Company, you will have no right to any bonus for 2015
and no right to any payment with respect to your RSUs for 2015 (and your RSUs will automatically and immediately terminate and you will have no right with respect thereto) should you cease to be employed by the Company or one of its subsidiaries
before the Vesting Date set forth above (regardless of the reason for such termination of employment). 

  
 2 

 Notwithstanding anything to the contrary in the applicable Restricted Stock Unit Award Notice and Restricted
Stock Unit Award Agreement or your written employment agreement (if any) with the Company, if you are involuntarily terminated Without Cause or are terminated for Good Reason outside of a Change of Control (as these terms are defined in the
applicable employment agreement), you will be eligible for pro-rata vesting of your RSUs related to this Program. The pro-rata RSU vesting will be determined with respect to the number of RSUs that would have vested under this Program had your
employment continued through the Vesting Date, multiplied by a fraction (x) the numerator of which is the number of whole months you were employed by the Company during 2015, and (y) the denominator of which is twelve. Payment of such pro-rata
amount will be made at the same time that payment would have been made had you continued to be employed through the Vesting Date. In the event that you are entitled to a pro-rata payment of your RSUs, payment will be made in cash (as opposed to
shares or other property) with the cash payment in respect of a vested RSU to equal (subject to applicable tax withholding) the closing price of a share of EFI common stock on the Determination Date. 

With respect to any RSUs granted under this Program, in the event of any conflict between the provisions of your employment agreement regarding acceleration
of performance equity outside of a Change of Control and this Program, this Program shall control. 
 No Right to Continued Employment 

Nothing contained in this Program, the RSUs, or any related document constitutes an employment or service commitment by the Company (or any affiliate), affects
your status (if you are employed at will) as an employee at will who is subject to termination at any time and for any reason, confers upon you any right to remain employed by or in service to the Company (or any affiliate), or interferes in any way
with the right of the Company (or any affiliate) to terminate your employment or to change your compensation or other terms of employment at any time. 

Program Administration and Interpretation 
 The Program
will be administered by, and interpretation of the Program, as it may apply to any one individual person, matter or circumstance, will be made by the CEO and Vice President of Human Resources (the “Program Administrator”). This
Program is not intended and shall not be construed to imply an employment contract between EFI and any of its employees. In the event of any conflict between the provisions of the Program and the RSU Agreement, this Program shall control. All
actions taken and all interpretations and determinations made by the Program Administrator in respect of such documents and matters shall be conclusive and binding on all persons and shall be given the maximum deference permitted by law. 

Clawback Policy 
 This Program, the RSU Awards, any
securities or other consideration you may receive in payment of or with respect to the RSU Awards, as well as any bonus opportunity under this Program, is subject to the terms of the EFI recoupment, clawback or similar policy as it may be in effect
from time to time, as well as any similar provisions of applicable law, any of which could in certain circumstances require repayment or forfeiture of your bonus, awards or any shares of stock or other cash or property received with respect to your
bonus or awards (including any value received from a disposition of any shares of stock you may receive in payment of the RSU Awards). 
 Construction

 This Program and the RSU Awards contemplated above are also intended to satisfy, and not be subject to any tax, penalty or interest under, Section
409A of the Internal Revenue Code. These arrangements shall be construed in accordance with such intents. 
 Program Changes and Duration of the
Program 
 This Program is effective as of January 1, 2015. It supersedes all prior performance based bonus programs and shall not be modified or
terminated unless authorized in writing by the Program Administrator and/or approved by the Compensation Committee. The Company reserves the right to modify, change or terminate the Program at any time including to revise goals, corporate
objectives or to correct bona fide errors in the Program, or for any other reason. Notices of such changes will be made in writing or via electronic mail to all Participants affected by such changes. 

These terms apply to the Program Year 2015 only and your bonus eligibility, targets, and any unvested RSUs do not carry over to the following year. 

  
 3 

  

By signing this Program, you acknowledge and accept that the potential value of your award is subject to market risk and any decline in EFI’s
common stock price may result in a lower realizable value upon vesting. You agree that any decline in the stock price impacting your bonus shall not be the responsibility of the Company and shall not constitute Good Reason under your employment
agreement. You agree that your awards are subject to termination as described above, and that you may not be eligible for any cash bonus with respect to 2015. 

I have read and understand the terms of this Program and the documents referred to herein, I acknowledge and agree to the preceding paragraph and to all
of the terms and conditions of this Program and such other documents. 
  

							
	  
	 		 	  
	  	
	[Participant Name]	 		 	[Date]	  	

  
 4

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