Document:

Exhibit 10.1

Exhibit 10.1

UGI CORPORATION

2009 DEFERRAL PLAN

As amended and restated effective June 1, 2010

 

 

TABLE OF CONTENTS

	 	 	 	 	 
	 	 	 	Page	 
	 
	 	 	 	 
	BACKGROUND
	 	 	1	 
	ARTICLE 1 DEFINITIONS
	 	 	1	 
	ARTICLE 2 ELIGIBILITY
	 	 	4	 
	ARTICLE 3 BENEFITS
	 	 	5	 
	ARTICLE 4 DISTRIBUTIONS TO PARTICIPANTS
	 	 	7	 
	ARTICLE 5 VESTING
	 	 	11	 
	ARTICLE 6 FUNDING
	 	 	11	 
	ARTICLE 7 INVESTMENTS
	 	 	11	 
	ARTICLE 8 ADMINISTRATION
	 	 	13	 
	ARTICLE 9 CLAIMS PROCEDURE
	 	 	15	 
	ARTICLE 10 AMENDMENT
	 	 	16	 
	ARTICLE 11 TERMINATION
	 	 	16	 
	ARTICLE 12 MISCELLANEOUS
	 	 	16	 
	EXHIBIT A DISTRIBUTION ELECTION FORM — UGI SERP PARTICIPANTS
	 	 	20	 
	EXHIBIT B DISTRIBUTION ELECTION FORM — AMERIGAS SERP PARTICIPANTS
	 	 	23	 
	EXHIBIT C DISTRIBUTION ELECTION FORM — UGI NON-EMPLOYEE DIRECTORS
	 	 	26	 
	EXHIBIT D DISTRIBUTION ELECTION FORM — 2009 UGI SERP PARTICIPANTS
	 	 	29	 
	EXHIBIT E DISTRIBUTION ELECTION FORM — AMERIGAS NON-EMPLOYEE DIRECTORS
	 	 	32	 

 

i

 

BACKGROUND

UGI Corporation currently maintains the UGI Corporation Supplemental Executive Retirement Plan
(“UGI SERP”), the UGI Corporation 2009 Supplemental Executive Retirement Plan (“2009 UGI SERP)
(collectively, the “UGI Plans”) and the UGI Corporation 2004 Omnibus Equity Compensation Plan, as
amended (“Equity Plan”), and AmeriGas Propane Inc. currently maintains the AmeriGas Propane, Inc.
Supplemental Executive Retirement Plan (“AmeriGas SERP”). On April 26, 2010, the AmeriGas Board
approved the AmeriGas Propane, Inc. 2010 Long-Term Incentive Plan on behalf of AmeriGas Partners,
L.P. (“2010 AmeriGas LTIP”), subject to approval by the unitholders of AmeriGas Partners, L.P.
(“APLP”). UGI Corporation has granted stock units to non-employee directors under the Equity Plan
or a predecessor plan and AmeriGas Propane, Inc. may grant phantom units to non-employee directors
under the 2010 AmeriGas LTIP.

UGI Corporation and AmeriGas Propane, Inc. desire to allow employees who are participants in
the UGI Plans or the AmeriGas SERP, and non-employee directors who hold stock units or phantom
units, to defer benefits under the UGI Plans, AmeriGas SERP, stock units or phantom units after
separation from service. UGI Corporation and AmeriGas Propane, Inc. have adopted this amended and
restated Plan to allow such deferral of benefits. Non-employee directors of the AmeriGas Board are
eligible to participate in the Plan as of the date on which the APLP unitholders approve the 2010
AmeriGas LTIP.

All shares of UGI Corporation common stock that are to be distributed pursuant to stock units
deferred under this Plan shall be issued under the Equity Plan and shall in all respects be subject
to the terms of the Equity Plan. All common units of APLP that are to be distributed pursuant to
phantom units deferred under this Plan shall be issued under the 2010 AmeriGas LTIP and shall in
all respect be subject to the terms of the 2010 AmeriGas LTIP.

ARTICLE 1

Definitions

	1.1	 	“2009 UGI SERP” means the UGI Corporation 2009 Supplemental Executive Retirement Plan.
	 
	1.2	 	“2010 AmeriGas LTIP” means the AmeriGas Propane, Inc. 2010 Long-Term Incentive Plan on behalf
of AmeriGas Partners, L.P.
	 
	1.3	 	“Account” means a bookkeeping account established pursuant to Section 3.1 to reflect the
total amount standing to the credit of the Participant under the Plan.
	 
	1.4	 	“Administrative Committee” shall mean the committee designated by the Compensation Committee
to administer the Plan.
	 
	1.5	 	“Affiliated Company” means any affiliate or subsidiary of the Company, including AmeriGas
Propane, Inc.

 

1

 

	1.6	 	“Agreement” means the written instrument that sets forth the terms and conditions of a grant
issued under the UGI Plans or AmeriGas SERP, or Stock Units, including all amendments thereto.

	1.7	 	“AmeriGas Board” means the Board of Directors of AmeriGas Propane, Inc., as constituted from
time to time.

	1.8	 	“AmeriGas LTIP Change of Control” means a “Change of Control” as defined in the 2010 AmeriGas
LTIP.

	1.9	 	“AmeriGas SERP” means the AmeriGas Propane, Inc. Supplemental Executive Retirement Plan, as
amended.
	 
	1.10	 	“APLP” means AmeriGas Partners, L.P.

	1.11	 	“APLP Partnership Agreement” means the Fourth Amended and Restated Agreement of Limited
Partnership of AmeriGas Partners, L.P., dated as of July 27, 2009, as amended from time to
time.

	1.12	 	“Beneficiary” means the person designated by a Participant to receive any benefits payable
after the Participant’s death. The Company shall provide a form for this purpose. In the
event a Participant has not filed a Beneficiary designation with the Company or none of the
designated Beneficiaries are living at the date of the Participant’s death, the Beneficiary
shall be the Participant’s estate.
	 
	1.13	 	“Board” means the Board of Directors of the Company.
	 
	1.14	 	“Change of Control” means “Change of Control” of the Company, as defined in the Equity Plan.
	 
	1.15	 	“Code” means the Internal Revenue Code of 1986, as amended.

	1.16	 	“Common Unit” means a unit representing a fractional part of the partnership interests of all
limited partners and assignees with respect to APLP and having the rights and obligations
specified with respect to common units in the APLP Partnership Agreement.

	1.17	 	“Compensation Committee” means the Compensation and Management Development Committee of the
Board.
	 
	1.18	 	“Company” means UGI Corporation and its successors.

	1.19	 	“Deferral Election” means an election to defer benefits under the UGI Plans, AmeriGas SERP
benefits, Stock Units or Phantom Units as described in Section 3.2.

 

2

 

	1.20	 	“Distribution Equivalent” means an amount determined by multiplying the number of Common
Units subject to Phantom Units by the per-Common Unit cash distribution, or the per Common
Unit fair market value of any distribution in consideration other than cash, paid by APLP on
its Common Units.

	1.21	 	“Dividend Equivalent” means an amount determined by multiplying the number of shares of
common stock of the Company subject to Stock Units by the per-share cash dividend, or the
per-share fair market value of any dividend in consideration other than cash, paid by the
Company on its common stock.
	 
	1.22	 	“Effective Date” of the Plan is January 1, 2009.

	1.23	 	“Employee” means any individual employed by the Employer as an officer, senior manager or
other highly compensated employee.

	1.24	 	“Employer” means the Company and its Affiliated Companies, either collectively or
individually, as the context requires.
	 
	1.25	 	“ERISA” means the Employee Retirement Income Security Act of 1974, as amended.
	 
	1.26	 	“Equity Plan” means the Company’s 2004 Omnibus Equity Compensation Plan, as amended.

	1.27	 	“Grant Letter” means the written instrument that sets forth the terms and conditions of the
Phantom Units, including all amendments thereto.

	1.28	 	“Key Employee” means a Employee who, at any time during the 12-month period ending on the
identification date, is a “specified employee” under section 409A of the Code, as determined
by the Compensation Committee or its delegate. The determination of Key Employees, including
the number and identity of persons considered specified employees and the identification date,
shall be made by the Compensation Committee or its delegate in accordance with the provisions
of section 409A of the Code and the regulations issued thereunder.

	1.29	 	“Non-Employee Director” means a member of the Board or AmeriGas Board, as applicable, who is
not an employee of the Employer.

	1.30	 	“Participant” means any Employee or Non-Employee Director who satisfies the eligibility
requirements set forth in Article 2 and elects to participate in the Plan.

	1.31	 	“Phantom Units” means phantom units issued to Non-Employee Directors of the AmeriGas Board
under the 2010 AmeriGas LTIP.

	1.32	 	“Plan” means this UGI Corporation 2009 Deferral Plan.

 

3

 

	1.33	 	“Postponement Period” means, for a Key Employee, the period of six months after Separation
from Service (or such other period as may be required by section 409A of the Code), during
which payments may not be made to the Key Employee under section 409A of the Code.

	1.34	 	“Re-Deferral Election” means an election to re-defer the payment date of an Account as
described in Section 4.3.
	 
	1.35	 	“Retirement Distribution Account” means a distribution account described in Section 4.2.

	1.36	 	“Separation from Service” means a Participant’s separation from service with the Employer
within the meaning of section 409A of the Code and the regulations promulgated thereunder.

	1.37	 	“Stock Units” means the stock units issued to Non-Employee Directors under the Equity Plan or
a predecessor plan.
	 
	1.38	 	“UGI Plans” means collectively, the UGI SERP and the 2009 UGI SERP.
	 
	1.39	 	“UGI SERP” means the UGI Corporation Supplemental Executive Retirement Plan, as amended.

	1.40	 	“Unit Value” means, at any time, the value of each Stock Unit or Phantom Unit, as applicable,
which shall be equal to the Fair Market Value (as defined in the Equity Plan or 2010 AmeriGas
LTIP, as applicable) of a share of the Company’s common stock or a Common Unit, as applicable,
on such date.

ARTICLE 2

Eligibility

	2.1	 	Participation.
	 
	 	 	Each Employee who has earned an accrued benefit under the UGI Plans or
the AmeriGas SERP, and each Non-Employee Director who receives a grant
of Stock Units or Phantom Units shall be eligible to participate in
the Plan. Non-Employee Directors of the AmeriGas Board shall become
eligible to participate in the Plan as of the date on which the APLP
unitholders approve the 2010 AmeriGas LTIP, or, if later, as of the
date of the Non-Employee Director’s first election to the AmeriGas
Board. Each such Employee or Non-Employee Director may elect to
become a Participant by electing to have an Account established under
this Plan upon Separation from Service, as described in Section 3.2
below.

 

4

 

ARTICLE 3

Benefits

	3.1	 	Account.
	 
	 	 	The Employer shall create and maintain on its books an Account for
each Participant after Separation from Service, to which it shall
credit amounts credited to the Plan pursuant to this Article 3. The
Employer shall also credit each Participant’s Account with deemed
earnings, Dividend Equivalents or Distribution Equivalents, as
applicable, in accordance with the provisions of Article 7 below.

	3.2	 	Deferral Elections with respect to the UGI Plans, AmeriGas SERP, Stock Units and Phantom
Units.

(a) An Employee who has an accrued benefit in the UGI SERP or the AmeriGas SERP as
of December 1, 2008, may elect in 2008 to have his or her benefit under the UGI SERP or
AmeriGas SERP at Separation from Service credited to the Employee’s Account under this
Plan as of the date of the Employee’s Separation from Service. A Non-Employee Director
who holds Stock Units as of December 31, 2008, may elect in 2008 to have his or her Stock
Units at Separation from Service credited to the Non-Employee Director’s Account under
this Plan as of the date of the Non-Employee Director’s Separation from Service.

(b) An Employee who first accrues a benefit in the UGI SERP after December 31, 2008,
may elect to have his or her benefit under the UGI SERP credited to the Employee’s
Account under this Plan as of the date of the Employee’s Separation from Service. The
election must be made no later than 30 days following the first day of the calendar year
following the calendar year in which the Employee first accrues a benefit under the UGI
SERP, or as otherwise required by section 409A.

(c) An Employee who first accrues a benefit in the AmeriGas SERP after December 31,
2008, may elect to have his or her benefit under the AmeriGas SERP credited to the
Employee’s Account under this Plan as of the date of the Employee’s Separation from
Service. The election must be made before the first year in which the Employee accrues a
benefit under the AmeriGas SERP (or any other nonqualified deferred compensation plan
that is aggregated with the AmeriGas SERP for purposes of section 409A) or in the case of
a newly hired Employee, not later than 30 days after the Employee first becomes eligible
to participate in the AmeriGas SERP (or any other nonqualified deferred compensation plan
that is aggregated with the AmeriGas SERP for purposes of section 409A), with respect to
compensation for services to be performed after the election, in accordance with section
409A.

 

5

 

(d) A Non-Employee Director of the Board who first receives Stock Units after
December 31, 2008, may elect to have his or her Stock Units credited to the Non-Employee
Director’s Account under this Plan as of the date of the Non-Employee
Director’s Separation from Service. The election must be made before the first year in
which the Non-Employee Director receives Stock Units or, in the case of a newly elected
(after January 1, 2009) Non-Employee Director, not later than 30 days after the
Non-Employee Director first becomes eligible to participate in the Plan, with respect to
compensation for services to be performed after the election, in accordance with section
409A.

(e) A Non-Employee Director of the AmeriGas Board who receives Phantom Units under
the 2010 AmeriGas LTIP may elect to have his or her Phantom Units credited to the
Non-Employee Director’s Account under this Plan as of the date of the Non-Employee
Director’s Separation from Service. For Non-Employee Directors of the AmeriGas Board who
first become eligible to participate in the Plan upon APLP unitholder approval of the
2010 AmeriGas LTIP, the election must be made no later than 30 days after they first
become eligible to participate in the Plan, with respect to compensation for services to
be performed after the election, in accordance with section 409A. Subsequently, newly
elected Non-Employee Directors of the AmeriGas Board must make the election no later than
30 days after the Non-Employee Director first becomes eligible to participate in the
Plan, with respect to compensation for services to be performed after the election, in
accordance with section 409A.

(f) An Employee who first accrues a benefit in the 2009 UGI SERP on or after October
1, 2009, may elect to have his or her benefit under the 2009 UGI SERP credited to the
Employee’s Account under this Plan as of the date of the Employee’s Separation from
Service. The election must be made before the first year in which the Employee accrues a
benefit under the 2009 UGI SERP (or any other nonqualified deferred compensation plan
that is aggregated with the 2009 UGI SERP for purposes of section 409A) or, in the case
of a newly hired Employee, not later than 30 days after the Employee first becomes
eligible to participate in the 2009 UGI SERP (or any other nonqualified deferred
compensation plan that is aggregated with the 2009 UGI SERP for purposes of section
409A), with respect to compensation for services to be performed after the election, in
accordance with section 409A.

(g) Each Employee or Non-Employee Director who makes an election under subsection
(a), (b), (c), (d), (e) or (f) shall elect, at the same time, the form and time of
payment of the benefits to be credited to his or her Account under this Plan, as
described in Section 3.3 below.

(h) Notwithstanding the foregoing, the Administrative Committee may impose such
rules and restrictions as it deems appropriate on Deferral Elections, in accordance with
section 409A, including rules and restrictions with respect to the ability of newly
promoted Employees to make Deferral Elections under the Plan.

 

6

 

	3.3	 	Election of Form and Time of Payment.
	 
	 	 	When an Employee or Non-Employee Director makes an election pursuant
to Section 3.2, the Employee or Non-Employee Director shall select one
or more of the following
forms and times of payment under the Plan for amounts credited from the UGI SERP,
AmeriGas SERP, Stock Units or Phantom Units, as applicable:

(a) An Employee may elect that the Employee’s benefits under the UGI Plans or the
AmeriGas SERP be paid in a lump sum payment within 30 business days after the Employee’s
Separation from Service date, subject to the Postponement Period for section 409A. A
Non-Employee Director may elect that his or her Stock Units or Phantom Units shall be
paid in a lump sum payment within 30 business days after his or her Separation from
Service date. To the extent that any benefits under the UGI Plans, AmeriGas SERP
benefits, Stock Units or Phantom Units are to be paid in a lump sum under this subsection
(a), such benefits, Stock Units or Phantom Units shall be paid in accordance with the UGI
Plans, AmeriGas SERP, Stock Unit Agreements or Phantom Unit Grant Letters, as applicable,
and no Account for such benefits, Stock Units or Phantom Units will be established under
this Plan.

(b) A Participant may elect that as of the Participant’s Separation from Service
date, the amounts deferred from the UGI Plans, AmeriGas SERP, Stock Units or Phantom
Units, as applicable, shall be credited to a Retirement Distribution Account and shall be
paid in installments over two to 10 years. The payments shall commence 14 months after
the Participant’s Separation from Service date and shall be paid annually thereafter in
the calendar year following the first payment and subsequent calendar years.

(c) A Participant may elect that as of the Participant’s Separation from Service
date, the amounts deferred from the UGI Plans, AmeriGas SERP, Stock Units or Phantom
Units, as applicable, shall be credited to up to five Retirement Distribution Accounts,
each of which shall be paid in a lump sum in the year specified by the Participant. The
first Retirement Distribution Account shall become payable 14 months after the
Participant’s Separation from Service date, unless the Participant has elected otherwise
in accordance with the Plan.

	3.4	 	Delivery Instructions
	 
	 	 	Each Participant’s deferral election must be made in writing on the
distribution election form attached hereto as Exhibits A, B, C, D or
E, as applicable, or similar forms, and must be filed with the
Company’s Corporate Secretary.

 

7

 

ARTICLE 4

Distributions to Participants

	4.1	 	Separation from Service.
	 
	 	 	When a Participant Separates from Service, the amounts to be credited
from the UGI Plans, AmeriGas SERP, Stock Units or Phantom Units, as
applicable, shall be credited to the Participant’s Account under this
Plan in accordance with the Participant’s distribution election pursuant to Section 3.3. The amounts shall be distributed as
follows:

(a) If the Participant has elected a lump sum payment under Section 3.3(a), the
amount shall be distributed in a lump sum payment as described in Section 3.3(a) under
the UGI Plans, AmeriGas SERP, Stock Unit Agreement or Phantom Unit Grant Letter, as
applicable.

(b) If the Participant has elected installment payments under Section 3.3(b), the
amount shall be distributed in the number of installments elected, as described in
Section 3.3(b). The installments will be paid annually, and each installment will be
calculated as the amount credited to the Participant’s Retirement Distribution Account
immediately before the distribution date, divided by the number of remaining years in the
payment schedule.

(c) If the Participant has elected one to five Retirement Distribution Accounts
under Section 3.3(c), each Retirement Distribution Account shall be paid in a lump sum on
the specified date after the Participant’s Separation from Service.

(d) If a Participant has not elected the form and timing of payment, the amount will
be distributed in a lump sum payment as described in Section 3.3(a).

(e) Notwithstanding the foregoing or any elections to the contrary, if the total
amounts credited to the Participant’s aggregate Retirement Distribution Accounts is less
than $25,000 at the Participant’s Separation from Service date, distribution shall be
made in a lump sum payment as described in Section 3.3(a).

	4.2	 	Death

(a) If a Participant dies before Separation from Service, the Participant’s benefit
under the UGI SERP will be paid to his or her surviving spouse in the form designated by
the Participant under Section 3.3. If a Participant dies before Separation from Service
and does not have a surviving spouse, no death benefit will be paid under the UGI SERP.
If a Participant dies after Separation from Service, the Participant’s benefit under the
UGI SERP will be paid to his or her Beneficiary in the form and at the time designated by
the Participant under Section 3.3.

(b) If a Participant dies before or after Separation from Service, the Participant’s
benefit under the AmeriGas SERP, the 2009 UGI SERP, the Participant’s Stock Units or
Phantom Units, as applicable, will be paid to his or her Beneficiary in the form and at
the time designated by the Participant under Section 3.3.

 

8

 

	4.3	 	Re-Deferral Elections.
	 
	 	 	Subject to the timing requirements described below, a Participant may
change his or her elections regarding the time and form of
distribution (a “Re-Deferral Election”), as follows:

(a) A Participant who has previously elected to receive his or her distribution in
the form of a lump sum (or whose distribution is payable in a lump sum by operation of
the Plan) may elect to re-defer all or any part of that scheduled distribution to a later
date pursuant to subsection (b) below. A Participant who has previously elected to
receive his or her distribution in the form of installments may elect to re-defer the
entire distribution amount to a later date, provided that the election must be made
pursuant to subsection (b) below before the installment payments begin.

(b) Any Re-Deferral Election (i) will be irrevocable when made, (ii) may not
accelerate the payment (in the case of installments, the Re-Deferral Election may not
accelerate the first scheduled payment), (iii) will not be effective as to any payment
scheduled to be made within 12 months of the Re-Deferral Election and (iv) must defer the
first payment to which the Re-Deferral Election applies for at least five additional
years. All Re-Deferral Elections must be made in accordance with section 409A of the
Code.

(c) No Re-Deferral Election may be made by a Participant who Separates from Service
before the Participant has attained age 55 and has completed 10 years of service with the
Employer. No Re-Deferral Election may be made after a Participant’s death. No
Re-Deferral Election may be made after the tenth anniversary of the Participant’s
Separation from Service.

(d) In addition, in no event may a Participant make a Re-Deferral Election unless
the Participant’s Retirement Distribution Account to be re-deferred is at least $25,000
at the time of the election.

(e) Notwithstanding the foregoing, the Company reserves the right to reject any new
Re-Deferral Election, in which case the applicable Account will be distributed in
accordance with the Participant’s deferral election or Re-Deferral Election then in
effect.

(f) A Participant’s Re-Deferral Election must be made in writing and filed with the
Company’s Corporate Secretary. The Company must acknowledge receipt of the Re-Deferral
Election in order for the Re-Deferral Election to be valid. The Re-Deferral Election must
designate a form and time of payment described in Section 3.3, except that the payment
date shall be postponed as described in the Re-Deferral Election. All references in
Sections 4.1 and 4.2 to payment dates and forms under Section 3.3 shall be deemed to
include any applicable Re-Deferral Elections.

 

9

 

	4.4	 	Change of Control.

(a) The following provisions apply in the event of a Change of Control of the
Company, notwithstanding anything in the Plan to the contrary:

(i) A Change of Control will not affect the form and timing of distribution of the
benefits under the UGI Plans and the AmeriGas SERP that are deferred under this Plan.

(ii) In the event of a Change of Control that is a change in control event under
section 409A of the Code, the Company shall redeem all the Stock Units then credited to
the Participant’s Account and the redemption amount shall be paid in cash on the closing
date of the Change of Control. The amount paid shall equal the product of the number of
Stock Units being redeemed multiplied by the Unit Value at the date of the Change of
Control.

(iii) In the event that the transaction constituting a Change of Control is not a
change in control event under section 409A of the Code, the Participant’s Stock Units
shall be redeemed and paid in cash within 30 business days after the Participant’s
Separation from Service date, instead of upon the Change of Control. (For example, an
acquisition by any person of 20% or more of the voting power of the Company’s stock may
be a Change of Control under the Equity Plan, whereas the section 409A definition
requires that the person acquire 30% of the voting power of the stock). If the Change of
Control is not a change in control event under section 409A of the Code and the
Participant Separated from Service before the Change of Control, the Participant’s Stock
Units shall be paid in cash at the applicable date specified in Section 4.1, 4.2 or 4.3.
If payment is delayed after the Change of Control pursuant to this subsection (iii), the
Compensation Committee may provide for the Stock Units to be valued at the Unit Value as
of the date of the Change of Control and interest to be credited on the amount so
determined at a market rate for the period between the Change of Control date and the
payment date.

(b) The following provisions apply in the event of an AmeriGas LTIP Change of
Control, notwithstanding anything in the Plan to the contrary:

(i) In the event of an AmeriGas LTIP Change of Control that is a change in control
event under section 409A of the Code, APLP shall redeem all the Phantom Units then
credited to the Participant’s Account and the redemption amount shall be paid in cash on
the closing date of the AmeriGas LTIP Change of Control. The amount paid shall equal the
product of the number of Phantom Units being redeemed multiplied by the Unit Value at the
date of the AmeriGas LTIP Change of Control.

(ii) In the event that the transaction constituting an AmeriGas LTIP Change of
Control is not a change in control event under section 409A of the Code, the
Participant’s Phantom Units shall be redeemed and paid in cash within 30 business days
after the Participant’s Separation from Service date, instead of upon the AmeriGas LTIP
Change of Control. If the AmeriGas LTIP Change of Control is not a change in control
event under section 409A of the Code and the Participant Separated from Service before
the AmeriGas LTIP Change of Control, the Participant’s Phantom Units shall be paid in
cash at the applicable date specified in Section 4.1, 4.2 or 4.3. If payment is delayed
after the AmeriGas LTIP Change of Control, pursuant to this
subsection (ii), the Compensation Committee may provide for the Phantom Units to be
valued at the Unit Value as of the date of the AmeriGas LTIP Change of Control and
interest to be credited on the amount so determined at a market rate for the period
between the AmeriGas LTIP Change of Control date and the payment date.

 

10

 

	4.5	 	Medium of Payment. All distributions under the Plan shall be made in cash, except
that (i) distributions of Stock Units (including Dividend Equivalents) shall be made 65% in
Company common stock issued under the Equity Plan and 35% in cash, or as otherwise specified
under the applicable Stock Unit Agreement or under Section 4.4, and (ii) distributions of
Phantom Units (including Distribution Equivalents) shall be made 65% in Common Units issued
under the 2010 AmeriGas LTIP and 35% in cash, or as otherwise specified under the applicable
Phantom Unit Grant Letter or under Section 4.4.

	4.6	 	Section 409A Six-Month Delay.
	 
	 	 	Notwithstanding any provision of the Plan to the contrary,
distributions upon a Separation from Service to a Participant who is a
Key Employee shall not be made during the Participant’s Postponement
Period. If payment is required to be delayed for the Postponement
Period pursuant to section 409A, the accumulated amounts withheld on
account of section 409A shall be paid in a lump sum payment within 15
days of the Postponement Period. If the Participant dies during the
Postponement Period prior to the distribution of the Participant’s
Retirement Distribution Account, the amounts withheld on account of
section 409A shall be paid to the Participant’s estate within 60 days
after the Participant’s death.

ARTICLE 5

Vesting

	5.1	 	The balance credited to a Participant’s Account shall be fully vested at all times.

ARTICLE 6

Funding

	6.1	 	The Board may, but shall not be required to, authorize the establishment of a rabbi trust for
the benefits described herein. In any event, the Company’s obligation hereunder shall
constitute a general, unsecured obligation, payable solely out of its general assets, and no
Participant shall have any right to any specific assets of the Company or any such vehicle.

 

11

 

ARTICLE 7

Investments

	7.1	 	After a Participant’s Separation from Service, amounts credited to the Plan from the UGI
Plans, AmeriGas SERP, Stock Units or Phantom Units shall be credited with earnings and losses
as follows:

(a) Amounts credited to a Participant’s Retirement Distribution Account from the UGI
Plans or the AmeriGas SERP that are to be paid pursuant to Section 3.3(b) or 3.3(c) shall
be deemed to be invested in investment funds according to procedures established by the
Administrative Committee. The Participant may select the investment funds from among the
funds made available by the Administrative Committee. If a Participant does not select
the investment funds, the amounts credited for the Participant shall be deemed invested
in a target retirement fund selected by the Administrative Committee.

(b) Stock Units that are credited to the Plan and are to be paid pursuant to Section
3.3(b) or 3.3(c) shall continue to be held in the form of Stock Units. Dividend
Equivalents shall be credited to the Participant’s Account with respect to Stock Units
when dividends are paid on Company common stock, in an amount equal to the Dividend
Equivalent associated with the Stock Units held by the Participant on the record date for
the dividend. On the last day of each calendar year, the amount of the Dividend
Equivalents credited to the Participant’s Account during that calendar year shall be
converted to a number of Stock Units, based on the Unit Value on the last day of that
calendar year. In the event of a Change of Control or in the event the Participant dies
or Separates from Service prior to the last day of a calendar year, as soon as
practicable following such event, and in no event later than the date on which Stock
Units are distributed, the Company shall convert the amount of Dividend Equivalents
previously credited to the Participant’s Account during the calendar year to a number of
Stock Units based on the Unit Value on the date of such Change of Control, death or
Separation from Service, as applicable.

(c) Phantom Units that are credited to the Plan and are to be paid pursuant to
Section 3.3(b) or 3.3(c) shall continue to be held in the form of Phantom Units.
Distribution Equivalents shall be credited to the Participant’s Account with respect to
Phantom Units when distributions are paid on Common Units, in an amount equal to the
Distribution Equivalent associated with the Phantom Units held by the Participant on the
record date for the distribution. On the last day of each calendar year, the amount of
the Distribution Equivalents credited to the Participant’s Account during that calendar
year shall be converted to a number of Phantom Units, based on the Unit Value on the last
day of that calendar year. In the event of an AmeriGas LTIP Change of Control or in the
event the Participant dies or Separates from Service prior to the last day of a calendar
year, as soon as practicable following such event, and in no event later than the date on
which Phantom Units are distributed, the Company shall convert the amount of Distribution
Equivalents previously credited to the Participant’s Account during the calendar year to
a number of Phantom Units based on the Unit Value on the date of such AmeriGas LTIP
Change of Control, death or Separation from Service, as applicable.

 

12

 

	7.2	 	Each Participant’s Account shall be adjusted periodically to take into account the gains,
losses and income returns of the deemed investments selected by the Participant or as
otherwise provided under this Article 7. The Employer shall not be required to invest any
funds in the forms of investment made available hereunder and, in any event, any such
investments shall at all times remain the property of the Employer.

ARTICLE 8

Administration

	8.1	 	Appointment and Tenure of Administrative Committee Members. The Administrative
Committee shall consist of one or more persons who shall be appointed by and serve at the
pleasure of the Compensation Committee. Any Administrative Committee member may resign by
delivering his or her written resignation to the Compensation Committee. Vacancies arising by
the death, resignation or removal of an Administrative Committee member may be filled by the
Compensation Committee.

	8.2	 	Meetings; Majority Rule. Any and all acts of the Administrative Committee taken at a
meeting shall be by a majority of all members of the Administrative Committee. The
Administrative Committee may act by vote taken in a meeting (at which a majority of members
shall constitute a quorum). The Administrative Committee may also act by unanimous consent in
writing without the formality of convening a meeting.

	8.3	 	Delegation. The Administrative Committee may, by majority decision, delegate to each
or any one of its members, authority to sign any documents on its behalf, or to perform
ministerial acts, but no person to whom such authority is delegated shall perform any act
involving the exercise of any discretion without first obtaining the concurrence of a majority
of the members of the Administrative Committee, even though such person alone may sign any
document required by third parties. The Administrative Committee shall elect one of its
members to serve as Chairperson. The Chairperson shall preside at all meetings of the
Administrative Committee or shall delegate such responsibility to another Administrative
Committee member. The Administrative Committee shall elect one person to serve as Secretary
to the Administrative Committee. All third parties may rely on any communication signed by
the Secretary, acting as such, as an official communication from the Administrative Committee.

 

13

 

	8.4	 	Authority and Responsibility of the Administrative Committee. The Administrative
Committee shall have only such authority and responsibilities as are delegated to it by the
Compensation Committee or specifically provided herein. The Administrative Committee shall
have full power and express discretionary authority to administer and interpret the Plan, to
make factual determinations and to adopt or amend such rules and regulations for implementing
the Plan and for the conduct of its business as it deems necessary or advisable, in its sole
discretion. The Administrative Committee’s authorities and responsibilities shall also
include:

(a) maintenance and preservation of records relating to Participants, former
Participants, and their beneficiaries;

(b) preparation and distribution to Participants of all information and notices
required under Federal law or the provisions of the Plan;

(c) preparation and filing of all governmental reports and other information
required under law to be filed or published;

(d) engagement of assistants and professional advisers;

(e) arrangement for bonding, if required by law; and

(f) promulgation of procedures for determination of claims for benefits.

	8.5	 	Compensation of Administrative Committee Members. The members of the Administrative
Committee shall serve without compensation for their services as such, but all expenses of the
Administrative Committee shall be paid or reimbursed by the Company.

	8.6	 	Administrative Committee Discretion. Any discretion, actions, or interpretations to
be made under the Plan by the Administrative Committee shall be made in its sole discretion,
need not be uniformly applied to similarly situated individuals, and shall be final, binding,
and conclusive on the parties. All benefits under the Plan shall be provided conditional upon
the Participant’s acknowledgement, in writing or by acceptance of the benefits, that all
decisions and determinations of the Administrative Committee shall be final and binding on the
Participant, his or her Beneficiaries and any other person having or claiming an interest
under the Plan.

	8.7	 	Indemnification of the Administrative Committee. Each member of the Administrative
Committee shall be indemnified by the Company against costs, expenses and liabilities (other
than amounts paid in settlement to which the Company does not consent) reasonably incurred by
him or her in connection with any action to which he or she may be a party by reason of his or
her service as a member of the Administrative Committee, except in relation to matters as to
which he or she shall be adjudged in such action to be personally guilty of gross negligence
or willful misconduct in the performance of his or her duties. The foregoing right to
indemnification shall be in addition to such other rights as the Administrative Committee
member may enjoy as a matter of law or by reason of insurance coverage of any kind, but shall
not extend to costs, expenses and/or liabilities otherwise covered by insurance or that would
be so covered by any insurance then in force if such insurance contained a waiver of
subrogation. Rights granted hereunder shall be in addition to and not in lieu of any rights
to indemnification to which the Administrative Committee member may be entitled pursuant to
the by-laws of the Company. Service on the Administrative Committee shall be deemed in
partial fulfillment of the Administrative Committee member’s function as an employee, officer
and/or director of the Company, if he or she serves in that capacity as well as in the role of
Administrative Committee member.

 

14

 

Article 9

Claims Procedure

	9.01	 	Claim. Any person or entity claiming a benefit, requesting an interpretation or
ruling under the Plan (hereinafter referred to as “claimant”), or requesting information under
the Plan shall present the request in writing to the Administrative Committee, which shall
respond in writing or electronically. The notice advising of the denial shall be furnished to
the claimant within 90 days of receipt of the benefit claim by the Administrative Committee,
unless special circumstances require an extension of time to process the claim. If an
extension is required, the Administrative Committee shall provide notice of the extension
prior to the termination of the 90 day period. In no event may the extension exceed a total
of 180 days from the date of the original receipt of the claim.

	9.02	 	Denial of Claim. If the claim or request is denied, the written or electronic notice
of denial shall state:

(a) The reasons for denial;

(b) Reference to the specific Plan provisions on which the denial is based;

(c) A description of any additional material or information required and an
explanation of why it is necessary; and

(d) An explanation of the Plan’s claims review procedures and the time limits
applicable to such procedures, including the right to bring a civil action under section
502(a) of ERISA.

	9.03	 	Final Decision. The decision on review shall normally be made within 60 days after
the Administrative Committee’s receipt of claimant’s claim or request. If an extension of
time is required for a hearing or other special circumstances, the claimant shall be notified
and the time limit shall be 120 days. The decision shall be in writing or in electronic form
and shall:

(a) State the specific reasons for the denial;

(b) Reference the relevant Plan provisions;

(c) State that the claimant is entitled to receive, upon request and free of
charge, and have reasonable access to and copies of all documents, records and other
information relevant to the claim for benefits; and

(d) State that the claimant may bring an action under section 502(a) of ERISA.

All decisions on review shall be final and binding on all parties concerned.

 

15

 

	9.04	 	Review of Claim. Any claimant whose claim or request is denied or who has not
received a response within 60 days may request a review by notice given in writing or
electronic form to the Administrative Committee. Such request must be made within 60 days
after receipt by the claimant of the written or electronic notice of denial, or in the event
the claimant has not received a response, 60 days after receipt by the Administrative
Committee of the claimant’s claim or request. The claim or request shall be reviewed by the
Administrative Committee which may, but shall not be required to, grant the claimant a
hearing. On review, the claimant may have representation, examine pertinent documents, and
submit issues and comments in writing.

ARTICLE 10

Amendment

	10.1	 	The provisions of the Plan may be amended at any time and from time to time by the
Compensation Committee for any reason without either the consent of or prior notice to any
Participant; provided, however, that no such amendment shall serve to reduce the benefit that
has been credited to an Account on behalf of a Participant as of the effective date of the
amendment.

ARTICLE 11

Termination

	11.1	 	While it is the Company’s intention to continue the Plan indefinitely in operation, the
Compensation Committee may terminate the Plan in whole or in part at any time for any reason
without either the consent of or prior notice to any Participant. No such termination shall
reduce the benefit that has been credited to an Account on behalf of a Participant as of the
effective date of the termination, but the Company may distribute all accrued benefits upon
termination of the Plan in accordance with section 409A of the Code.

 

16

 

ARTICLE 12

Miscellaneous

	12.1	 	Nonalienation of Benefits. None of the payments, benefits or rights of any
Participant under the Plan shall be subject to any claim of any creditor, and, in particular,
to the fullest extent permitted by law, all such payments, benefits and rights shall be free
from attachment, garnishment, trustee’s process, or any other legal or equitable process
available to any creditor of such Participant. No Participant shall have the right to alienate, anticipate, commute, pledge, encumber or assign any of the benefits or
payments which he or she may expect to receive, contingently or otherwise, under the
Plan.

	12.2	 	Compensation. Any amounts payable hereunder shall not be deemed salary or other
compensation to a Participant for the purposes of computing benefits to which the Participant
may be entitled under any other arrangement established by the Employer for the benefit of its
employees.

	12.3	 	No Contract of Employment. Neither the establishment of the Plan, nor any
modification thereof, nor the creation of any fund, trust or account, nor the payment of any
benefits shall be construed as giving any Participant or Employee, or any person whomsoever,
the right to be retained in the service of the Company or any other participating employer
hereunder, and all Participants and other Employees shall remain subject to discharge to the
same extent as if the Plan had never been adopted.

	12.4	 	Severability of Provisions. If any provision of the Plan shall be held invalid or
unenforceable, such invalidity or unenforceability shall not affect any other provisions
hereof, and the Plan shall be construed and enforced as if such provision had not been
included.

	12.5	 	Heirs, Assigns and Personal Representatives. The Plan shall be binding upon the
heirs, executors, administrators, successors and assigns of the parties, including each
Participant, present and future.

	12.6	 	Successors. Unless the Compensation Committee directs otherwise before a Change of
Control, in the event of a Change of Control, the Company shall require any successor or
successors (whether direct or indirect, by purchase, merger, consolidation or otherwise) to
all or substantially all of the business and/or assets of the Company thereof, (i) to
acknowledge expressly that this Plan is binding upon and enforceable against such successor in
accordance with the terms hereof, (ii) to become jointly and severally obligated with the
Company to perform the obligations under this Plan, and (iii) to agree not to amend or
terminate the Plan for a period of three years after the date of succession without the
consent of the affected Participant.

	12.7	 	Headings and Captions. The headings and captions herein are provided for reference
and convenience only, and shall not be considered part of the Plan, and shall not be employed
in the construction of the Plan.

	12.8	 	Controlling Law. The Plan shall be construed and enforced according to the laws of
the Commonwealth of Pennsylvania, exclusive of conflict of law provisions thereof, to the
extent not preempted by Federal law, which shall otherwise control.

	12.9	 	Payments to Minors, Etc. Any benefit payable to or for the benefit of a minor, an
incompetent person or other person incapable of receipting therefore shall be deemed paid when
paid to such person’s guardian or to the party providing or reasonably appearing to provide for the care of such person, and such payment shall fully discharge
the Company, the Board, the Compensation Committee, the Administrative Committee and all
other parties with respect thereto.

 

17

 

	12.10	 	Reliance on Data and Consents. The Company, the Board, the Compensation Committee,
the Administrative Committee and all other persons or entities associated with the operation
of the Plan, and the provision of benefits thereunder, may reasonably rely on the truth,
accuracy and completeness of all data provided by the Participant, including, without
limitation, data with respect to age, health and marital status. Furthermore, the Company,
the Board, the Compensation Committee and the Administrative Committee may reasonably rely on
all consents, elections and designations filed with the Plan or those associated with the
operation of the Plan by any Participant, or the representatives of any such person without
duty to inquire into the genuineness of any such consent, election or designation. None of
the aforementioned persons or entities associated with the operation of the Plan or the
benefits provided under the Plan shall have any duty to inquire into any such data, and all
may rely on such data being current to the date of reference, it being the duty of the
Participants to advise the appropriate parties of any change in such data.

12.11 Section 409A

(a) The Plan is intended to comply with the requirements of section 409A of the
Code, and shall in all respects be administered in accordance with section 409A.
Notwithstanding anything in the Plan to the contrary, distributions may only be made
under the Plan upon an event and in a manner permitted by section 409A of the Code. To
the extent that any provision of the Plan would cause a conflict with the requirements of
section 409A of the Code, or would cause the administration of the Plan to fail to
satisfy the requirements of section 409A, such provision shall be deemed null and void to
the extent permitted by applicable law. In no event shall a Participant, directly or
indirectly, designate the calendar year of payment, except as permitted by section 409A
of the Code.

(b) If a Participant is subject to tax under the Federal Insurance Contribution Act
(FICA) on his or her Account before distributions are to be made under the Plan, a
distribution may be made under the Plan to pay the FICA tax imposed under section 3101 of
the Code, section 3121(a) of the Code, and section 3121(v)(2) of the Code, or to pay the
income tax at source on wages imposed under section 3401 of the Code or the corresponding
withholding provisions of applicable state, local, or foreign tax laws as a result of the
payment of the FICA amount, and to pay the additional income tax at source on wages
attributable to the pyramiding section 3401 of the Code wages and taxes. The total
payment made pursuant to this subsection must not exceed the aggregate FICA and related
tax amount permitted under section 409A of the Code.

 

18

 

	12.11	 	Stock Units Subject to Equity Plan Provisions. In addition to the provisions of
this Plan, Stock Units shall be governed by the Equity Plan and the Terms and Conditions
established with respect to the Equity Plan, both of which are incorporated herein by reference. Stock Units shall be interpreted and administered in accordance with the
Equity Plan, including provisions pertaining to (i) the registration, qualification or
listing of the shares of Company common stock, (ii) changes in capitalization of the
Company and (iii) other requirements of applicable law.

	12.12	 	Phantom Units Subject to 2010 AmeriGas LTIP Provisions. In addition to the
provisions of this Plan, Phantom Units shall be governed by the 2010 AmeriGas LTIP and the
Terms and Conditions established with respect to the 2010 AmeriGas LTIP, both of which are
incorporated herein by reference. Phantom Units shall be interpreted and administered in
accordance with the 2010 AmeriGas LTIP, including provisions pertaining to (i) the
registration, qualification or listing of the Common Units, (ii) changes in capitalization of
APLP and (iii) other requirements of applicable law.

 

19

 

Exhibit A

Distribution Election Form — UGI SERP Participants

	 	 	 
	UGI Corporation 

2009 Deferral Plan

	 	Distribution Election Form — UGI SERP Participants

	 	 	 	 	 
	Name
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Address
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Daytime Phone Number
	 	 	 	 
	 

	 	 

	 	 

Under the UGI Corporation 2009 Deferral Plan (the “Deferral Plan”), you may elect to have your
accrued benefit in the UGI Corporation Supplemental Executive Retirement Plan (“UGI SERP”) at
separation from service credited to the Deferral Plan upon your separation from service. If you
wish to do this, you must also elect the time and form of payment of the account that will be
established for you under the Deferral Plan. The alternative times and forms of payment are listed
below.

You should review the Deferral Plan document for a complete description of how the Deferral Plan
works. The capitalized terms used below are defined in the Deferral Plan. This election is
subject to the terms and conditions of the Deferral Plan, which are incorporated herein by
reference.

Please complete and return this form to the Corporate Secretary, UGI Corporation, 460 Gulph Road,
King of Prussia, PA 19406.

I. TIME AND FORM OF PAYMENT (After Separation from Service)

Note: You may check one form of payment for your entire UGI SERP benefit, or you may specify that
your UGI SERP benefit will be paid in several forms of payment, by specifying whole percentages. If
you specify several forms of payment, you should make sure that the percentages add up to 100%.

Upon Separation from Service, I elect to have my UGI SERP benefit distributed as follows:

	 	A.	 	Lump Sum Payment:

	 	•	 	Lump sum payment at my Separation from Service. (Note: Under section
409A of the Internal Revenue Code, this payment will be made six months following
your Separation from Service.)

This election applies to                     % of my UGI SERP benefit.

	 	B.	 	Installment Payments:

	 	•	 	Payments in                      (Note: Fill in 2 to 10) annual installments,
commencing 14 months following my Separation from Service, and annually
thereafter in the calendar year following the first payment and subsequent
calendar years.

This election applies to                     % of my UGI SERP benefit.

 

20

 

	 	C.	 	One to Five Retirement Distribution Accounts:

	 	•	 	Retirement Distribution Account #1 — Lump sum payment 14 months following my
Separation from Service. This election applies to                     % of my UGI SERP
benefit.

	 	•	 	Retirement Distribution Account #2 — Lump sum payment in the first calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my UGI SERP benefit.

	 	•	 	Retirement Distribution Account #3 — Lump sum payment in the second calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my UGI SERP benefit.

	 	•	 	Retirement Distribution Account #4 — Lump sum payment in the third calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my UGI SERP benefit.

	 	•	 	Retirement Distribution Account #5 — Lump sum payment in the fourth calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my UGI SERP benefit.

Note: These elections are irrevocable. Under the Deferral Plan and section 409A of the
Internal Revenue Code, you may make a Re-Deferral Election to postpone a payment, but not to
accelerate a payment. Any Re-Deferral Election must be made at least one year before the scheduled
payment date and must postpone payment for at least five years beyond the scheduled payment
date. Re-Deferral Elections are subject to other restrictions described in the Deferral Plan.

II. BENEFICIARY DESIGNATION

Note: If you die before your Separation from Service, only your surviving spouse will
receive a benefit under the UGI SERP. No other death benefits are provided under the UGI SERP in
the event of death before Separation from Service.

If you die after Separation from Service but before your UGI SERP benefit has been
completely distributed, your unpaid benefit will be payable to your designated Beneficiary. If you
designate more than one Beneficiary, you should make sure that the percentages add up to 100%.

Beneficiary Designation: I designate the following persons to be the Beneficiary of my UGI SERP
benefit (including my account under the Deferral Plan) if I die after Separation from
Service. If any designated Beneficiary is not living (or is not in existence) at my death, then
that Beneficiary’s share shall be allocated pro rata to the other surviving Beneficiaries. If no
designated Beneficiary is living (or is in existence) at my death, then my Beneficiary shall be my
estate. (Note: If more than one Beneficiary is named, please indicate percentage to be paid
to each.)

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

 

21

 

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

The foregoing Beneficiary designation supersedes and replaces any previous Beneficiary designation
that I may have made under the UGI SERP or the Deferral Plan.

III. ACKNOWLEDGMENT AND SIGNATURE

By signing this election form, I understand that these elections are made in accordance with and
are subject to the terms of the Deferral Plan. I understand and agree that the Deferral Plan’s
Administrative Committee shall have full power and express discretionary authority to interpret and
administer the Deferral Plan and to make all determinations with respect to the Deferral Plan. All
actions taken by the Deferral Plan’s Administrative Committee shall be final, conclusive and
binding upon all participants, beneficiaries, spouses and all other persons having an interest
therein.

These elections are irrevocable and are subject to the terms of the Deferral Plan.

	 	 	 
	 

	 	 
	Date

	 	Name

[To be completed by [_____]]

Filing Date

Date received by [_____]:
 _____, _____ 

 

22

 

Exhibit B

Distribution Election Form — AmeriGas SERP Participants

	 	 	 
	UGI Corporation 

2009 Deferral Plan

	 	Distribution Election Form — AmeriGas SERP Participants

	 	 	 	 	 
	Name
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Address
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Daytime Phone Number
	 	 	 	 
	 

	 	 

	 	 

Under the UGI Corporation 2009 Deferral Plan (the “Deferral Plan”), you may elect to have your
accrued benefit in the AmeriGas Propane, Inc. Supplemental Executive Retirement Plan (“AmeriGas
SERP”) at separation from service credited to the Deferral Plan upon your separation from service.
If you wish to do this, you must also elect the time and form of payment of the account that will
be established for you under the Deferral Plan. The alternative times and forms of payment are
listed below.

You should review the Deferral Plan document for a complete description of how the Deferral Plan
works. The capitalized terms used below are defined in the Deferral Plan. This election is
subject to the terms and conditions of the Deferral Plan, which are incorporated herein by
reference.

Please complete and return this form to the Corporate Secretary, UGI Corporation, 460 Gulph Road,
King of Prussia, PA 19406.

I. TIME AND FORM OF PAYMENT (After Separation from Service)

Note: You may check one form of payment for your entire AmeriGas SERP benefit, or you may specify
that your AmeriGas SERP benefit will be paid in several forms of payment, by specifying whole
percentages. If you specify several forms of payment, you should make sure that the percentages add
up to 100%.

Upon Separation from Service, I elect to have my AmeriGas SERP benefit distributed as follows:

	 	A.	 	Lump Sum Payment:

	 	•	 	Lump sum payment at my Separation from Service. (Note: Under section
409A of the Internal Revenue Code, this payment will be made six months following
your Separation from Service.)

This election applies to                     % of my AmeriGas SERP benefit.

	 	B.	 	Installment Payments:

	 	•	 	Payments in                      (Note: Fill in 2 to 10) annual installments,
commencing 14 months following my Separation from Service, and annually
thereafter in the calendar year following the first payment and subsequent
calendar years.

This election applies to                     % of my AmeriGas SERP benefit.

 

23

 

	 	C.	 	One to Five Retirement Distribution Accounts:

	 	•	 	Retirement Distribution Account #1 — Lump sum payment 14 months following my
Separation from Service. This election applies to                     % of my AmeriGas
SERP benefit.

	 	•	 	Retirement Distribution Account #2 — Lump sum payment in the first calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my AmeriGas SERP benefit.

	 	•	 	Retirement Distribution Account #3 — Lump sum payment in the second calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my AmeriGas SERP benefit.

	 	•	 	Retirement Distribution Account #4 — Lump sum payment in the third calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my AmeriGas SERP benefit.

	 	•	 	Retirement Distribution Account #5 — Lump sum payment in the fourth calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my AmeriGas SERP benefit.

Note: These elections are irrevocable. Under the Deferral Plan and section 409A of the
Internal Revenue Code, you may make a Re-Deferral Election to postpone a payment, but not to
accelerate a payment. Any Re-Deferral Election must be made at least one year before the scheduled
payment date and must postpone payment for at least five years beyond the scheduled payment
date. Re-Deferral Elections are subject to other restrictions described in the Deferral Plan.

II. BENEFICIARY DESIGNATION

If you die before receiving your entire AmeriGas SERP benefit, your benefit under the AmeriGas SERP
will be payable to your designated Beneficiary. If you designate more than one Beneficiary, you
should make sure that the percentages add up to 100%.

Beneficiary Designation: I designate the following persons to be the Beneficiary of my AmeriGas
SERP benefit (including my account under the Deferral Plan) if I die before or after Separation
from Service. If any designated Beneficiary is not living (or is not in existence) at my death,
then that Beneficiary’s share shall be allocated pro rata to the other surviving Beneficiaries. If
no designated beneficiary is living (or in existence) at my death, then my Beneficiary shall be my
estate. (Note: If more than one Beneficiary is named, please indicate percentage to be
paid to each.)

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

 

24

 

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

The foregoing Beneficiary designation supersedes and replaces any previous Beneficiary designation
that I may have made under the AmeriGas SERP or the Deferral Plan.

III. ACKNOWLEDGMENT AND SIGNATURE

By signing this election form, I understand that these elections are made in accordance with and
are subject to the terms of the Deferral Plan. I understand and agree that the Deferral Plan’s
Administrative Committee shall have full power and express discretionary authority to interpret and
administer the Deferral Plan and to make all determinations with respect to the Deferral Plan. All
actions taken by the Deferral Plan’s Administrative Committee shall be final, conclusive and
binding upon all participants, beneficiaries, spouses and all other persons having an interest
therein.

These elections are irrevocable and are subject to the terms of the Deferral Plan.

	 	 	 
	 

	 	 
	Date

	 	Name

[To be completed by [_____]]

[To be completed by [_____]]

Filing Date

Date received by [_____]:
 _____, _____ 

 

25

 

Exhibit C

Distribution Election Form — Non-Employee Directors

	 	 	 
	UGI Corporation 

2009 Deferral Plan

	 	Distribution Election Form — UGI Non-Employee Directors

	 	 	 	 	 
	Name
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Address
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Daytime Phone Number
	 	 	 	 
	 

	 	 

	 	 

Under the UGI Corporation 2009 Deferral Plan (the “Deferral Plan”), you may elect to have your
outstanding Stock Units at separation from service credited to the Deferral Plan upon your
separation from service. If you wish to do this, you must also elect the time and form of payment
of the account that will be established for you under the Deferral Plan. The alternative times and
forms of payment are listed below.

You should review the Deferral Plan document for a complete description of how the Deferral Plan
works. The capitalized terms used below are defined in the Deferral Plan. This election is
subject to the terms and conditions of the Deferral Plan, which are incorporated herein by
reference.

Please complete and return this form to the Corporate Secretary, UGI Corporation, 460 Gulph Road,
King of Prussia, PA 19406.

I. TIME AND FORM OF PAYMENT (After Separation from Service)

Note: You may check one form of payment for all of your Stock Units, or you may specify that your
Stock Units be paid in several forms of payment, by specifying whole percentages. If you specify
several forms of payment, you should make sure that the percentages add up to 100%.

Upon Separation from Service, I elect to have my Stock Units distributed as follows:

	 	A.	 	Lump Sum Payment:

	 	•	 	Lump sum payment at my Separation from Service.

This election applies to                     % of my Stock Units.

	 	B.	 	Installment Payments:

	 	•	 	Payments in
 _____ 

(Note: Fill in 2 to 10) annual installments,
commencing 14 months following my Separation from Service, and annually
thereafter in the calendar year following the first payment and subsequent
calendar years.

This election applies to                     % of my Stock Units.

 

26

 

	 	C.	 	One to Five Retirement Distribution Accounts:

	 	•	 	Retirement Distribution Account #1 — Lump sum payment 14 months following my
Separation from Service. This election applies to                     % of my Stock
Units.

	 	•	 	Retirement Distribution Account #2 — Lump sum payment in the first calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Stock Units.

	 	•	 	Retirement Distribution Account #3 — Lump sum payment in the second calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Stock Units.

	 	•	 	Retirement Distribution Account #4 — Lump sum payment in the third calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Stock Units.

	 	•	 	Retirement Distribution Account #5 — Lump sum payment in the fourth calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Stock Units.

Note: These elections are irrevocable. Under the Deferral Plan and section 409A of the
Internal Revenue Code, you may make a Re-Deferral Election to postpone a payment, but not to
accelerate a payment. Any Re-Deferral Election must be made at least one year before the scheduled
payment date and must postpone payment for at least five years beyond the scheduled payment
date. Re-Deferral Elections are subject to other restrictions described in the Deferral Plan.

II. BENEFICIARY DESIGNATION

If you die before payment of all your Stock Units, your Stock Units will be payable to your
designated Beneficiary, notwithstanding any provision of your Stock Unit agreement to the contrary.
If you designate more than one Beneficiary, you should make sure that the percentages add up to
100%.

Beneficiary Designation: I designate the following persons to be the Beneficiary under the Deferral
Plan if I die before or after Separation from Service. If any designated Beneficiary is not living
(or is not in existence) at my death, then that Beneficiary’s share shall be allocated pro rata to
the other surviving Beneficiaries. If no designated Beneficiary is living (or in existence) at my
death, then my Beneficiary shall be my estate. (Note: If more than one Beneficiary is
named, please indicate percentage to be paid to each.)

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

 

27

 

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

The foregoing Beneficiary designation supersedes and replaces any previous Beneficiary designation
that I may have made with respect to the Stock Units under the Deferral Plan.

III. ACKNOWLEDGMENT AND SIGNATURE

By signing this election form, I understand that these elections are made in accordance with and
are subject to the terms of the Deferral Plan. I understand and agree that the Deferral Plan’s
Administrative Committee shall have full power and express discretionary authority to interpret and
administer the Deferral Plan and to make all determinations with respect to the Deferral Plan. All
actions taken by the Deferral Plan’s Administrative Committee shall be final, conclusive and
binding upon all participants, beneficiaries, spouses and all other persons having an interest
therein.

These elections are irrevocable and are subject to the terms of the Deferral Plan.

	 	 	 
	 

	 	 
	Date

	 	Name

[To be completed by [_____]]

Filing Date

Date received by [_____]:
 _____,
 _____ 

 

28

 

Exhibit D

Distribution Election Form — 2009 UGI SERP Participants

	 	 	 
	UGI Corporation 

2009 Deferral Plan

	 	Distribution Election Form — 2009 UGI SERP Participants

	 	 	 	 	 
	Name
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Address
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Daytime Phone Number
	 	 	 	 
	 

	 	 

	 	 

Under the UGI Corporation 2009 Deferral Plan (the “Deferral Plan”), you may elect to have your
accrued benefit in the UGI Corporation 2009 Supplemental Executive Retirement Plan (“2009 UGI
SERP”) at separation from service credited to the Deferral Plan upon your separation from service.
If you wish to do this, you must also elect the time and form of payment of the account that will
be established for you under the Deferral Plan. The alternative times and forms of payment are
listed below.

You should review the Deferral Plan document for a complete description of how the Deferral Plan
works. The capitalized terms used below are defined in the Deferral Plan. This election is
subject to the terms and conditions of the Deferral Plan, which are incorporated herein by
reference.

Please complete and return this form to the Corporate Secretary, UGI Corporation, 460 Gulph Road,
King of Prussia, PA 19406.

I. TIME AND FORM OF PAYMENT (After Separation from Service)

Note: You may check one form of payment for your entire 2009 UGI SERP benefit, or you may specify
that your 2009 UGI SERP benefit will be paid in several forms of payment, by specifying whole
percentages. If you specify several forms of payment, you should make sure that the percentages add
up to 100%.

Upon Separation from Service, I elect to have my 2009 UGI SERP benefit distributed as follows:

	 	A.	 	Lump Sum Payment:

	 	•	 	Lump sum payment at my Separation from Service. (Note: Under section
409A of the Internal Revenue Code, this payment will be made six months following
your Separation from Service.)

This election applies to                     % of my 2009 UGI SERP benefit.

	 	B.	 	Installment Payments:

	 	•	 	Payments in
 _____ 

(Note: Fill in 2 to 10) annual installments,
commencing 14 months following my Separation from Service, and annually
thereafter in the calendar year following the first payment and subsequent
calendar years.

This election applies to                     % of my 2009 UGI SERP benefit.

 

29

 

	 	C.	 	One to Five Retirement Distribution Accounts:

	 	•	 	Retirement Distribution Account #1 — Lump sum payment 14 months following my
Separation from Service. This election applies to                     % of my 2009 UGI
SERP benefit.

	 	•	 	Retirement Distribution Account #2 — Lump sum payment in the first calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my 2009 UGI SERP benefit.

	 	•	 	Retirement Distribution Account #3 — Lump sum payment in the second calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my 2009 UGI SERP benefit.

	 	•	 	Retirement Distribution Account #4 — Lump sum payment in the third calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my 2009 UGI SERP benefit.

	 	•	 	Retirement Distribution Account #5 — Lump sum payment in the fourth calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my 2009 UGI SERP benefit.

Note: These elections are irrevocable. Under the Deferral Plan and section 409A of the
Internal Revenue Code, you may make a Re-Deferral Election to postpone a payment, but not to
accelerate a payment. Any Re-Deferral Election must be made at least one year before the scheduled
payment date and must postpone payment for at least five years beyond the scheduled payment
date. Re-Deferral Elections are subject to other restrictions described in the Deferral Plan.

II. BENEFICIARY DESIGNATION

If you die before receiving your entire 2009 UGI SERP benefit, your benefit under the 2009 UGI
SERP will be payable to your designated Beneficiary. If you designate more than one Beneficiary,
you should make sure that the percentages add up to 100%.

Beneficiary Designation: I designate the following persons to be the Beneficiary of my 2009 UGI
SERP benefit (including my account under the Deferral Plan) if I die after Separation from
Service. If any designated Beneficiary is not living (or is not in existence) at my death, then
that Beneficiary’s share shall be allocated pro rata to the other surviving Beneficiaries. If no
designated Beneficiary is living (or is in existence) at my death, then my Beneficiary shall be my
estate. (Note: If more than one Beneficiary is named, please indicate percentage to be paid
to each.)

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

 

30

 

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

The foregoing Beneficiary designation supersedes and replaces any previous Beneficiary designation
that I may have made under the 2009 UGI SERP or the Deferral Plan.

III. ACKNOWLEDGMENT AND SIGNATURE

By signing this election form, I understand that these elections are made in accordance with and
are subject to the terms of the Deferral Plan. I understand and agree that the Deferral Plan’s
Administrative Committee shall have full power and express discretionary authority to interpret and
administer the Deferral Plan and to make all determinations with respect to the Deferral Plan. All
actions taken by the Deferral Plan’s Administrative Committee shall be final, conclusive and
binding upon all participants, beneficiaries, spouses and all other persons having an interest
therein.

These elections are irrevocable and are subject to the terms of the Deferral Plan.

	 	 	 
	 

	 	 
	Date

	 	Name

[To be completed by [_____]]

Filing Date

Date received by [_____]:  _____,
 _____ 

 

31

 

Exhibit E

Distribution Election Form — AmeriGas Non-Employee Directors

	 	 	 
	UGI Corporation 

2009 Deferral Plan

	 	Distribution Election Form — AmeriGas Non-Employee Directors

	 	 	 	 	 
	Name
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Address
	 	 	 	 
	 

	 	 

	 	 

	 	 	 	 	 
	Daytime Phone Number
	 	 	 	 
	 

	 	 

	 	 

Under the UGI Corporation 2009 Deferral Plan (the “Deferral Plan”), you may elect to have your
outstanding phantom units under the AmeriGas Propane, Inc. 2010 Long-Term Incentive Plan on behalf
of AmeriGas Partners, L.P. (“Phantom Units”) at separation from service credited to the Deferral
Plan upon your separation from service. If you wish to do this, you must also elect the time and
form of payment of the account that will be established for you under the Deferral Plan. The
alternative times and forms of payment are listed below.

You should review the Deferral Plan document for a complete description of how the Deferral Plan
works. The capitalized terms used below are defined in the Deferral Plan. This election is
subject to the terms and conditions of the Deferral Plan, which are incorporated herein by
reference.

Please complete and return this form to the Corporate Secretary, UGI Corporation, 460 Gulph Road,
King of Prussia, PA 19406.

I. TIME AND FORM OF PAYMENT (After Separation from Service)

Note: You may check one form of payment for all of your Phantom Units, or you may specify that
your Phantom Units will be paid in several forms of payment, by specifying whole percentages. If
you specify several forms of payment, you should make sure that the percentages add up to 100%.

Upon Separation from Service, I elect to have my Phantom Units distributed as follows:

	 	A.	 	Lump Sum Payment:

	 	•	 	Lump sum payment at my Separation from Service.

This election applies to                     % of my Phantom Units.

	 	B.	 	Installment Payments:

	 	•	 	Payments in
 _____ 

(Note: Fill in 2 to 10) annual installments,
commencing 14 months following my Separation from Service, and annually
thereafter in the calendar year following the first payment and subsequent
calendar years.

This election applies to                     % of my Phantom Units.

 

32

 

	 	C.	 	One to Five Retirement Distribution Accounts:

	 	•	 	Retirement Distribution Account #1 — Lump sum payment 14 months following my
Separation from Service. This election applies to                     % of my Phantom
Units.

	 	•	 	Retirement Distribution Account #2 — Lump sum payment in the first calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Phantom Units.

	 	•	 	Retirement Distribution Account #3 — Lump sum payment in the second calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Phantom Units.

	 	•	 	Retirement Distribution Account #4 — Lump sum payment in the third calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Phantom Units.

	 	•	 	Retirement Distribution Account #5 — Lump sum payment in the fourth calendar
year following payment of Retirement Distribution Account #1. This election
applies to                     % of my Phantom Units.

Note: These elections are irrevocable. Under the Deferral Plan and section 409A of the
Internal Revenue Code, you may make a Re-Deferral Election to postpone a payment, but not to
accelerate a payment. Any Re-Deferral Election must be made at least one year before the scheduled
payment date and must postpone payment for at least five years beyond the scheduled payment
date. Re-Deferral Elections are subject to other restrictions described in the Deferral Plan.

II. BENEFICIARY DESIGNATION

If you die before payment of all your Phantom Units, your Phantom Units will be payable to your
designated Beneficiary. If you designate more than one Beneficiary, you should make sure that the
percentages add up to 100%.

Beneficiary Designation: I designate the following persons to be the Beneficiary under the Deferral
Plan if I die before or after Separation from Service. If any designated Beneficiary is not living
(or is not in existence) at my death, then that Beneficiary’s share shall be allocated pro rata to
the other surviving Beneficiaries. If no designated beneficiary is living (or in existence) at my
death, then my Beneficiary shall be my estate. (Note: If more than one Beneficiary is
named, please indicate percentage to be paid to each.)

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

 

33

 

	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	%	 
	 

	 	 
	 	 	 	 	 	 
	Name

	 	Street	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	Relationship

	 	City	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	State

	 	Zip	 	 	 	 	 	 

The foregoing Beneficiary designation supersedes and replaces any previous Beneficiary designation
that I may have made with respect to the Phantom Units under the Deferral Plan.

III. ACKNOWLEDGMENT AND SIGNATURE

By signing this election form, I understand that these elections are made in accordance with and
are subject to the terms of the Deferral Plan. I understand and agree that the Deferral Plan’s
Administrative Committee shall have full power and express discretionary authority to interpret and
administer the Deferral Plan and to make all determinations with respect to the Deferral Plan. All
actions taken by the Deferral Plan’s Administrative Committee shall be final, conclusive and
binding upon all participants, beneficiaries, spouses and all other persons having an interest
therein.

These elections are irrevocable and are subject to the terms of the Deferral Plan.

	 	 	 
	 

	 	 
	Date

	 	Name

To be completed by [_____]]

Filing Date

Date received by [_____]:
 _____,
 _____ 

 

34exv10w4

Exhibit 10.4

CARDIAC SCIENCE

EXECUTIVE INCENTIVE PLAN

June 2010

SECTION 1 — INTRODUCTION

Plan Objectives

The goal of Cardiac Science’s Executive Incentive Plan (the “Plan”) is to enhance and reinforce the
goals of Cardiac Science Corporation (the “Company”) by providing Participants with additional
financial incentives and rewards upon the attainment of such goals. Final approval of the payment
of any awards made under the Plan is subject to the sole discretion of the Compensation Committee.
This Plan is intended to be a “bonus program” as defined under U.S. Department of Labor Regulation
Section 2510.3-2(c) and shall be construed and administered in accordance with such intention.

Effective Date

The Plan is effective beginning June 1, 2010 and ending December 31, 2010 coinciding with the
Company’s annual fiscal year and will be referred to as the “Year” or “Plan Year”. This plan
supersedes any and all prior Executive Incentive Plans.

SECTION 2 — DEFINITIONS

Unless defined elsewhere in the Plan, definitions of terms as used throughout this Plan document
are as follows:

	•	 	“Executive” means an employee who holds a VP level position or higher.
	 
	•	 	“Participant(s)” means an “Executive”, as the case may be, designated and approved by the
Compensation Committee and/or the Chief Executive Officer to participate in the Plan.

SECTION 3 — PLAN ADMINISTRATION

Administration

The Plan shall be administered by the Chief Executive Officer under the oversight of and subject to
the discretion of the Compensation Committee.

Participation

Participation in the Plan shall be limited to Executives of the Company selected by the Chief
Executive Officer and/or the Compensation Committee who remain employed during the applicable
vesting period and date. In addition to be or remain eligible to participate in the Plan, an
employee’s performance in the Plan Year must be at or above the Company’s performance expectations
for that employee. In selecting Participants, the Chief Executive Officer and/or the Compensation
Committee shall consider an employee’s position and potential impact on the Company’s business
results and performance. Any bonus for a Participant who joins the Plan after the start of the
Plan Year will be based on the Participant’s base salary gross earnings beginning when the
Participant becomes eligible during the Plan Year.

Payment of Incentives

Normal Payment. Bonus vests and is payable in two parts as follows: (1) 50% shall vest and
be payable in bi-weekly installments through regularly scheduled payroll effective June 1, 2010;
(2) 50% shall vest on December

2010 Revised Executive Incentive Plan A1

Page 1 of 3

 

31, 2010 and be payable in the first regularly scheduled payroll thereafter. There shall be no
pro-rated bonus if participants’ employment terms prior to December 31, 2010.

Should an Executive Employment Agreement be in effect, and the executive becomes eligible for
payment under the change in control (“CIC”) provisions of such agreement, on the effective date on
which the executive becomes eligible for payments under the CIC, the CIC provisions supersede, the
Executive Incentive Plan becomes null and void from that point and there will be no future payments
under the Executive Incentive Plan.

Plan Changes

The Company reserves the right to amend, revoke, or terminate this Plan or any portion of it, at
any time, for any reason whatsoever, with or without cause or advance notice. Payments may not be
made under this Plan at any time if, in the sole discretion of the Chief Executive Officer or
Compensation Committee, the overall performance or financial condition of the Company does not
warrant the payment of incentive awards.

Other Conditions

Right of Assignment. No Participant may sell, assign, transfer, discount, or pledge as
collateral for a loan or otherwise anticipate his or her right to any distribution under the Plan.
In the event of a Participant’s death, payment shall be made to the Participant’s designated
beneficiary, or in the absence of such designation, to the Participant’s estate.

Right of Employment. Nothing in this Agreement alters the “at will” nature of every
Participant’s employment. A Participant or the Company may terminate a Participant’s employment
relationship with the Company for any reason or for no reason, with or without cause or advance
notice.

Withholding for Taxes. The Company shall have the right, and the Participant consents, to
deduct from all payments under this Plan any federal or state taxes or other payroll withholdings
required by law to be withheld with respect to such payments.

Section 409A. The Company makes no representations or warranties to Participants with
respect to any tax, economic or legal consequences of this Plan or any payments or other benefits
provided hereunder, including without limitation under Section 409A of the Internal Revenue Code of
1986, as amended, the regulations issued thereunder and any applicable guidance (together “Code
Section 409A”) and no provision of the Plan shall be interpreted or construed to transfer any
liability for failure to comply with Code Section 409A from a Participant or any other individual
to the Company or any of its affiliates. Each Participant by accepting payment under the Plan
shall be deemed to have waived any claim against the Company and its affiliates with respect to any
such tax, economic or legal consequences. However, the parties intend that this Plan and the
payments and other benefits provided hereunder be exempt from the requirements of Code Section 409A
to the maximum extent possible, whether pursuant to the short-term deferral exception described in
Treasury Regulation Section 1.409A-1(b)(4), the involuntary separation pay plan exception described
in Treasury Regulation Section 1.409A-1(b)(9)(iii), or otherwise. To the extent Code Section 409A
is applicable to this Plan (and such payments and benefits), the parties intend that this Plan (and
such payments and benefits) comply with the deferral, payout and other limitations and restrictions
imposed under Code Section 409A. In addition, if a Participant is a “specified employee,” within
the meaning of Code Section 409A, then to the extent necessary to avoid subjecting the Participant
to the imposition of any additional tax under Code Section 409A, amounts that would otherwise be
payable under this Plan during the six month period immediately following a Participant’s
“separation from service,” as defined under Code Section 409A, shall not be paid to the Participant
during such period, but shall be accumulated and paid to the Participant in a lump sum on the first
business day after the earlier of the date that is six months following his or her separation from
service or his or her death. Notwithstanding any other provision of this Plan to the contrary,
this Plan shall be interpreted, operated and administered in a manner consistent with such
intentions. In accordance with the foregoing, the Plan shall be deemed to be amended, and
any deferrals and distributions hereunder shall be deemed to be modified, to the extent permitted
by and

2010 Revised Executive Incentive Plan A1

Page 2 of 3

 

necessary to comply with Code Section 409A and to avoid or mitigate the imposition of
additional taxes under Code Section 409A.

Gender. Any masculine terminology used herein shall also include the feminine, and the
definition of any terms herein in the singular shall also include the plural.

SECTION 4 — OPERATING RULES

Plan Design

The Compensation Committee, may, at any time in its sole discretion, based on relevant facts and
circumstances, adjust incentive percentages or actual payout levels to be above or below the
established targets.

Bonus. For 2010, bonuses are based on participant continuing to perform the following:

	1.	 	Take or support actions to assure ongoing liquidity.
	 
	2.	 	Take or support appropriate actions to assure public safety within the means of the company.
	 
	3.	 	Take or support strategic actions to optimize shareholder value.
	 
	4.	 	Assure continuity of key systems, processes and business functions.
	 
	5.	 	Assure ongoing compliance with applicable laws, regulations and standards within span of
control.

Target Incentives A Participant’s target incentive is a percentage of annual base salary
gross earnings based on his or her position with the Company in accordance with the chart below.

	 	 	 	 	 
	CEO	 	CFO/SVP	 	VP
	100%
	 	100%
	 	60%

The Compensation Committee, may, at any time in its sole discretion, based on relevant facts and
circumstances, adjust incentive percentages or actual payout levels to be above or below the
established targets.

The Plan
is adopted by the Company and is effective June 1, 2010.

CARDIAC SCIENCE CORPORATION

	 	 	 	 	 

	By:

	 	 
	 	 
	 

	 	 	 	 
	 
	 	 	 	 
	Its:
	 	 	 	 
	 

	 	 	 	 
	 
	 	 	 	 
	Date:
	 	 	 	 
	 

	 	 	 	 

2010 Revised Executive Incentive Plan A1

Page 3 of 3

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00176-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00176-of-00352.parquet"}]]