WILSON BANK & TRUST Executive Survivor Income Agreement

Exhibit 10.86

▇▇▇▇▇▇ BANK & TRUST

Executive Survivor Income Agreement

This Executive Survivor Income Agreement is made this 14th day of April 2014, by and between ▇▇▇▇▇▇ Bank & Trust with its main office in Lebanon, Tennessee, (“Bank”), and ▇▇▇▇▇ ▇▇▇▇▇▇ (“Executive”).

Whereas, to encourage the Executive to remain an employee of the Bank, the Bank is willing to provide benefits to the Executive’s beneficiary(ies) if the Executive dies prior to terminating employment. The Bank will pay the benefits from its general assets, but only so long as one of its general assets is a life insurance policy on the Executive’s life.

WHEREAS, this Agreement is designed primarily for purposes of providing benefits for a select group of management and highly compensated employees of the Bank and is intended to qualify as a “top hat” plan under Sections 201(2), 301(a)(3) and 401(a)(1) of the Employee Retirement Income Security Act of 1974, as amended.

 

Now Therefore, in consideration of the foregoing premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Bank and the Executive hereby agree as follows.

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

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(a) Gross negligence or gross neglect of duties;

(b) Commission of a felony or of a gross misdemeanor involving moral turpitude; or

(c) Fraud, disloyalty, or willful violation of any law or significant Bank policy committed in connection with the Executive’s employment and resulting in an adverse effect on the Bank.

(a) Initiation: Written Claim. The claimant initiates a claim by submitting to the Bank a written claim for the benefits.

(b) Timing of Bank Response. The Bank shall respond to such claimant within 90 days after receiving the claim. If the Bank determines that special circumstances require additional time for processing the claim, the Bank can extend the response period by an additional 90 days by notifying the claimant in writing, prior to the end of the initial 90-day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Bank expects to render its decision.

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(c) Notice of Decision. If the Bank denies part or all of the claim, the Bank shall notify the claimant in writing of such denial. The Bank shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth:

(a) Initiation: Written Request. To initiate the review, the claimant, within 60 days after receiving the Bank’s notice of denial, must file with the Bank a written request for review.

(b) Additional Submissions: Information Access. The claimant shall then have the opportunity to submit written comments, documents, records, and other information relating to the claim. The Bank shall also provide the claimant, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant (as defined in applicable ERISA regulations) to the claimant’s claim for benefits.

(c) Considerations on Review. In considering the review, the Bank shall take into account all materials and information the claimant submits relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.

(d) Timing of Bank Response. The Bank shall respond in writing to such claimant within 60 days after receiving the request for review. If the Bank determines that special circumstances require additional time for processing the claim, the Bank can extend the response period by an additional 60 days by notifying the claimant in writing, prior to the end of the initial 60-day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Bank expects to render its decision.

(e) Notice of Decision. The Bank shall notify the claimant in writing of its decision on review. The Bank shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth:

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(a) Interpreting the provisions of the Agreement;

(b) Establishing and revising the method of accounting for the Agreement;

(c) Maintaining a record of benefit payments; and

(d) Establishing rules and prescribing any forms necessary or desirable to administer the Agreement.

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(a) If to the Bank, to:
	▇▇▇▇▇▇ Bank & Trust
	ATTN: ▇▇▇▇ ▇▇▇▇▇▇▇▇
	PO 768
	Lebanon, TN 37088
(b) If to the Executive, to:

and to such other or additional person or persons as either party shall have designated to the other party in writing by like notice.

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

Executive:			Bank:
▇▇▇▇▇ ▇▇▇▇▇▇			▇▇▇▇▇▇ Bank & Trust
(Name of Executive)
/s/ ▇▇▇▇▇ ▇▇▇▇▇▇			By:	/s/ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇
(Signature of Executive)
Title:	SVP		Its:	President

 

 

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SCHEDULE A

▇▇▇▇▇ ▇▇▇▇▇▇
Age	Benefit Amount
45	400,000
46	400,000
47	400,000
48	400,000
49	400,000
50	400,000
51	400,000
52	400,000
53	400,000
54	400,000
55	400,000
56	400,000
57	400,000
58	400,000
59	400,000
60	400,000
61	400,000
62	400,000
63	400,000
64	400,000
65	400,000
66	400,000
67	400,000
68	398,788
69	387,008
70	0

 

 

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▇▇▇▇▇▇ BANK & TRUST

EXECUTIVE SURVIVOR INCOME AGREEMENT

DESIGNATION OF BENEFICIARY

 

Executive:

Definitions:

Primary Beneficiary means the person(s) who will receive the Benefits in the event of the Executive’s death. Proceeds will be divided in equal shares if multiple primary beneficiaries are named, unless otherwise indicated. If percentages are listed, the total must equal 100%.

Contingent Beneficiary means the person(s) who will receive the Benefits if the primary beneficiary is not living at the time of the Executive’s death.

Trust as Beneficiary Designation can be done by using the following written statement: “To [name of trustee, trustee of the [name of trust], under a trust agreement dated [date of trust].”

Primary Beneficiary DOB Social Security # Address % of Proceeds

___________________ ____ _______________ ___________________________ _______

____________________ ____ _______________ ___________________________ _______

Contingent Beneficiary DOB Social Security # Address % of Proceeds

____________________ ____ _______________ ___________________________ _______

____________________ ____ _______________ ___________________________ _______

The undersigned employee acknowledges that ▇▇▇▇▇▇ Bank Bank (“Bank”) is providing this Death Benefit subject to the terms and conditions of the Agreement entered into with Executive.

Executive's Signature		Date
Acknowledged Receipt by the Bank:
Officer

 

 

This beneficiary designation supersedes all previously executed beneficiary designations.

 

 

 

 

 

 

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