ATLANTIC COAST FEDERAL
DEFERRED COMPENSATION PLAN
INITIAL PARTICIPATION AGREEMENT
This Participation Agreement ("Agreement") is entered into this _____
day of _______________, ________, by and between Atlantic Coast Federal a
Georgia corporation, having its principal place of business at 505 Haines
Avenue, Waycross, GA 31501 (hereinafter the "Employer") and
_________________________________, an individual having his/her principal place
of residence located at __________________________________, __________________,
___________, __________ (address) (city) (state) (zip) (hereinafter
"Participant").
RECITALS
A. The Employer has previously adopted a Nonqualified Deferred Compensation
Plan effective AUGUST 1, 2002 (hereinafter the "Plan") primarily for the
purpose of providing deferred compensation benefits for a select group
of management or highly compensated participants.
B. The Participant, in recognition of his/her valuable service to the
Employer, has been selected by the committee as an eligible participant
in the Plan.
In consideration of the mutual covenants and conditions contained
herein, and for such good and valuable consideration, the receipt and adequacy
of which is hereby admitted and acknowledged, the parties hereto agree as
follows:
1. ACCEPTANCE OF PLAN: (Participant must check one of the two options)
/ / The Participant, by virtue of his/her execution of this Agreement,
does hereby acknowledge receiving a copy of the Plan Summary and
agrees to be bound by the terms and conditions contained within
the Plan. The provisions of the Plan are hereby incorporated by
reference into this Agreement.
OR
/ / The Participant, by virtue of his/her execution of the
Agreement, does hereby acknowledge receiving a copy of the Plan
Summary and DECLINES to participate in the Plan at this time.
Initial Here ____
1
2. DEFERRAL OF COMPENSATION:
Pursuant to the terms of the Plan, the Participant hereby agrees to
defer his/her compensation from the Employer as follows:
A. DEFERRAL OF DIRECTOR'S FEES
/ / Percentage: _____% from each paycheck or payment
/ / Fixed Amount: $_____ from each paycheck or payment
/ / No deferral
B. OPTION FOR PAYMENT
I have been informed of the options for payment of my benefit
from the above-named plan. THE DEFAULT WILL BE LUMP SUM IF NO
ELECTION IS MADE AT ENROLLMENT. I understand the options, and I
choose payments in the form of (elect one):
/ / Lump sum
/ / Annual installments for _____ years
(MAXIMUM OF 10 YEARS)
If I should die prior to the completion of payment of my
benefit, I understand that the remainder of my benefit will be
paid in a lump sum to my designated beneficiary.
Initial Here ____
2
3. INVESTMENT ALLOCATION:
As established in the Plan, the Employer has established a Deferred
Compensation Account, to which the Participant's compensation Deferral will be
credited. The Deferred Compensation Account will be credited with earnings (and
losses) based upon the investment returns and expense Deferrals (or
enhancements) of the following indices. Participant must specify one or more of
the following indices. The indices selected must be in whole percentages with a
minimum of 5% per index and total 100%. IF INCOMPLETE, THE FUNDS WILL
AUTOMATICALLY DEFAULT TO 100% MONEY MARKET ACCOUNT.
-------------------------------------------- ----------------
INDICES:
-------------------------------------------- ----------------
PRINCIPAL MANAGEMENT CORPORATION
-------------------------------------------- ----------------
Money Market %
-------------------------------------------- ----------------
Bond %
-------------------------------------------- ----------------
Real Estate %
-------------------------------------------- ----------------
PRINCIPAL GLOBAL INVESTORS, LLC
-------------------------------------------- ----------------
Balanced %
-------------------------------------------- ----------------
Capital Value %
-------------------------------------------- ----------------
Government Securities %
-------------------------------------------- ----------------
Growth %
-------------------------------------------- ----------------
MidCap %
-------------------------------------------- ----------------
International %
-------------------------------------------- ----------------
International SmallCap %
-------------------------------------------- ----------------
SmallCap %
-------------------------------------------- ----------------
LargeCap Stock Index %
-------------------------------------------- ----------------
Utilities %
-------------------------------------------- ----------------
FIDELITY MANAGEMENT & Research Company
-------------------------------------------- ----------------
Fidelity VIP High Income %
-------------------------------------------- ----------------
Fidelity VIP Equity-Income %
-------------------------------------------- ----------------
Fidelity VIP II Contrafund %
-------------------------------------------- ----------------
MORGAN STANLEY ASSET MANAGEMENT INC.
-------------------------------------------- ----------------
Asset Allocation %
-------------------------------------------- ----------------
Equity Growth %
-------------------------------------------- ----------------
PUTNAM INVESTMENT MANAGEMENT, LLC
-------------------------------------------- ----------------
Putnam VT Voyager %
-------------------------------------------- ----------------
FUND ALLOCATION OPTIONS CONTINUED ON THE NEXT PAGE
Initial Here ____
3
FUND ALLOCATION OPTIONS CONTINUED
-------------------------------------------- ----------------
INDICES:
-------------------------------------------- ----------------
THE DREYFUS CORPORATION
-------------------------------------------- ----------------
Money Market %
-------------------------------------------- ----------------
J.P. MORGAN INVESTMENT MANAGEMENT
-------------------------------------------- ----------------
SmallCap Value %
-------------------------------------------- ----------------
AIM ADVISORS, INC.
-------------------------------------------- ----------------
AIM V.I. Growth %
-------------------------------------------- ----------------
AIM V.I. Premier Equity %
-------------------------------------------- ----------------
AIM V. I. Core Equity %
-------------------------------------------- ----------------
AMERICAN CENTURY INVESTMENTS
-------------------------------------------- ----------------
American Century VP Ultra %
-------------------------------------------- ----------------
American Century VP Income & Growth %
-------------------------------------------- ----------------
Founders Asset Management, LLC
-------------------------------------------- ----------------
DIP Founders Discovery %
-------------------------------------------- ----------------
INVESCO FUNDS GROUP
-------------------------------------------- ----------------
INVESCO VIF Technology
-------------------------------------------- ----------------
INVESCO VIF Health Sciences
-------------------------------------------- ----------------
INVESCO VIF Small Company Growth
-------------------------------------------- ----------------
INVESCO VIF Dynamics %
-------------------------------------------- ----------------
JANUS CAPITAL MANAGEMENT LLC
-------------------------------------------- ----------------
Janus Aspen Mid-Cap Growth %
-------------------------------------------- ----------------
NEUBERGER BERMAN MANAGEMENT, INC.
-------------------------------------------- ----------------
MidCap Value %
-------------------------------------------- ----------------
UBS GLOBAL ASSET MANAGEMENT
-------------------------------------------- ----------------
SmallCap Growth %
-------------------------------------------- ----------------
-------------------------------------------- ----------------
TOTALS (MUST EQUAL 100%) 100%
-------------------------------------------- ----------------
Initial Here ____
4
4. EFFECTIVE DATE:
This agreement shall become effective for the first payroll period that
commences on or after the January 1 that next follows the date the Agreement is
filed with the Employer. If the Participant first becomes eligible to
participate in the Plan during a plan year, but after January 1 of that plan
year, this Agreement shall be effective as of the first payroll period next
following the later of the date he/she is eligible to enter the Plan or the date
the committee receives an executed copy of this Agreement. This Agreement shall
continue in effect, unless modified or revoked by the Participant, until the
Participant terminates his/her service with the Employer, or, if earlier, until
the Participant ceases to be an Active Participant under the plan.
5. COUNTERPARTS:
This Agreement may be executed in two or more counterparts, each of
which shall be deemed an original but all of which together shall constitute one
and the same instrument.
6. ACKNOWLEDGEMENTS: The Participant hereby acknowledges the following:
A. The obligation of the Employer to make payments under the Plan
and the Agreement is a contractual liability of the Employer to
the Participant.
B. Such payments shall be made from the general funds of the
Employer, and the Employer shall not be required to establish or
maintain any special or separate fund, or otherwise to segregate
assets to make the payment.
C. The Participant shall not have any interest in any particular
assets of the Employer by reason of the Employer's obligation
under the Plan and this Agreement.
D. To the extent that the Participant or any other person acquires
a right to receive payments from the Employer, such rights shall
be no greater than the right or an unsecured creditor of the
Employer.
IN WITNESS WHEREOF, This Agreement has been executed by and on behalf of the
parties hereto as of the dale first written above.
- ----------------------------------
Participant Signature
ATLANTIC COAST FEDERAL
- --------------------------------------- ----------------------------------
Signature of Company Officer Title of Company Officer
Initial Here ____
5
ATLANTIC COAST FEDERAL
DEFERRED COMPENSATION PLAN
BENEFICIARY DESIGNATION FORM
PRIMARY BENEFICIARY(S): ______ I am married ______ I am not married
Note: If two or more beneficiaries are named, and if the "Percent" sections are not complete, the
assets shall be paid to the named beneficiaries, or to the survivors, in equal shares. If no beneficiary
is designated, your estate will be considered the designated beneficiary.
Name Relationship SSN Percent
_______________________________ _______________________ _____ - _____ - _______ (______%)
_______________________________ _______________________ _____ - _____ - _______ (______%)
CONTINGENT BENEFICIARY(S):
Note: If all primary beneficiaries die before the full program benefits are paid, any remaining benefits
shall be paid to the contingent beneficiary(s). If two or more contingent beneficiaries are named, and
if the "Percent" sections are not complete, the assets shall be paid to the named beneficiaries, or to the
survivors, in equal shares.
Name Relationship SSN Percent
_______________________________ _______________________ _____ - _____ - _______ (______%)
_______________________________ _______________________ _____ - _____ - _______ (______%)
NON-SPOUSAL PRIMARY BENEFICIARY:
If you are married and live in a community property state or marital property state, you must complete the
spouse's consent to a nonspousal primary beneficiary designated below. (These states include California,
Texas, Washington, Arizona, Louisiana, Wisconsin, Idaho, Nevada, and New Mexico.)
SPOUSE'S CONSENT: I consent to the beneficiary(s) designated above to receive the benefits payable under
this program. I understand this eliminates benefits otherwise payable to me in the event my spouse dies
prior to all benefits having been paid. I hereby waive any and all rights to such benefit. The spouse's
signature must be witnessed below.
Spouse Signature:__________________________________________________ Date:___________________
WITNESS: The spouse appeared before me and signed the consent above.
Program Representative or Notary Public:___________________________ Date:___________________
The Employee may change the beneficiaries designated above in accordance with the terms of said Agreement
by a written amendment to this Beneficiary Designation executed by the Employee and reflecting the change.
_________________________________________ _______________________________________
Participant Name (Please Print) Signature of Participant
Executed this _________ day of ___________________________, 20_____.
ATLANTIC COAST FEDERAL
DEFERRED COMPENSATION PLAN
PERSONAL IDENTIFICATION NUMBER FORM
AND
ONLINE ACCOUNT TRANSACTIONS
----------------------------------------------
-------- --------- -------- ---------
-------- --------- -------- ---------
----------------------------------------------
1) Select a four digit Personal Identification Number (PIN#) and write it
into the box above. If you decide to use "letters" keep in mind that our
system is "case sensitive."
2) By selecting "YES" below, you are authorizing us to accept any
electronic transactions for your account requested over the Internet.
Confirmations of transactions will be sent to the listed email address.
/ / YES, I wish to enable this function for my account.
_________________________________________ _______________________
(email address) (daytime phone number)
ATLANTIC COAST FEDERAL
______________________________ ____________________________ _____________
Participant Name (Please Print) Participant Signature Date