To the Corporate Secretary:
DEFERRAL AMOUNT: Pursuant to Article 6 of the Ventas Executive Deferred Stock Compensation Plan (the Plan), I hereby elect to have (select one):
|¨||percent ( %)|
of my (select one or both):
|¨||base salary per pay period|
payable hereafter deferred and credited to a Stock Unit Account for me, net of any required FICA or other withholdings. I understand that I may revoke or modify this election only with respect to amounts payable on or after the first day of a subsequent calendar year and only by filing a new election form before the first day of such subsequent calendar year in accordance with Plan procedures.
DIVIDEND CHOICE: I elect to have dividend equivalents with respect to Stock Units in my Stock Unit Account (select one):
|¨||paid to me in cash as soon as practicable after dividends are paid on shares of Ventas, Inc.|
|¨||converted to additional Stock Units and distributed at the time and in the manner selected for my Stock Unit Account.|
PAYMENT OPTIONS: I direct that distribution of my Stock Unit Account be made after my Termination of Employment as follows (select one):
|¨||a lump sum.|
|¨||a series of annual payments over years (10 or less, not to extend more than 10 years after my Termination of Employment).|
I direct that distribution of my Stock Unit Account commence as soon as administratively feasible after (select one):
|¨||my Termination of Employment occurs.|
|¨||January 1 of the calendar year immediately following my Termination of Employment.|
|¨||seven months following my Termination of Employment.|
|¨||. (select date)|
Change in Control Accelerated Payment (select if desired):
|¨||Notwithstanding my elections above, I direct that distribution of Stock Units in my Stock Unit Account be accelerated and occur in a lump sum upon a Change in Control (as defined in the 2000 Incentive Compensation Plan).|
DESIGNATION OF BENEFICIARY: Pursuant to Article 9 of the Plan, I designate my beneficiary (or beneficiaries) as follows:
I reserve the right to make new designations as provided in the Plan.
ACKNOWLEDGEMENT: By signing this Deferral Election, I hereby acknowledge my understanding and acceptance of the following:
1. Irrevocable Election. This election is irrevocable. I understand that I may not revoke or modify this election (except in such limited circumstances as the Compensation Committee may permit in accordance with law). I do not expect to be able to make any changes to the manner of timing of distributions set forth in this Deferral Election.
2. Company Right to Terminate Election and Early Transfer. The Company reserves the right to terminate this Deferral Election at any time. In such case, Stock Units which are subject to the Deferral Election may be converted into Shares and such Shares may be transferred to me immediately. Notwithstanding any election made herein and without limitation on the preceding provisions, the Company reserves the right to transfer to me all of the Shares associated with the Stock Units subject to this Deferral Election at any time following the termination of my employment with the Company or any affiliate or following the termination of the Plan.
3. Withholding. The Company and its affiliates shall have the right to deduct from all deferrals or payments hereunder, any federal, state, or local tax required by law to be withheld.
By signing this Deferral Election, I hereby acknowledge my understanding of an agreement with all the terms and provisions set forth in this Deferral Election as well as the Plan.
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