EXHIBIT 10.4
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Plan Agreement
Under The
Firstbank Northwest Executive Non-Qualified Retirement Plan
(Complete Both Pages)
THIS AGREEMENT, entered into as of this 20th day of December , 2001, by
and between ▇▇▇▇▇ ▇. ▇▇▇▇▇▇ (the "Participant") and FirstBank Northwest (the
"Bank").
WHEREAS, the Bank maintains the FirstBank Northwest Executive
Non-Qualified Retirement Plan (the "Plan"), which is incorporated into and forms
a part of this Agreement by this reference, and a copy of which the Participant
has received.
WHEREAS, the Participant has been selected by the Plan Committee to
participate in the Plan.
NOW, THEREFORE, for good and valuable consideration, the sufficiency of
which is hereby acknowledged, the Bank and the Participant agree that the
following provisions shall apply for purposes of determining the Participant's
entitlement under the Plan (if any provision shall be left blank, the default
provision in the Plan shall apply):
Accrued Benefit: The cumulative sum of the annual benefit accruals under the
insurance policy(ies) acquired by the Bank to informally fund the Participant's
Monthly Benefit for the Participant's Years of Participation, determined as of
the last day of the Plan Year, and at such other times as determined appropriate
by the Committee. Refer to attached Executive Non-Qualified Retirement Plan
Benefit Accrual/Vesting Schedule. If no such insurance policy has been acquired
by the Bank then the Accrued Benefit shall be determined under the terms of the
Plan. Once benefits commence under the Plan, the Accrued Benefit shall be
increased by the Inflator Factor.
Monthly Benefit: The Monthly Benefit shall be $5,079.17. The Monthly Benefit
shall be increased by the Inflator Factor. This is the total monthly benefit to
be provided by under this Agreement, and a previous Agreement.
Inflator Factor: 2 1/2 percent annually, commencing with the first anniversary
of the date the Participant's benefits commence under the Plan.
Normal Retirement Date: Age sixty (60).
Vesting Schedule: The Participant shall be 100 percent vested in his Plan
benefits at all times, except upon Termination for Cause.
Other Provisions: None
Continued on Next Page
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Beneficiary Designations
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Add extra sheet if necessary
Primary (Required)
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Name: Relationship:
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Address:
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Name: Relationship:
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Address:
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Contingent (Optional)
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Name: Relationship:
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Address:
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Contingent
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Name: Relationship:
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Address:
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Payable After Death of Both Participant and Beneficiary (Optional)
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Name: Relationship:
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Address:
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Contingent
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Name: Relationship:
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Address:
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IN WITNESS WHEREOF, the Participant has executed this Agreement, and
the Bank has caused these presents to be executed in its name and on its behalf,
all as of the date set forth above.
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Participant: Date:
December 20, 2001
/s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
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FIRSTBANK NORTHWEST Date:
By: /s/ ▇▇▇▇▇ ▇. ▇▇▇ December 20, 2001
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