COVER
EXHIBIT A
KEY EMPLOYEE PHANTOM STOCK AGREEMENT
Payment Option Election
Part I. I hereby elect to receive the balance of my Account under the
Agreement in the following manner: (check one)
a. ____ as the Share Units vest.
b. ____ in three annual installments with the first of
such installments occurring when all Share Units
are vested.
c. ____ in a lump sum at the time my employment with Xxxx
terminates.
d. ____ in three annual installments with the first of such
installments occurring when my employment with Xxxx
terminates.
I understand that if I elect to receive distributions in installments,
each installment will be determined by dividing the then value of the amount
to be distributed by the number of installments remaining to be paid
(including the installment then due). If the total distribution is less
than $20,000.00, I understand installment option b and installment option d
will not be available and I will receive a single lump sum payment.
I further understand that in the event that my employment with Xxxx
has terminated for any reason and the distributions under this Agreement are
to be paid in installments rather than in a single lump sum, then (regardless
of whether there has or has not been a merger or Change in Control of LMI or
Xxxx) I will be deemed to have automatically made an elective transfer to
Phantom Treasury Bills.
2
Key Employee Phantom Stock Agreement
Payment Option Election
Page Two
Part II. I hereby direct that, in the event of my death, any balance in my
Account shall be paid to the beneficiary(ies) designated by me in the
following manner: (check one)
a. ____ in a single lump sum distribution
b. ____ continuation of the manner of distribution elected by
me pursuant to Part I above.
Employee:
____________________________
Signature Date
____________________________
Print Full Name
Receipt Acknowledged:
XXXX XXXXX XXXX XXXXXX, INCORPORATED
By:___________________________________
Signature
