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Exhibit
10.3(e)
Form Revised January 2007
Form of
FPIC INSURANCE GROUP, INC.
OMNIBUS INCENTIVE PLAN
RESTRICTED STOCK AWARD
AGREEMENT
[Date]
[Name]
[Address]
In accordance with the terms of the Omnibus Incentive Plan (the
"Plan") maintained by FPIC Insurance Group, Inc. (the "Company"),
pursuant to action of the Budget and Compensation Committee of the
Company’s Board of Directors (acting as the "Committee" as
defined in the Plan), the Company hereby grants to you (the
"Participant"), subject to the terms and conditions set forth in
this Restricted Stock Award Agreement (including Annex A hereto and
all documents incorporated herein by reference), an award of
restricted shares of Company common stock (the "Restricted Stock"),
as set forth below:
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Date of Grant:
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_________________________________
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Number of Shares of Restricted Stock:
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_________________________________
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Period of Restriction:
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Date of Grant through _______________
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Performance Goal:
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N/A
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Vesting Schedule:
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The Shares of Restricted Stock subject to this
Award shall vest as follows:
1/3 shall vest on ____________________;
1/3 shall vest on ____________________; and
1/3 shall vest on ____________________;
provided, that the Participant remains
employed through each such vesting date.
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THESE SHARES OF RESTRICTED STOCK ARE SUBJECT TO FORFEITURE AS
PROVIDED IN ANNEX A HERETO AND THE PLAN.
Further terms and conditions of the Award are set forth in Annex
A hereto, which is an integral part of this Restricted Stock Award
Agreement.
All terms, provisions and conditions applicable to the Award set
forth in the Plan and not set forth herein are hereby incorporated
by reference herein. To the extent any provision hereof is
inconsistent with the Plan, the Plan will govern. The Participant
hereby acknowledges receipt of a copy of this Restricted Stock
Award Agreement including Annex A hereto and a copy of the Plan and
agrees to be bound by all the terms and provisions hereof and
thereof.
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FPIC INSURANCE GROUP, INC.
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By:
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Attachment: Annex A
ANNEX A
TO
FPIC INSURANCE GROUP, INC.
OMNIBUS INCENTIVE PLAN
RESTRICTED STOCK AWARD
AGREEMENT
It is understood and agreed that
the Award of Restricted Stock evidenced by the Restricted Stock
Award Agreement to which this is annexed and a part is subject to
the following additional terms and conditions:
1. Forfeiture and Transfer Restrictions
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A. Forfeiture Restrictions . Except as
provided otherwise in the Participant's employment, severance or
other agreement (if applicable) (any such applicable provisions of
which being referred to herein as the "Applicable Provisions") and
except as otherwise provided in Section 2 of this Annex A, in the
event of the Participant's termination of employment (as defined
below) during the Period of Restriction (as set forth in the
Restricted Stock Award Agreement)
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