Severance (anticipated cash payment)
Report an arrangement to receive a cash severance payment in Part 3. In addition, report the anticipated severance in Part 2 (see Part 2 of this guide for details).
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Employer or Party
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City/State
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Status and Terms
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Date
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SendNow Co.
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Fort Wayne, IN
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Pursuant to my employment agreement, I will receive a lump-sum severance payment within 90 days of my separation from the firm.
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5/2009
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For You
Part 3
Report any arrangement to receive a severance payment. In addition, if you are an Annual or Termination filer, report any arrangement to receive a severance payment that you had at any point during the reporting period.
Employer or Party: Provide the name of the employer.
City/State: Provide the city and state in which the employer is located.
Status and Terms: Describe the terms under which the severance will be (or was) paid (e.g., “quarterly payments over two years” or “lump sum before entering government service”). If the severance is being (or was) paid pursuant to an established agreement or company policy, also note that fact in your description. Consult your ethics official for additional assistance regarding the language.
Date: Provide the month and year in which you became covered by the policy or arrangement that provides for a severance payment.
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