A “Dollars for Doers” Program Rewarding Employee Volunteer Entrepreneurship

DOINGCOUNTSWHAT

At SouthStar Energy Services® our motto has been Working Together…Serving Together. And for over a decade, our TrueBlue

Crew employee volunteers have helped to make a difference in

our local communities. We’re proud of our employee volunteers

and wish to celebrate their accomplishments and dedication.

WE’RE DOING WHAT COUNTS… AND FOLLOWING YOUR LEADEvery year, SouthStar offers a number of different

company-sponsored volunteer activities for

employees to participate in. Typically, the events

and opportunities are aligned with our corporate

outreach focus areas:

• Children and Education

• Seniors

• Energy Assistance

• Environment/Sustainability

CHOOSE A NONPROFIT TO BENEFIT FROM YOUR VOLUNTEER TIMEWe would like to recognize SouthStar employees by

giving them the opportunity to designate a nonprofit

organization of their choice, as the recipient of up to

$250.00 in the form of a grant. While we would like

for the grant designees/recipients to align with our

corporate giving focus areas, we recognize that this is

not always the case. Good news! This means that if you

have a favorite little league team, or a health walk/run

that’s close to your heart, you may self-select to sponsor

it. It’s a great opportunity.

SouthStar can provide the organization this grant for the

following purposes:

• As a direct donation to a deserving nonprofit.

• To sponsor an organization’s official fundraising event.

• As a nonprofit board donation.

WHO IS QUALIFIED TO PARTICIPATE? To be eligible to take part in the program,

participants must:

• Be a full-time employee in good standing with the

company.

• Have participated in at least one official corporate

community relations-sponsored outreach event over

the course of the year.

• Choose an organization that is eligible in accordance

with characteristic corporate giving and the AGL

Resources Code of Conduct and Ethics.

• Fill out the Doing What Counts application form,

naming one (1) nonprofit as the recipient.

• Understand that fulfillment is based on availability of

company funds.

• Submit only one request per calendar year.

ORGANIZATION CRITERIAIn determining eligibility for funding, all of the

following criteria are required:

• Organizations must be outside of SouthStar’s typical

employee giving campaign activities; for example,

the United Way or the Salvation Army will not be

considered.

• Must be registered in the state of Georgia or any of

the other states in which SSE operates as a 501(c)(3)

tax-exempt organization.

• Must be an equal opportunity employer and

not discriminate on the basis of any protected

characteristic.

• Must be able and willing to complete SouthStar

designated vendor forms to receive funds.

Philanthropic budgets for all SouthStar corporate giving

and related giving programs vary from year-to-year and

are at the sole discretion of the company.

RESTRICTIONSOf course, it is our goal to fund the employee’s desired

nonprofit organization. However, the company may

refuse a donation for any reason deemed appropriate

by the company in its sole discretion such as:

• Funding of a nonprofit for any part in sole or partial

personal, financial gain.

• Organizations that may be generally considered or

perceived as controversial or unlawful.

• Organizations whose practices are not in keeping with

SouthStar’s equal opportunity policy.

• Organizations whose practices are not in keeping with

SouthStar’s ethical and social values.

• Funding of raffles, lotteries, sweepstakes, or auctions

where funds are used to purchase chances.

TAX BENEFITSAll tax benefits and related rights arising from program

contributions, including, but not limited to, charitable

contributions deductions, shall accrue to, and be

retained by, the company.

Please note that this policy does not create an

employment relationship or affect employees at will

employment status. The Company reserves the right to

terminate this program at any time for any reason in its

sole discretion.

DOING WHAT COUNTS! APPLY TODAY!

Official Application

Fill out the form (below) as completely as possible.

Date

Employee Name (Requestor)

Title

Direct Supervisor

Department

Phone/Ext.

City/State

Location

Please list your SouthStar volunteer participation for the current year.

Please list your volunteer participation for the previous year.

Nonprofit organization you are requesting funds for:

Is there a specific program or event within the nonprofit you wish to support?

How are you affiliated with this organization?

Amount that you are requesting? (May be up to $250 in a one-time payment.)

DOING WHAT COUNTS A “Dollars for Doers” Program Rewarding Employee Volunteer Entrepreneurship

STEP

1

BRAND PROMOTIONWith sponsorships of nonprofits, there may be an opportunity to promote the corporate brand(s) to the organization’s

members, supporters, participants, and the general public. Please identify whether there is an opportunity to promote

the SouthStar's brands to the public. This typically involves use of our registered logos.

Check off any opportunities that may apply:

Banners Print Ads Direct Mail T-shirts Broadcast

Official Application

Employee should complete STEP 2 which requests basic information about the nonprofit organization.

Name of Recipient Organization

Does the organization operate under any other names? Please list

Contact Name

Title

E-mail address

Street Address

City State Zip

Phone/Ext.

Fax

URL

Official Application

To be completed by the nonprofit organization.

The nonprofit organization is required to fill out basic accounting information for the processing

of grant funds. They are also requested to submit a Form W-9.

Please contact Community Relations if you have additional questions.

form continued

Completed application and additional forms should be submitted to:

SouthStar Energy Services LLC

Community Relations

817 W. Peachtree St., Suite 1000

Atlanta, GA 30308

STEP

2

STEP

3

© SouthStar Energy Services 12/2014 SSE-1001