Phantom Stock Plan

Report your participation in a phantom stock plan in Part 3.  In addition, report the phantom stock in Part 2 (see Part 2 of this guide for details).

Employer or Party


Status and Terms


Steamship Taxi Co.

St. Louis, MO

Upon separation, I will receive a lump-sum cash payment equal to the value of my vested phantom stock, calculated as of the date of my separation.  I will forfeit any unvested phantom stock interests.


For You

Part 3

Report your continuing participation in a phantom stock planIn addition, if you are an Annual or Termination filer, report a phantom stock plan in which you participated 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:  Identify the plan as a phantom stock plan and describe its terms in detail.  Among other details, state what you will receive and when you will receive it.  In addition, state any deviations from the normal terms of the plan that the employer will make for you.  This includes any acceleration of payment, any waiving of vesting requirements, and any change in the form or timing of payment or eligibility.

Date:  Provide the month and year in which you began participating in the phantom stock plan.