Restricted Stock Unit Plan

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

Employer or Party


Status and Terms


Mimeograph Supply Co.

Nashville, TN

Pursuant to the company’s executive compensation plan, my unvested restricted stock units will vest upon separation.  At that time, I will receive a cash payout.


For You

Part 3

Report your participation in a restricted stock unit plan.  In addition, if you are an Annual or Termination filer, report a restricted stock unit 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 restricted stock unit plan and describe what will happen (or has happened) to your restricted stock units (e.g., retention of RSUs, payout of vested RSUs, forfeiture of unvested RSUs, or accelerated payout of unvested RSUs prior to government appointment, etc.).  If applicable, specify the timeframe in which these actions will occur and the form that any payout will take (e.g., cash or stock).

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