Stock Option Plan
Report your participation in an incentive stock option plan in Part 3. In addition, report the incentive stock options 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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Mimeograph Supply Co.
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Nashville, TN
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I will forfeit my unvested stock options upon separation. I will retain my vested stock options.
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11/2004
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For You
Part 3
Report your participation in an incentive stock option plan. In addition, if you are an Annual or Termination filer, report a stock option 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 stock option plan and describe what will happen (or has happened) to your stock options (e.g., retention, exercise, forfeiture, accelerated vesting, etc.). If applicable, specify the timeframe in which these actions will occur (e.g., “upon my separation”).
Date: Provide the month and year in which you began participating in the incentive stock option plan.
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