Exercise of Stock Options Worksheet

Exercise of Stock Options Worksheet Includes Vesting of Restricted Stock Units and Purchase of ESPP Shares (Buy and Hold) o' Keep for your records 2014 Name(s) Shown on Return Social Security Number Company and Employee Information 1 a Company name. . . b Stock symbol 2 Employee is (check one): a Taxpayer b Spouse Incentive Stock Option (ISO) 3 Enter stock grant and acquisition information in columns (b) through (i) for incentive stock options exercised and held (not sold) in 2014. (Box numbers refer to Form 3921; see Tax Help.) • Grant Information Acquisition Information (a) Lot # (b) Road on Form 3921? (c) Number of Shares (Box 5) (d) Date Option Granted (Box 1) (e) Exercise Price Per Share (Box 3) (f) Date Option Exercised (Box 2) (9) FMV/Share on Exercise Date (Box 4) (h) Bargain Element Per Share (I) Fees Paid (it any) 4 Alternative Minimum Tax (AMT) Summary a Exercise of ISO (Form 6251, line 14) AMT Regular Tax Adjustment Part III Non-Qualified Stock Option (NOSO) 5 Enter stock grant and exercise information in columns (b) through (h) for non-qualified stock options exercised and held (not sold) in 2014. Grant Information Acquisition Information (a) Lot # (b) Number of Shares (c) Date Option Granted (d) Exercise Price Per Share (e) Date Option Exercised (f) FMV/Share on Exercise Date (9) Bargain Element Per Share (h) Fees Paid (if any) 6 Total compensation income EFTA01220833 Page 2 I I Restricted Stock Unit (RSU) 7 Enter vesting information in columns (b) through (g) for Restricted Stock Units vested but not sold in 2014. (a) Lot # (b) Number of Shares (c) Date Shares Vested (d) FMV/Share on Vesting Date (e) Price Paid Per Share (if any) (f) Fees Paid (if any) (9) Number of Shares Withheld (if any) 8 Computation of compensation income and basis of shares. (a) Lot # (b) Market Price (c) Amount Paid (d) Compensation Income (e) Net Shares (0 Basis Total (9) Basis Per Share Total Total for 2014 Part V Employee Stock Purchase Plan (ESPP) 9 Plan discount percent (if none, enter zero) 10 For each transfer of stock to an employee from an ESPP in 2014 enter grant and acquisition information in columns (b) through (j) for all shares purchased but not sold. (Box numbers refer to Form 3922; see Tax Help.) Grant Information Acquisition Information (a) Lot # (b) RprId on Form 3922? (c) Number of Shares (Box 6) (d) Date Option Granted (Box 1) (e) FMV/Share on Grant Date (Box 3) (f) Price/Share as if Exercise on Grant Date (Box 8) (g) Date Option Exercised (Box 2) (h) FMV/Share on Exercise Date (Box 4) (I) Exercise Price Paid Per Share (Box 5) 0) Fees Paid (if any) EFTA01220834