EFTA01220833.pdf

Exercise of Stock Options Worksheet 2014 Includes Vesting of Restricted Stock Units and Purchase of ESPP Shares (Buy and Hold) o' Keep for your records 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) (b) (c) (d) (e) (f) (9) (h) (I) Lot Road Number Date Exercise Date FMV/Share Bargain Fees # on of Option Price Option on Element Paid Form Shares Granted Per Share Exercised Exercise Date Per Share (it any) 3921? (Box 5) (Box 1) (Box 3) (Box 2) (Box 4) 4 Alternative Minimum Tax (AMT) Summary AMT Regular Tax Adjustment a Exercise of ISO (Form 6251, line 14) 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) (b) (c) (d) (e) (f) (9) (h) Lot Number Date Exercise Date FMV/Share Bargain Fees # of Option Price Option on Element Paid Shares Granted Per Share Exercised Exercise Date Per Share (if any) 6 Total compensation income EFTA01220833  Page 2 II Restricted Stock Unit (RSU) 7 Enter vesting information in columns (b) through (g) for Restricted Stock Units vested but not sold in 2014. (a) (b) (c) (d) (e) (f) (9) Lot Number Date FMV/Share Price Paid Fees Number of # of Shares on Per Share Paid Shares Withheld Shares Vested Vesting Date (if any) (if any) (if any) 8 Computation of compensation income and basis of shares. (a) (b) (c) (d) (e) (0 (9) Lot Market Amount Compensation Net Basis Basis # Price Paid Income Shares Total 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) (b) (c) (d) (e) (f) (g) (h) (I) 0) Lot RprId Number Date FMV/Share Price/Share Date FMV/Share Exercise Fees # on of Option on as if Option on Price Paid Paid Form Shares Granted Grant Date Exercise on Exercised Exercise Per Share (if any) 3922? (Box 6) (Box 1) (Box 3) Grant Date (Box 2) Date (Box 5) (Box 8) (Box 4) EFTA01220834