This is a reminder that annual information statements must be delivered to all employees that exercised incentive stock options (“ISOs”) during the last calendar year. An employer is required to deliver an information statement to each employee (who exercised an ISO) no later than January 31 of the calendar year following the year in which the ISO was exercised. The statements to employees must be sent to them at their last known address and the statement must include the following information:
(i) the employer’s name, address, and taxpayer identification number;
(ii) the name, address and taxpayer identification number of the person to whom the ISO shares are transferred;
(iii) the name and address of the corporation the stock of which is the ISO shares (only if different from the employer);
(iv) the date the ISO was granted;
(v) the date the shares were transferred pursuant to the exercise of the ISO;
(vi) the fair market value of the stock on the date of exercise;
(vii) the number of shares transferred upon exercise of the ISO;
(viii) a statement that the option was an ISO; and
(ix) the total cost of the ISO shares.
To assist in complying with the requirements of Section 6039 of the Code, we have prepared the attached form of information statement:
__________________, INC.
[YEAR] STOCK INCENTIVE PLAN
STATEMENT OF INFORMATION REGARDING EXERCISE OF AN INCENTIVE STOCK OPTION
________________, Inc. (the “Company”) hereby provides this statement of information regarding the Company’s transfer of shares of Common Stock (the “Shares”) of the Company to the Optionee pursuant to the Optionee’s exercise of an incentive stock option (the “Option”) under and pursuant to the Company’s [YEAR] Stock Incentive Plan and the Incentive Stock Option Agreement dated ____, 200_. In satisfaction of its obligation under Section 6039 of the Internal Revenue Code of 1986, as amended (the “Code”) and the regulations thereunder, the Company is furnishing the Optionee with this statement of information containing the following information:
1. Company transferring the Shares (and the Company the Shares of which are the subject of the Option):
Name: _____________, Inc.
Address: _____________________________
_____________________________
EIN: [___-_________]
2. Person to whom the Shares were transferred:
Name: ___________________________
Address: ___________________________
___________________________
SSN: _____-____-______
3. The date the Option was granted: ________________, 200_.
4. The date the Shares were transferred to the person exercising the Option: _________________, 200_.
5. The fair market value of the Shares at the time the Option was exercised: $________.
6. The number of Shares transferred pursuant to the exercise of the Option: _________.
7. The type of option under which the Shares were transferred: an Incentive Stock Option under Section 422(b) of the Code.
8. The total cost of the transferred Shares: $________________.
If you have any questions regarding this statement, please contact ______________ at (___) ___-______.
Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
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