CapMx ® - FORM 3921 – COPY A – HARD COPY FILING Tax Year 2012

Form 3921 – Hard Copy Filing Information Covered: ▪Form 3921 – General Info ▪Form 1096 – General Info ▪Copy A – Hard Copy Filing ▪How to Generate in CapMx ▪URLs, Phone Numbers, and Where to Find Stuff… 2

Form 3921 – Hard Copy Filing 3 Form 3921 – General Info

Form 3921 – Where Do I Find It? Information on Form 3921 can be found at: 4 Attention: This form is provided for informational purposes only. Copy A appears in red, similar to the official IRS form. Do not file Copy A downloaded from this website with the SSA. The official printed version of this IRS form is scannable, but the online version of it, printed from this website, is not. A penalty may be imposed for filing forms that can’t be scanned. See the penalties section in the current General Instructions for Forms W-2 and W-3 for more information. To order official IRS forms, call TAX-FORM ( ) or Order Information Returns and Employer Returns Online, and we’ll mail you the scannable forms and other products. You may file Forms W-2 and W-3 electronically on the SSA’s website at Employer Reporting Instructions & Information. You can create fill-in versions of Forms W-2 and W-3 for filing with SSA. You may also print out copies for filing with state or local governments, distribution to your employees, and for your records. See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms.

Form 1096 – Where Do I Find It? Information on Form 1096 can be found at: 5 Attention: This form is provided for informational purposes only. Copy A appears in red, similar to the official IRS form. Do not file Copy A downloaded from this website. The official printed version of this IRS form is scannable, but the online version of it, printed from this website, is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the current General Instructions for Certain Information Returns for more information about penalties. To order official IRS forms, call TAX-FORM ( ) or Order Information Returns and Employer Returns Online, and we’ll mail you the scannable forms and other products. See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms.

Form 3921 – Hard Copy Filing Form 3921 – Copy A How to Generate in CapMx 6

Form 3921 – What Does It Look Like? This is a single Copy A: 7

Form 3921 This is the official multi-part Form 3921(IRS version): It is a 3 forms per page, 4-page carbonized form. The first page is Copy A; the second thru fourth pages are Copy B, C and D, respectively. 8

Form 3921 This is the Copy A of Form 3921 (office supply company version): It is a 3 forms per page, 1-page form. 9

Form 3921 – IRS vs. Office Supply Company Versions The IRS version (free from the IRS) Multi page form (carbonized for Copies B – D). Perforated on the left. Perforation strip has “U.S. Government Printing Office” information. Bottom of form has “Cat. No ”. The office supply company version (purchased from a stationer, Office Depot, Office Max, etc.) Single page form. Perforated on the right. Perforation strip has some other printer information. “Catalog No.” information does not match the IRS version. 10

Form 3921 and Form 1096 Form 3921 – Copy A How to Generate in CapMx Form

Form 3921 – Hard Copy With CapMx, hard copy (paper) filing is easy, fast and simple. CapMx can generate the paper Copy A for the IRS. However, you will need the actual, official Form 3921 from the IRS or a version from a stationer/office supply company. Feed the blank Form through your printer (like printing a stock certificate) and CapMx will fill-in the fields. CapMx will also generate the transmittal Form 1096 that must accompany the Forms 3921 that you send to the IRS. Information on that Form is found at slide 5. Follow the “General Instructions” to file with the IRS. 12

Form 3921 – Using the Blank Form Remove and discard the perforated edge along with any additional attached Form copies. ▪NOTE: the Form, prior to removing the perforated edge, is a standard A4 paper size. ▪Once the perforated edge is removed, the Form is now 8.5” x 11”. DO NOT use the regular paper tray on your printer. Instead, use the by- pass tray and narrow the side-guides to fit the size of the Form. KNOW YOUR PRINTER!!!! ▪Does your printer by-pass tray feed horizontally or vertically? ▪Does it feed with the printed side of the Form face down or face up? ▪Make a few copies of the Form and try it out before committing to using the actual Form. ▪You may need to adjust the left and top margins on your printer setup screen. Using the by-pass tray, feed the Form through your printer (like printing a stock certificate) and CapMx will fill-in the fields. 13

Form 3921 & Form 1096 – Using the Blank Form IMPORTANT!!! Due to printer differences, information may not align correctly in the boxes on the Form. If that happens, re-generate the Form in CapMx and save as a Word ® document. You can modify the Word ® document to adjust the data placement (typically by moving the data up/down a line) so that it aligns in the boxes correctly. 14

Steps to Generate the Hard Copy of Form 3921 At the Reports Main Menu, select “Form 3921” under the “Option & Stock Purchase Right” category. 15

Steps to Generate the Hard Copy of Form 3921 At the report generation screen, CapMx will automatically default to the 2012 tax year, i.e., the calendar year in which the ISOs were exercised. The year cannot be earlier than 2010 because Form 3921 is required only for ISO exercises after 12/31/09. For ISO exercises before 01/01/10, run the “ISO Year-End Statement”. 16

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Steps to Generate the Hard Copy of Form 3921 Select “Copy A for Internal Revenue Service”. The grid will expand to include “Contact” fields for completion of information that will go onto the Form

Copy A of Form 3921 – “Void” Forms 19 At the generation screen, CapMx does not have a “Void” check box. Each Form on the page has a “Void” box at the top. To mark a Form as “Void”, you will have to manually check the “Void” box at the top of the Form. CapMx will automatically complete all three Forms on each page. If the last page has only one or two Forms completed, do not check the “Void” box on the blank Form(s). The “Void” box is to be checked only if a Form is partially completed and you do not want the IRS to scan it. Please note that incomplete Forms, i.e., missing address, federal identification number, etc., may result in the IRS contacting you.

Copy A of Form 3921 – “Corrected” Forms At the generation screen, CapMx has a “Corrected” check box. Checking that box will cause all of the selected exercises to have the “Corrected” status on the electronic file. When generating a “Corrected” electronic file, be sure to select only those exercises that are actually being corrected. 20

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Form 1096 Form 1096 is a “transmittal” cover page and MUST accompany the hard-copy Form A delivered to the IRS. (See slide #5 for information on Form 1096 and ordering instructions). 22

Form 1096 – What Does It Look Like? Form 1096 is a two page 8.5” x 11” sheet. The top half of Page 1 is the actual Form (the next slide); the instructions begin on the bottom half of Page 1 and continues on to Page 2. Only the information on the top red portion of Form 1096 will generate from CapMx. You must complete the Signature, Title and Date fields on the Form. NOTE: You must file the entire sheet of Page 1 with the IRS. 23

Form 1096 – What Does It Look Like? 24

Form 1096 Form 1096 CapMx instruction page following the last Form 3921: THIS PAGE INTENTIONALLY LEFT BLANK. THE NEXT PAGE IS FORM ACCORDINGLY, PLEASE INSERT A BLANK FORM 1096 INTO YOUR PRINTER BEFORE PRINTING THE NEXT PAGE. 25

Form 1096 The data to complete Form 1096 is automatically generated by CapMx at the same time as the data for Form Information on the Form: Form Box: Filer’s name, street address and City, State, Zip will come from the Company > Corporate Management > Company Profile screen fields: ▫Name ▫Address Form Boxes: Name of Person to Contact; Telephone Number; address and Fax number will come from the Reports > Options and Stock Purchase Rights > Form 3921 grid “Generate Form 1096” fields: ▫Contact Name ▫Contact Telephone No. ▫Contact ▫Contact Fax No. 26

Form 1096 Form Box 1: “Employer identification number” will come from the Company > Corporate Management > Company Profile screen field “Federal Tax ID”. Form Box 2: “Social security number” will be left blank. Form Box 3: “Total number of forms” will equal the number of Copy A Forms 3921 generated. See slide 17, it shows 5 records in the Search Results. The “Total number of forms” will be the number of records you select at the Search Results screen. Form Box 4: “Federal income tax withheld” will be left blank as no taxes are withheld upon exercise of an ISO. 27

Form 1096 Form Box 5: “Total amount reported with this Form 1096” will be the sum of all generated Forms 3921 as follows: The “Exercise price per share” (Box 3 on Form 3921) plus the “Fair market value per share on exercise date” (Box 4 on Form 3921). Using the above values, the Box 5 input is $7.75 ($ $4.95) Form Box 6: “Enter an ‘X’ in only one box to indicate the type of form being filed”. An ‘X’ will be placed in box 25 to indicate that the Form 1096 covers Form Holder NameForm 3921 Box 3 (Exercise price per share) Form 3921 Box 4 (FMV per share on exercise date) Adams, John$0.75$1.00 Carey, Chris$0.50$0.90 Connor, Roseanne$0.50$0.90 Schmidt, Hannah$0.80$0.90 White, Effie$0.25$1.25 TOTALS$2.80$4.95

URLs, Phone Numbers, & Where to Find Stuff… URLs, Phone Numbers, and Where to Find Stuff… 29

URLs, Phone Numbers, & Where to Find Stuff… 1.Information on Form 3921 can be found at: 2.Information on Form 1096 can be found at: 3.Download Form 8809 here: 4.IRS Publication “2012 General Instructions for Forms, 1099, 1098, 3921, 3922, 5498 and W-2G” is here: 30

URLs, Phone Numbers, & Where to Find Stuff… 5.IRS Forms Order Desk: IRS Information Help Line:

Questions? Contact your CapMx Account Manager directly. Call the CapMx Support Line: the CapMx Support Team: 32