(1) | (2) | (3) | (4) |
Title | Name of | Amount and | Percent |
Of | Beneficial | Nature of | of |
Class | Owner | Beneficial | Class |
Ownership |
(A) Name of individual or number of persons in group | (B) Capacities in which served | (C) Cash and cash- equivalent forms of renumeration | (D) Aggregate of contingent forms of remuneration | |
(C1) Salaries, fees, director's fees, commissions, and bonuses | (C2) Securities of property insurance benefits or reimbursements, personal benefits |
COLUMN C Include all Cash and Cash Equivalent Forms of Remuneration received during the fiscal year and all such amounts accrued during the fiscal year which, with reasonable certainty, will be distributed or vested in the future. | COLUMN D Include all contingent forms of remuneration, distribution, vesting and measurement of which is subject to future events. Report only amounts relating to the latest fiscal year, not amounts accrued in previous periods. | |
COLUMN C-1 Salaries, Bonuses, Fees and Commissions | COLUMN C-2 Securities, Property,Insurance Benefits or Reimbursements, Personal Benefits (Perquisites) | |
1. All cash remuneration distributed or accrued in the form of salaries, commissions, bonuses andfees for services rendered | 1. Spread between the acquisition price, if any, and fair market price of securities or property acquired under any contract, plan or arrangement. | 1. Amount expenses for financial reporting purposes representing non-vested contributions, payments or accruals under any pension or retirement plans,annuities, employment contracts, deferred compensation plans including IRS qualified plans, unless the amount for the individual cannot be separated in which case a footnote is required indicating the percentage which contributions to the plan to participants total remuneration. |
2. Compensation earned for services performed in the latest fiscal year even if it is deferred for future payment | 2. Cost of any life insurance premiums, health insurance premiums and medical reimbursement plans. Premiums for non-discriminatory plans generally available to all salaried employees are excluded. | 2. The amount expensed for financial reporting purposes under any incentive compensation plans (long-term income plans), such as stock appreciation rights, stock options, performance share plans, where payout is based on objective standards or stock values. a. In subsequent years, if the corporation credits compensation expense for financial reporting purposes as a result of a decline in the value of contingent compensation, Column D may be reduced by a corresponding amount. A footnote explaining such action should be included. |
3. Payments received in the latest fiscal year but earned in prior years which were deferred until the latest year, if such amounts were not shown in an earlier proxy statement or annual report to stockholders. | 3. Personal benefits (perquisites) not directly related to job performance, excluding benefits provided on a non-discriminatory basis, valued on the basis of cost to the insurer of providing such benefits. a. If unreasonable effort or expense is required to determine the amounts of personal benefits, they may be omitted if their aggregate value does not exceed $10,000 for each officer. b. If the amount of personal benefits exceed 10% of the amount of total remuneration or $25,000, whichever is less, the amount and a brief description of the benefits must be disclosed in a footnote. | 3. The amount expensed for financial reporting purposes for any non-vested contribution payment or accrual to stock purchase plans, profit sharing, and thrift plans whether or not they are qualified under the Internal Revenue Code. |
4. Vested company contributions to thrift, profit, sharing, pension stock purchase and similar plans. |
Name | Name | Name | All directors and officers as a group | |
Title of Securities | ||||
Granted: 19__ to date: | ||||
1. Number of shares | ____ | ____ | ____ | ____ |
2. Average per share option price | $____ | $____ | $____ | $____ |
Exercised: 19__ to date: | ||||
1. Number of shares | ____ | ____ | ____ | ____ |
2. Aggregate option price of options exercised | $____ | $____ | $____ | $____ |
3. Aggregate market values of shares on date options exercised | $____ | $____ | $____ | $____ |
Sales: 19__ to date: | ||||
1. Number of shares | ____ | ____ | ____ | ____** |
Unexercised at 19__: | ||||
1. Number of shares | ____ | ____ | ____ | ____ |
2. Average per share option price | $____ | $____ | $____ | $____ |
In addition, during the period employees were granted options for ____ shares at an average price per share of $____. __________
**Sales by directors and officers who exercised options during the period 19__ to date.
Note: All figures should be adjusted, where applicable, in accordance with the terms of the options to reflect stock splits and to give effect to share dividends.
N.M. Admin. Code § 13.3.4.19