Form 3921 - Exercise of an Incentive Stock Option Under Section 422(b) - Copy B

Sep 19, 2026

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This document contains IRS Form 3921, “Exercise of an Incentive Stock Option Under Section 422(b),” Copy B for employees. It provides key option and transfer details, including dates granted and exercised, exercise price per share, fair market value on the exercise date, number of shares transferred, and the issuing corporation’s name, address, and EIN. It also includes employee instructions about reporting gain or loss, retaining the form, and potential alternative minimum tax treatment using amounts related to the FMV.

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Instructions for Employee

Reporting gain or loss

Alternative minimum tax considerations

Box-by-box data fields

| INTEGRATED DATA MANAGEMENT SYSTEMS
ACCOUNT ABILITY COMPLIANCE SOFTWARE
555 BROADHOLLOW ROAD SUITE 273
MELVILLE NY 11747-5001

631-249-7744/SALES DEPT
TRANSFEROR'S FEDERAL ID NO. 99-9999999
This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the Internal Revenue Service determines that it has not been reported.
TATFDDFDFATDATDDDFATFDFTFDDTDTDADFDTFDFTDADTTAADFADDFFTFTTDATDDTD
JOHN DOE
33 EAST 17 STREET UNIT 2101
NEW YORK NY 10003-2005

| | OMB No. 1545-2129 Form 3921
Exercise of an Incentive Stock Option Under Section 422(b) Copy B
For Employee Page 1

TOTAL SHARES TRANSFERRED
2,980

EMPLOYEE IDENTIFICATION NO
XXX-XX-0029
Department of the Treasury- Internal Revenue Service | | --- | --- | --- | | Corr
1. Date Option Granted
2. Date Option Exercised
3. Exercise Price Per Share
4. FMVon Date Exercised
5. Number of Shares Transferred
6. Name of Corporation Whose Stock is Being Transferred | | | | 11/16/17 03/18/25 $6.17 $7.01 350 ALPHA-BETA-GAMMA CORP
ACCT: 349859-58383
10/16/18 02/14/24 $6.02 $6.86 750 ALPHA-BETA-GAMMA CORP
ACCT: 349859-58383
10/16/18 05/18/24 $6.02 $6.86 750 ALPHA-BETA-GAMMA CORP 141
ACCT: 349859-58383
11/14/18 06/02/24 $6.17 $7.01 350 ALPHA-BETA-GAMMA CORP 141
ACCT: 349859-58383
12/12/19 08/09/24 $6.46 $7.08 390 ALPHA-BETA-GAMMA CORP
ACCT: 349859-58383
12/12/19 08/09/24 $6.46 $7.08 390 ALPHA-BETA-GAMMA CORP 141
ACCT: 349859-58383 | | | | INSTRUCTIONS FOR EMPLOYEE
You have received this form because your employer (or transfer agent) transferred your employer’s stock to you pursuant to your exercise of an incentive stock option (ISO) . You must recognize (report) gain or loss on your tax return for the year in which you sell or otherwise dispose of the stock. Keep this form and use it to figure the gain or loss. For more information, see Pub. 525, Taxable and Nontaxable Income.
When you exercise an ISO, you may have to include in alternative minimum taxable income a portion of the fair market value of the stock acquired through the exercise of the option. For more information, see Form 6251, Alternative Minimum Tax- Individuals, and its instructions. | Account number. May show an account or other unique number your employer or transfer agent assigned to distinguish your account.
Box 1. Shows the date the option to purchase the stock was granted to you. Box 2. Shows the date you exercised the option to purchase the stock. Box 3. Shows the exercise price per share of stock.
Box 4. Shows the fair market value (FMV) of a share of stock on the date the option was exercised.
Box 5. Shows the number of shares of stock transferred to you pursuant to the exercise of the option.
Box 6. Shows the name, address, and employer identification number (EIN) of the corporation whose stock is being transferred (if other than the corporation shown in TRANSFEROR above) . | |

FAQs

What does IRS Form 3921 (Copy B) document for an employee?

It records the exercise of an incentive stock option under Section 422(b), including transfer details and corporate information needed for tax reporting.

When must I report gain or loss related to an ISO exercise?

Recognize and report gain or loss on your tax return for the year in which you sell or otherwise dispose of the stock.

How does exercising an ISO affect alternative minimum taxable income?

You may need to include in alternative minimum taxable income a portion of the fair market value of the stock acquired through the exercise of the option.

Sep 19, 2026

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