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Exhibit H

Internal Revenue Bulletin 2003-16 · 2026-10-03 edition · updated 2026-10-04 · United States

Changes in

Corporate Control and

Copy A

For Internal Revenue

Service Center File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act Notice, see the

2003 General Instructions for Forms 1099, 1098,

5498, and W-2G.

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 1 Date of sale or exchange OMB No. 1545-1814
2003
Form 1099-CAP
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 

1.40"
2
CUSIP No.		 

1.40"
2
CUSIP No.		 

1.40"
2
CUSIP No.
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 4
Federal income tax withheld
$		 No. of shares exchanged
5		 No. of shares exchanged
5
CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 6 Classes of stock exchanged
7		 Classes of stock exchanged
7
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name 8
$
FMV of stock received		 9
$
FMV of other property received		 9
$
FMV of other property received
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.)
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) 10 Description 10 Description 10 Description
City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code

2.70"
Account number (optional)		 
2.70"
Account number (optional)		 
Check if filed
by broker		 

2nd TIN not.		 Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return

Form 1099-CAP - Cat. No. 35115M� Department of the Treasury - Internal Revenue Service

.60"

Form 1099-CAP - Cat. No. 35115M� Department of the Treasury - Internal Revenue Service

.60"

Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page

Changes in

Corporate Control and

Copy A

For Internal Revenue

Service Center File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act Notice, see the

2003 General Instructions for Forms 1099, 1098,

5498, and W-2G.

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 1 Date of sale or exchange OMB No. 1545-1814
2003
Form 1099-CAP
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 2
CUSIP No.		 2
CUSIP No.		 2
CUSIP No.
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 4
Federal income tax withheld
$		 No. of shares exchanged
5		 No. of shares exchanged
5
CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 6 Classes of stock exchanged
7		 Classes of stock exchanged
7
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name 8
$
FMV of stock received		 9
$
FMV of other property received		 9
$
FMV of other property received
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.)
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) 10 Description 10 Description 10 Description
City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code
Account number (optional) Account number (optional) Check if filed
by broker		 2nd TIN not. Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return

Form 1099-CAP Cat. No. 35115M Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page

Changes in

Corporate Control and

Copy A

For Internal Revenue

Service Center File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act Notice, see the

2003 General Instructions for Forms 1099, 1098,

5498, and W-2G.

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 1 Date of sale or exchange OMB No. 1545-1814
2003
Form 1099-CAP
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 2
CUSIP No.		 2
CUSIP No.		 2
CUSIP No.
CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and
telephone no.		 Cash received
3
Reported
to IRS
$
		 Cash received
3
Reported
to IRS
$

CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 4
Federal income tax withheld
$		 No. of shares exchanged
5		 No. of shares exchanged
5
CORPORATION’S/BROKER’S
Federal identification no.		 SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. SHAREHOLDER’S identification no. 6 Classes of stock exchanged
7		 Classes of stock exchanged
7
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name
SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name SHAREHOLDER’S name 8
$
FMV of stock received		 9
$
FMV of other property received		 9
$
FMV of other property received
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.)
Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) Street address (including apt. no.) 10 Description 10 Description 10 Description
City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code City, state, and ZIP code
Account number (optional) Account number (optional) Check if filed
by broker		 2nd TIN not. Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return		 Check the box if shareholder cannot take a loss on their
tax return

Form 1099-CAP Cat. No. 35115M Department of the Treasury - Internal Revenue Service

April 21, 2003 785 2003–16 I.R.B.

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Internal Revenue Bulletin 2003-16

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