Form 13H Information Required Of Large Traders Pursuant To Section 13(h) (SEC2858) {13H}

United States Securities and Exchange Commission FORM 13H Large Trader Registration Information Required of Large Traders Pursuant To Section 13(h) of the Securities Exchange Act of 1934 and Rules Thereunder [ ] INITIAL FILING: Date identifying transactions first effected (mm/dd/yyyy) Voluntary filing? [ ] no [ ] yes Date of voluntary filing [ ] ANNUAL FILING: Calendar year ending [ ] AMENDED FILING[ ] INACTIVE STATUS: Date commencing Inactive Status (mm/dd/yyyy) [ ] TERMINATION FILING: Effective date (mm/dd/yyyy) [ ] REACTIVATED STATUS: Date identifying transactions first effected, post-Inactive Status (mm/dd/yyyy) Name of Large Trader Filing This Form LTID Taxpayer Identification Number Business Address of the Large Trader (Street, City, State, Zip, Country) Mailing Address of the Large Trader (Street, City, State, Zip, Country) Telephone No. () - Facsimile No. () - Email The Form and the schedules thereto must be submitted by a natural person who is authorized to make this submission on behalf of the large trader. OMB APPROVAL Persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com Name of Authorized Person (First, Middle Initial, Last) Title of Authorized Person Relationship to Large Trader Business Address of Authorized Person (Street, City, State, Zip, Country) Authorized Person222s Telephone No. () - Facsimile No. () - Authorized Person222s Email ATTENTION Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Intentional misstatements or omissions of facts may result in civil fines and other sanctions pursuant to the Securities Exchange Act of 1934. The authorized person signing this form represents that all information contained in the form, schedules, and continuation sheets is true, correct, and complete. It is understood that all information whether contained in the form, schedules, or continuation sheets, is considered an integral part of this form and that any amendment represents that all unamended information remains true, correct, and complete. Signature of Person Authorized to Submit this Form SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com FORM 13H INFORMATION REQUIRED OF ALL LARGE TRADERS ITEM 1. BUSINESSES OF THE LARGE TRADER (check as many as applicable) (a) Businesses engaged in by the large trader and any of the large trader222s affiliates (check as many as applicable) [ ] Broker or Dealer [ ] Bank Holding Company [ ] Government Securities Broker or Dealer [ ] Non-Bank Holding Company [ ] Municipal Securities Broker or Dealer [ ] Bank [ ] Investment Adviser [ ] Pension Trustee [ ] to Registered Investment Companies [ ] Non-Pension Trustee [ ] to Hedge Funds or other Funds not registered [ ] Insurance Company under the Investment Company Act [ ] Futures Commission Merchant [ ] Other (specify) [ ] Commodity Pool Operator (b) Describe the nature of the business of the large trader including a description for each Securities Affiliate: ITEM 2. SECURITIES AND EXCHANGE COMMISSION FILINGS Does the large trader or any of its Securities Affiliates file any other forms with the Commission? [ ] Yes [ ] No If yes, specify the entity and the forms filed: Entity Form(s) Filed CIK Number ITEM 3. CFTC REGISTRATION AND FOREIGN REGULATORS SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com (a) Is the large trader or any of its affiliates registered with the Commodity Futures Trading Commission in any capacity, including as a 223registered trader224 pursuant to sections 4i and 9 of the Commodity Exchange Act? [ ] Yes [ ] No If yes, identify each entity and specify the registration number: Entity Registration Number (b) Is the large trader or any of its Securities Affiliates regulated by a foreign regulator? [ ] Yes [ ] No If yes, identify each entity and its primary foreign regulator(s): Entity Primary Foreign Regulator ITEM 4. ORGANIZATION INFORMATION (a) Attach an Organizational Chart that identifies the large trader, its parent company (if applicable), all Securities Affiliates, and all entities identified in Item 3(a). (b) Provide the following information on all Securities Affiliates and all entities identified in Item 3(a): Entity MPID(s) Description of Relationship to the Business Large Trader (c) If any affiliates file separately, identify each entity: SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com Entity LTID Suffix (if any) (d) If any affiliates have been assigned an LTID suffix, identify such entities and their corresponding suffixes: Entity Suffix ITEM 5. GOVERNANCE OF THE LARGE TRADER (a) STATUS OF THE LARGE TRADER (check as many as apply) [ ] Individual [ ] Partnership [ ] Limited Partnership [ ] Trustee [ ] Corporation [ ] Limited Liability Company [ ] Other (specify) (b) Complete the following for each general partner, and in the case of limited partnerships, each limited partner that is the owner of more than a 10 percent financial interest in the accounts of the large trader: Name Status (check one for each) [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner [ ] General Partner [ ] Limited Partner SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com (c) Complete the following for each executive officer, director, or trustee of a large trader corporation or trustee: Name Status (check one for each) [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee [ ] Executive Officer [ ] Director [ ] Trustee (d) Jurisdiction in which the large trader entity is incorporated or organized: (state and country) ITEM 6. LIST OF BROKER-DEALERS AT WHICH THE LARGE TRADER OR ITS SECURITIES AFFILIATES HAS AN ACCOUNT Identify each broker-dealer at which the large trader or any of its Securities Affiliates has an account and the types of services provided. Name of Broker-Dealer [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker [ ] Prime Broker [ ] Executing Broker [ ] Clearing Broker SEC 2858 (11-11) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR FORM 13H Submission of the Form. All submissions on Form 13H must be filed electronically through the Commission222s Electronic Data Gathering, Analysis, and Retrieval (223EDGAR224) system. For more information on filing through EDGAR, including instructions on how to obtain access to and file electronically through EDGAR, see the EDGAR Filer Manual (available on the Commission222s website at: http://www.sec.gov/info/edgar.shtml ). Definitions. The term 223Securities Affiliate 224 means an affiliate of the large trader that exercises investment discretion over NMS securities. The term 223affiliate 224 means any person that directly or indirectly controls, is under common control with, or is controlled by the large trader. The term 223bank 224 means a national bank, state member bank of the Federal Reserve System, state non-member bank, savings bank or association, credit union, or foreign bank. The term 223executive officer 224 means 223policy-making officer224 and otherwise is interpreted in accordance with Rule 16a-1(f) under the Exchange Act. Type of Filing. Indicate the type of Form 13H filing by checkin