Form SEC-1685 Form 13F

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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F ORM 1 3 F
INFORMATION REQUIRED OF INSTITUTIONAL INVESTMENT MANAGERS PURSUANT TO SECTION
13(f) OF THE SECURITIES EXCHANGE ACT OF 1934 AND RULES THEREUNDER
GENERAL INSTRUCTIONS
1.

Rule as to Use of Form 13F. Institutional investment managers (“Managers”) must use Form 13F for reports to the
Commission required by Section 13(f) of the Securities Exchange Act of 1934 [15 U.S.C. 78m(f)] (“Exchange Act”)
and rule 13f-1 [17 CFR 240.13f-1] thereunder. Rule 13f-1(a) provides that every Manager which exercises
investment discretion with respect to accounts holding Section 13(f) securities, as defined in rule 13f-1(c), having
an aggregate fair market value on the last trading day of any month of any calendar year of at least $100,000,000 shall
file a report on Form 13F with the Commission within 45 days after the last day of such calendar year and within 45
days after the last day of each of the first three calendar quarters of the subsequent calendar year.

2.

Rules to Prevent Duplicative Reporting. If two or more Managers, each of which is required by rule 13f-1 to file a
report on Form 13F for the reporting period, exercise investment discretion with respect to the same securities, only
one such Manager must include information regarding such securities in its reports on Form 13F.
A Manager having securities over which it exercises investment discretion that are reported by another Manager (or
Managers) must identify the Manager(s) reporting on its behalf in the manner described in Special Instruction 6.
A Manager reporting holdings subject to shared investment discretion must identify the other Manager(s) with
respect to which the filing is made in the manner described in Special Instruction 8.

3.

Filing of Form 13F. A Manager must file a Form 13F report with the Commission within 45 days after the end of
each calendar year and each of the first three calendar quarters of each calendar year. As required by Section 13(f)(4)
of the Exchange Act, a Manager which is a bank, the deposits of which are insured in accordance with the Federal
Deposit Insurance Act, must file with the appropriate regulatory agency for the bank a copy of every Form 13F report
filed with the Commission pursuant to this subsection by or with respect to such bank. Filers who file Form 13F
electronically can satisfy their obligation to file with other regulatory agencies by sending (a) a paper copy of the
EDGAR filing (provided the Manager removes or blanks out the confidential access codes); (b) the filing in
electronic format, if the regulatory agency with which the filing is being made has made provisions to receive filings
in electronic format; or (c) for filers filing in paper format under continuing hardship exemptions, a copy of the
Form 13F paper filing.

4.

Official List of Section 13(f) Securities. The official list of Section 13(f) Securities published by the Commission
(the “13F List”) lists the securities the holdings of which a Manager is to report on Form 13F. See rule 13f-1(c) [17
CFR 240.13f-1(c)]. Form 13F filers may rely on the current 13F List in determining whether they need to report any
particular securities holding. Paper copies are available at a reasonable fee from the Securities and Exchange
Commission, Public Reference Room, 450 Fifth Street, N.W., Washington, D.C. 20549.
INSTRUCTIONS FOR CONFIDENTIAL TREATMENT REQUESTS

Pursuant to Section 13(f)(3) of the Exchange Act [15 U.S.C. 78m(f)(3)], the Commission (1) may prevent or delay
public disclosure of information reported on this form in accordance with Section 552 of Title 5 of the United States Code,
the Freedom of Information Act [5 U.S.C. 552], and (2) shall not disclose information reported on this form identifying
securities held by the account of a natural person or an estate or trust (other than a business trust or investment company).
A Manager must submit in accordance with the procedures for requesting confidential treatment any portion of a report
which contains information identifying securities held by the account of a natural person or an estate or trust (other than
a business trust or investment company).

SEC 1685 (10-03)

Persons who 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.

A Manager should make requests for confidential treatment of information reported on this form in accordance with
rule 24b-2 under the Exchange Act [17 CFR 240.24b-2]. Requests relating to the non-disclosure of information
identifying the securities held by the account of a natural person or an estate or trust (other than a business trust or
investment company) must so state but need not, in complying with paragraph (b)(2)(ii) of rule 24b-2, include an analysis
of any applicable exemptions from disclosure under the Commission’s rules and regulations adopted under the Freedom
of Information Act [17 CFR 200.80].
Paragraph (b) of rule 24b-2 requires a Manager filing confidential information with the Commission to indicate at
the appropriate place in the public filing that the confidential portion has been so omitted and filed separately with the
Commission. A Manager should comply with this provision by including on the Summary Page, after the Report Summary
and prior to the List of Other Included Managers, a statement that confidential information has been omitted from the
public Form 13F report and filed separately with the Commission.
A Manager must file in paper, in accordance with rule 101(c)(1)(i) of Regulation S-T [17 CFR 232.101(c)(1)(i)], all
requests for and information subject to the request for confidential treatment filed pursuant to Section 13(f)(3) of the
Exchange Act. If a Manager requests confidential treatment with respect to information required to be reported on
Form 13F, the Manager must file in paper with the Secretary of the Commission an original and four copies of the
Form 13F reporting information for which the Manager requests confidential treatment.
A Manager requesting confidential treatment must provide enough factual support for its request to enable the
Commission to make an informed judgment as to the merits of the request. The request should address all pertinent factors,
including all of the following that are relevant:
1.

If confidential treatment is requested as to more than one holding of securities, discuss each holding separately unless
the Manager can identify a class or classes of holdings as to which the nature of the factual circumstances and the
legal analysis are substantially the same.

2.

If a request for confidential treatment is based upon a claim that the subject information is confidential, commercial
or financial information, provide the information required by paragraphs 2.a through 2.e of this Instruction except
that, if the subject information concerns security holdings that represent open risk arbitrage positions and no previous
requests for confidential treatment of those holdings have been made, the Manager need provide only the information
required in paragraph 2.f.
a.

Describe the investment strategy being followed with respect to the relevant securities holdings, including the
extent of any program of acquisition and disposition (note that the term “investment strategy,” as used in this
instruction, also includes activities such as block positioning).

b.

Explain why public disclosure of the securities would, in fact, be likely to reveal the investment strategy;
consider this matter in light of the specific reporting requirements of Form 13F (e.g., securities holdings are
reported only quarterly and may be aggregated in many cases).

c.

Demonstrate that such revelation of an investment strategy would be premature; indicate whether the Manager
was engaged in a program of acquisition or disposition of the security both at the end of the quarter and at the
time of the filing; and address whether the existence of such a program may otherwise be known to the public.

d.

Demonstrate that failure to grant the request for confidential treatment would be likely to cause substantial harm
to the Manager’s competitive position; show what use competitors could make of the information and how harm
to the Manager could ensue.

e.

State the period of time for which confidential treatment of the securities holdings is requested. The time period
specified may not exceed one (1) year from the date that the Manager is required to file the Form 13F report
with the Commission.

f.

For securities holdings that represent open risk arbitrage positions, the request must include good faith
representations that:

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i.

the securities holding represents a risk arbitrage position open on the last day of the period for which the
Form 13F report is filed; and

ii.

the reporting Manager has a reasonable belief as of the period end that it may not close the entire position
on or before the date that the Manager is required to file the Form 13F report with the Commission.

If the Manager makes these representations in writing at the time that the Form 13F is filed, the Commission
will automatically accord the subject securities holdings confidential treatment for a period of up to one (1) year
from the date that the Manager is required to file the Form 13F report with the Commission.
g.

At the expiration of the period for which confidential treatment has been granted pursuant to paragraph 2.e or
2.f of this Instruction (the “Expiration Date”), the Commission, without additional notice to the reporting
manager, will make such security holdings public unless a de novo request for confidential treatment of the
information that meets the requirements of paragraphs 2.a through 2.e of this Instruction is filed with the
Commission at least fourteen (14) days in advance of the Expiration Date.

3.

If the Commission grants a request for confidential treatment, it may delete details which would identify the Manager
and use the information in tabulations required by Section 13(f)(3) absent a separate showing that such use of
information could be harmful.

4.

Upon the denial by the Commission of a request for confidential treatment, or upon the expiration of the confidential
treatment previously granted for a filing, unless a hardship exemption is available, the Manager must submit
electronically, within six (6) business days of the expiration or notification of the denial, as applicable, a Form 13F
report, or an amendment to its publicly filed Form 13F report, if applicable, listing those holdings as to which the
Commission denied confidential treatment or for which confidential treatment has expired. If a Manager files an
amendment, the amendment must not be a restatement; the Manager must designate it as an amendment which adds
new holdings entries. The Manager must include at the top of the Form 13F Cover Page the following legend to
correctly designate the type of filing being made:
THIS FILING LISTS SECURITIES HOLDINGS REPORTED ON THE FORM 13F FILED ON
(DATE) PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FOR
WHICH (THAT REQUEST WAS DENIED/CONFIDENTIAL TREATMENT EXPIRED) ON
(DATE).
SPECIAL INSTRUCTIONS

1.

This form consists of three parts: the Form 13F Cover Page (the “Cover Page”), the Form 13F Summary Page (the
“Summary Page”), and the Form 13F Information Table (the “Information Table”).

2.

When preparing the report, omit all bracketed text. Include brackets used to form check boxes.

The Cover Page:
3.

The period end date used in the report (and in the EDGAR submission header) is the last day of the calendar year
or quarter, as appropriate, even though that date may not be the same as the date used for valuation in accordance
with Special Instruction 9.

4.

Amendments to a Form 13F report must either restate the Form 13F report in its entirety or include only holdings
entries that are being reported in addition to those already reported in a current public Form 13F report for the same
period. If the Manager is filing the Form 13F report as an amendment, then, the Manager must check the amendment
box on the Cover Page; enter the amendment number; and check the appropriate box to indicate whether the
amendment (a) is a restatement or (b) adds new holdings entries. Each amendment must include a complete Cover
Page and, if applicable, a Summary Page and Information Table. See rule 13f-1(a)(2) [17 CFR 240.13f-1(a)(2)].

5.

Present the Cover Page and the Summary Page information in the format and order provided in the form. The Cover
Page may include information in addition to the required information, so long as the additional information does not,
either by its nature, quantity, or manner of presentation, impede the understanding or presentation of the required
information. Place all additional information after the signature of the person signing the report (immediately

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preceding the Report Type section). Do not include any additional information on the Summary Page or in the
Information Table.
6.

Designate the Report Type for the Form 13F report by checking the appropriate box in the Report Type section of
the Cover Page, and include, where applicable, the List of Other Managers Reporting for this Manager (on the Cover
Page), the Summary Page and the Information Table, as follows:
a.

If all of the securities with respect to which a Manager has investment discretion are reported by another
Manager (or Managers), check the box for Report Type “13F NOTICE,” include (on the Cover Page) the List
of Other Managers Reporting for this Manager, and omit both the Summary Page and the Information Table.

b.

If all of the securities with respect to which a Manager has investment discretion are reported in this report,
check the box for Report Type “13F HOLDINGS REPORT,” omit from the Cover Page the List of Other
Managers Reporting for this Manager, and include both the Summary Page and the Information Table.

c.

If only part of the securities with respect to which a Manager has investment discretion is reported by another
Manager (or Managers), check the box for Report Type “13F COMBINATION REPORT,” include (on the
Cover Page) the List of Other Managers Reporting for this Manager, and include both the Summary Page and
the Information Table.

Summary Page:
7.

8.

Include on the Summary Page the Report Summary, containing the Number of Other Included Managers, the
Information Table Entry Total and the Information Table Value Total.
a.

Enter as the Number of Other Included Managers the total number of other Managers listed in the List of Other
Included Managers on the Summary Page, not counting the Manager filing this report. See Special
Instruction 8. If none, enter the number zero (“0”).

b.

Enter as the Information Table Entry Total the total number of line entries providing holdings information
included in the Information Table.

c.

Enter as the Information Table Value Total the aggregate fair market value of all holdings reported in this report,
i.e., the total for Column 4 (Fair Market Value) of all line entries in the Information Table. The Manager must
express this total as a rounded figure, corresponding to the individual Column 4 entries in the Information
Table. See Special Instruction 9.

Include on the Summary Page the List of Other Included Managers. Use the title, column headings and format
provided.
a.

If this Form 13F report does not report the holdings of any Manager other than the Manager filing this report,
enter the word “NONE” under the title and omit the column headings and list entries.

b.

If this Form 13F report reports the holdings of one or more Managers other than the Manager filing this report,
enter in the List of Other Included Managers all such Managers together with their respective Form 13F file
numbers, if known. (The Form 13F file numbers are assigned to Managers when they file their first Form 13F.)
Assign a number to each Manager in the List of Other Included Managers, and present the list in sequential
order. The numbers need not be consecutive. The List of Other Managers must include all other Managers
identified in Column 7 of the Information Table. Do not include the Manager filing this report.

Information Table:
9.

In determining fair market value, use the value at the close of trading on the last trading day of the calendar year or
quarter, as appropriate. Enter values rounded to the nearest one thousand dollars (with “000” omitted).

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10.

A Manager may omit holdings otherwise reportable if the Manager holds, on the period end date, fewer than 10,000
shares (or less than $200,000 principal amount in the case of convertible debt securities) and less than $200,000
aggregate fair market value (and option holdings to purchase only such amounts).

11. A Manager must report holdings of options only if the options themselves are Section 13(f) securities. For purposes
of the $100,000,000 reporting threshold, the Manager should consider only the value of such options, not the value
of the underlying shares. The Manager must give the entries in Columns 1 through 5 and in Columns 7 and 8 of the
Information Table, however, in terms of the securities underlying the options, not the options themselves. The
Manager must answer Column 6 in terms of the discretion to exercise the option. The Manager must make a separate
segregation in respect of securities underlying options for entries for each of the columns, coupled with a designation
“PUT” or “CALL” following such segregated entries in Column 5, referring to securities subject respectively to put
and call options. A Manager is not required to provide an entry in Column 8 for securities subject to reported call
options.
12. Furnish the Information Table using the table title, column headings and format provided. Provide column headings
once at the beginning of the Information Table; repetition of column headings on subsequent pages is not required.
Present the table in accordance with the column instructions provided in Special Instructions 12.b.i through 12.b.viii.
Do not include any additional information in the Information Table. Begin the Information Table on a new page;
do not include any portion of the Information Table on either the Cover Page or the Summary Page.
a.

In entering information in Columns 4 through 8 of the Information Table, list securities of the same issuer and
class with respect to which the Manager exercises sole investment discretion separately from those with respect
to which investment discretion is shared. Special Instruction 12.b.vi for Column 6 describes in detail how to
report shared investment discretion.

b.

Instructions for each column in the Information Table:
i.

Column 1. Name of Issuer. Enter in Column 1 the name of the issuer for each class of security reported
as it appears in the current official list of Section 13(f) Securities published by the Commission in
accordance with rule 13f-1(c) (the “13F List”). Reasonable abbreviations are permitted.

ii.

Column 2. Title of Class. Enter in Column 2 the title of the class of the security reported as it appears
in the 13F List. Reasonable abbreviations are permitted.

iii.

Column 3. CUSIP Number. Enter in Column 3 the nine (9) digit CUSIP number of the security.

iv.

Column 4. Market Value. Enter in Column 4 the market value of the holding of the particular class of
security as prescribed by Special Instruction 9.

v.

Column 5. Amount and Type of Security. Enter in Column 5 the total number of shares of the class of
security or the principal amount of such class. Use the abbreviation “SH” to designate shares and “PRN”
to designate principal amount. If the holdings being reported are put or call options, enter the designation
“PUT” or “CALL,” as appropriate.

vi.

Column 6. Investment Discretion. Segregate the holdings of securities of a class according to the nature
of the investment discretion held by the Manager. Designate investment discretion as “sole” (SOLE);
“shared-defined” (DEFINED); or “shared-other” (OTHER), as described below:
(A) Sole. Designate as “sole” securities over which the Manager exercised sole investment discretion.
Report “sole” securities on one line. Enter the word SOLE in Column 6.
(B) Shared-Defined. If investment discretion is shared with controlling and controlled companies (such
as bank holding companies and their subsidiaries); investment advisers and investment companies
advised by those advisers; or insurance companies and their separate accounts, then designate
investment discretion as “shared-defined” (DEFINED).

5

For each holding of DEFINED securities, segregate the securities into two categories: those securities
over which investment discretion is shared with another Manager or Managers on whose behalf this
Form 13F report is being filed, and those securities over which investment discretion is shared with
any other person, other than a Manager on whose behalf this Form 13F report is being filed.
Enter each of the two segregations of DEFINED securities holdings on a separate line, and enter the
designation DEFINED in Column 6. See Special Instruction vii for Column 7.
(C) Shared-Other. Designate as “shared-other” securities (OTHER) those over which investment
discretion is shared in a manner other than that described in Special Instruction (B) above.
For each holding of OTHER securities, segregate the securities into two categories: those securities
over which investment discretion is shared with another Manager or Managers on whose behalf this
Form 13F report is being filed, and those securities over which investment discretion is shared with
any other person, other than a Manager on whose behalf this Form 13F report is being filed.
Enter each segregation of OTHER securities holdings on a separate line, and enter the designation
“OTHER” in Column 6. See Special Instruction vii for Column 7.
NOTE: A Manager is deemed to share discretion with respect to all accounts over which any person
under its control exercises discretion. A Manager of an institutional account, such as a pension fund
or investment company, is not deemed to share discretion with the institution unless the institution
actually participated in the investment decision-making.
vii. Column 7. Other Managers. Identify each other Manager on whose behalf this Form 13F report is being
filed with whom investment discretion is shared as to any reported holding by entering in this column the
number assigned to the Manager in the List of Other Included Managers.
Enter this number in Column 7 opposite the segregated entries in Columns 4, 5 and 8 (and the relevant
indication of shared discretion set forth in Column 6) as required by the preceding special instruction.
Enter no other names or numbers in Column 7.
A Manager must report the conditions of sharing discretion with other Managers consistently for all
holdings reported on a single line.
viii. Column 8. Voting Authority. Enter the number of shares for which the Manager exercises sole, shared,
or no voting authority (none) in this column, as appropriate.
The Commission deems a Manager exercising sole voting authority over specified “routine” matters, and
no authority to vote in “non-routine” matters, for purposes of this Form 13F report to have no voting
authority. “Non-routine” matters include a contested election of directors, a merger, a sale of substantially
all the assets, a change in the articles of incorporation affecting the rights of shareholders, and a change
in fundamental investment policy; “routine” matters include selection of an accountant, uncontested
election of directors, and approval of an annual report.
If voting authority is shared only in a manner similar to a sharing of investment discretion which would
call for a response of “shared-defined” (DEFINED) under Column 6, a Manager should report voting
authority as sole under subdivision (a) of Column 8, even though the Manager may be deemed to share
investment discretion with that person under Special Instruction 12.b.vi.
13. Preparation of the electronic filing:
a.

No line on the Cover Page or the Summary Page may exceed 80 characters in length. See rule 305 of
Regulation S-T [17 CFR 232.305].

6

b.

No line in the Form 13F Information Table may exceed 132 characters in length. See rule 305 of Regulation S-T
[17 CFR 232.305].

c.

If the Form 13F Report Type is “13F HOLDINGS REPORT” or “13F COMBINATION REPORT,” then place
one EDGAR tag at the end of the Cover Page and one tag at the end of the Summary Page.
Additional EDGAR tags are not required. Those electing to include additional tags should,
for each page containing a tag, include no more than sixty (60) lines per page, including the line on
which the tag is placed.

d.

In preparing the Form 13F report for electronic filing, a Manager may omit underscoring used in the form to
indicate the placement of information that the Manager is to furnish.

e.

Use the following EDGAR submission types for the following Form 13F Report Types:
Form 13F Report Type

EDGAR Submission Type

13F HOLDINGS REPORT
Initial Filing
Amendments

13F-HR
13F-HR/A

13F NOTICE
Initial Filing
Amendments

13F-NT
13F-NT/A

13F COMBINATION REPORT
Initial Filing
Amendments

13F-HR
13F-HR/A

PAPERWORK REDUCTION ACT INFORMATION
Persons who are to respond to the collection of information contained in this form are not required to respond to the
collection of information unless the form displays a currently valid OMB control number.
Section 13(f) of the Exchange Act requires the Commission to adopt rules creating a reporting and disclosure system
to collect specific information and to disseminate such information to the public. Rule 13f-1 under the Exchange Act (17
CFR 240.13f-1) requires institutional investment managers who exercise investment discretion over certain accounts of
equity securities described in Section 13(d)(1) of the Exchange Act [15 U.S.C. 78m(d)(1)] (generally, exchange traded
or NASDAQ-quoted securities) having, in the aggregate, a fair market value of at least $100,000,000 to file quarterly
reports with the Commission on Form 13F with respect to the value of those securities over which they have investment
discretion.
The purpose of Form 13F is to provide a reporting and disclosure system to collect specific information and to
disseminate such information to the public about the holdings of institutional investment managers who exercise
investment discretion over certain accounts of equity securities described in Section 13(d)(1) of the Exchange Act [15
U.S.C. 78m(d)(1)] (generally, exchange traded or NASDAQ-quoted securities) having, in the aggregate, a fair market
value of at least $100,000,000. We believe that investors will find Form 13F report information useful in tracking
institutional investor holdings in their investments and that issuers, too, will find detail as to institutional investor holdings
useful because much of their shareholder list may reflect holdings in “street name” rather than beneficial ownership. We
believe that mandatory electronic dissemination of this data will help ensure timely and efficient dissemination of this
important information. We believe that these reports should have the same degree of availability as other filings with the
Commission, and that electronic filing will speed their dissemination in accordance with the intent of Congress.
We estimate that each filer spends an average of 23.5 hours preparing each quarterly report. In addition, we estimate
that, each quarter, approximately 129 managers will resubmit information to: (1) correct an error or omission; or (2) supplement
a request for confidential treatment that expires or is denied, and that each such manager will spend an additional hour on
the resubmission.

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Any member of the public may direct to the Commission any comments concerning the accuracy of this burden estimate
and any suggestions for reducing this burden.
Responses to the collection of information are mandatory. See Section 13(f) of the Exchange Act [15 U.S.C. 78m(f)]
and rule 13f-1 [17 CFR 240.13f-1] thereunder.
Section 13(f)(3) of the Exchange Act [15 U.S.C. 78m(f)(3)] authorizes the Commission, as it determines necessary
or appropriate in the public interest or for the protection of investors, to delay or prevent public disclosure of any
information filed under Section 13(f) upon request. It also prohibits the Commission from disclosing to the public
information identifying securities held by the account of a natural person or any estate or trust (other than a business trust
or investment company).
This collection of information has been reviewed by OMB in accordance with the clearance requirements of 44
U.S.C. Section 3507.

8

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

Fo r m 1 3 F
FORM 13F COVER PAGE
Report for the Calendar Year or Quarter Ended: _______________________________
Check here if Amendment [ ]; Amendment Number: ______
This Amendment (Check only one.):
[ ] is a restatement.
[ ] adds new holdings entries.
Institutional Investment Manager Filing this Report:
Name:
__________________________________________
Address: __________________________________________
__________________________________________
__________________________________________
Form 13F File Number: 28-____________
The institutional investment manager filing this report and the person by whom it is signed hereby represent that the person
signing the report is authorized to submit it, that all information contained herein is true, correct and complete, and that
it is understood that all required items, statements, schedules, lists, and tables, are considered integral parts of this form.
Person Signing this Report on Behalf of Reporting Manager:
Name:
Title:
Phone:

__________________________________________
__________________________________________
__________________________________________

Signature, Place, and Date of Signing:
____________________________________
[Signature]

_________________________________
[City, State]

_______________
[Date]

Report Type (Check only one.):
[ ]

13F HOLDINGS REPORT. (Check here if all holdings of this reporting manager are reported in this report.)

[ ]

13F NOTICE. (Check here if no holdings reported are in this report, and all holdings are reported by other reporting
manager(s).)

[ ]

13F COMBINATION REPORT. (Check here if a portion of the holdings for this reporting manager are reported in
this report and a portion are reported by other reporting manager(s).)

List of Other Managers Reporting for this Manager:
[If there are no entries in this list, omit this section.]
Form 13F File Number
28-__________________
[Repeat as necessary.]

Name
________________________________________________

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FORM 13F SUMMARY PAGE
Report Summary:

Number of Other Included Managers:

_____________________

Form 13F Information Table Entry Total: _____________________
Form 13F Information Table Value Total: _____________________
(thousands)

List of Other Included Managers:

Provide a numbered list of the name(s) and Form 13F file number(s) of all institutional investment managers with respect
to which this report is filed, other than the manager filing this report.
[If there are no entries in this list, state “NONE” and omit the column headings and list entries.]
No.

Form 13F File Number

Name

____

28-________________________

______________________________________

[Repeat as necessary.]

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11

TITLE OF CLASS

NAME OF ISSUER

[Repeat as necessary]

COLUMN 2

COLUMN 1

CUSIP

COLUMN 3
VALUE
(x$1000)

COLUMN 4
SHRS OR SH/ PUT/
PRN AMT PRN CALL

COLUMN 5

FORM 13F INFORMATION TABLE
COLUMN 7

COLUMN 8

INVESTMENT OTHER
VOTING AUTHORITY
DISCRETION MANAGERS SOLE SHARED NONE

COLUMN 6