Form SEC 617 SEC 617 Form 11-K

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

OMB APPROVAL
OMB Number:
3235-0082
Expires:
February 28, 2022
Estimated average burden
hours per response. . . . . 30.00

FORM 11-K
FOR ANNUAL REPORTS OF EMPLOYEE STOCK PURCHASE, SAVINGS
AND SIMILAR PLANS PURSUANT TO SECTION 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934
GENERAL INSTRUCTIONS
A.

Rule as to Use of Form 11-K.

This Form shall be used for annual reports pursuant to Section 15(d) of the Securities Exchange Act of 1934 (“Exchange Act”)
with respect to employee stock purchase, savings and similar plans, interests in which constitute securities registered under the Securities
Act of 1933. This Form also shall be used for transition reports filed pursuant to Section 15(d) of the Act. Such a report is required to
be filed even though the issuer of the securities offered to employees pursuant to the plan also files annual reports pursuant to Section
13(a) or 15(d) of the Exchange Act. However, attention is directed to Rule 15d-21 (§240.15d-21), which provides that in certain cases
the information required by this Form may be furnished with respect to the plan as a part of the annual report of such issuer. Reports on
this Form shall be filed within 90 days after the end of the fiscal year of the plan, provided that plans subject to the Employee Retirement
Income Security Act of 1974 (“ERISA”) shall file the plan financial statements within 180 days after the plan’s fiscal year end.
B.

C.

Application of General Rules and Regulations.
(a)

The General Rules and Regulations under the Exchange Act contain requirements applicable to reports on any form. These
general requirements should be carefully read and observed in the preparation and filing of reports on this Form.

(b)

Particular attention is directed to Regulation 12B, which contains general requirements regarding matters such as the kind
and size of paper to be used, the legibility of the report, and the filing of the report. The definitions contained in Rule 12b-2
(§240.12b-2) should be especially noted. See also Regulation 15D.

(c)

Four complete copies of each report on this Form, including exhibits and all papers and documents filed as a part thereof, shall
be filed with the Commission. At least one of the copies filed shall be manually signed. Copies not manually signed shall bear
typed or printed signatures.

Preparation of Report.

This Form is not to be used as a blank form to be filled in, but only as a guide in the preparation of the report on paper meeting the
requirements of Rule 12b-12 (§240.12b-12). The report may omit the text of Form 11-K specifying the information required provided
the answers thereto are prepared in the manner specified in Rule 12b-13 (§240.12b-13).
D.

Incorporation of Information in Report to Employees.

Any financial statements contained in any plan annual report to employees covering the latest fiscal year of the plan may be
incorporated by reference from such document in response to part or all of the requirements of this Form, provided such financial statements
substantially meet the requirements of this Form and provided that such document is filed as an exhibit to this report on Form 11-K.
E.

Electronic Filers.
Reports on this Form may be filed either in paper or in electronic format, at the filer’s option. See Rule 101(b)(3) of Regulation
S-T (§232.101(b)(3) of this chapter).

SEC 617 (1-21)

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.

FORM 11-K
(Mark One)
ANNUAL REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the fiscal year ended ___________________________________________________________________________________
_________
OR
TRANSITION REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from _________________________________________ to ____________________________________
Commission file number ____________________
A.

Full title of the plan and the address of the plan, if different from that of the issuer named below:

B.

Name of issuer of the securities held pursuant to the plan and the address of its principal executive office:
REQUIRED INFORMATION
The following financial statements shall be furnished for the plan:

1.
An audited statement of financial condition as of the end of the latest two fiscal years of the plan (or such lesser period as the
plan has been in existence).
2.
An audited statement of comprehensive income (either in a single continuous financial statement or in two separate but
consecutive financial statements; or a statement of net income if there was no other comprehensive income) and changes in plan equity
for each of the latest three fiscal years of the plan (or such lesser period as the plan has been in existence).
3.
The statements required by Items 1 and 2 shall be prepared in accordance with the applicable provisions of Article 6A of
Regulation S-X (17 CFR 210.6A-01—.6A-05).
4.
In lieu of the requirements of Items 1-3 above, plans subject to ERISA may file plan financial statements and schedules prepared
in accordance with the financial reporting requirements of ERISA. To the extent required by ERISA, the plan financial statements shall
be examined by an independent accountant, except that the “limited scope exemption” contained in Section 103(a)(3)(C) of ERISA shall
not be available.
Note: A written consent of the accountant is required with respect to the plan annual financial statements which have been incorporated
by reference in a registration statement on Form S-8 under the Securities Act of 1933. The consent should be filed as an exhibit to this
annual report. Such consent shall be currently dated and manually signed.
SIGNATURES
The Plan. Pursuant to the requirements of the Securities Exchange Act of 1934, the trustees (or other persons who administer the
employee benefit plan) have duly caused this annual report to be signed on its behalf by the undersigned hereunto duly authorized.
_______________________________________________________
(Name of Plan)
Date _______________________________

Print name and title of the signing official under the signature.

*

_______________________________________________________
(Signature) *