Form SEC 1474 SEC 1474 Form 4 - Statement of Changes In Beneficial Ownership

FORM 4
☐ Check this box if no longer subject to
Section 16. Form 4 or Form 5
obligations may continue. See
Instruction 1(b).
☐ Check this box to indicate that a
transaction was made pursuant to a
contract, instruction or written plan
that is intended to satisfy the
affirmative defense conditions of Rule
10b5-1(c). See Instruction 10.

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

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STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of
1934, Section 17(a) of the Public Utility Holding Company Act of
1935 or Section 30(h) of the Investment Company Act of 1940

(Print or Type Responses)

1. Name and Address of Reporting
Person*

2. Issuer Name and Ticker or Trading Symbol

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

(Last)

(First)

(Middle)

3. Date of Earliest
Transaction Required to
be Reported
(Month/Day/Year)

4. If Amendment,
Date Original Filed
(Month/Day/Year)

(Street)

Director
Officer (give
below)

10% Owner
Other (specify title below)

6. Individual or Joint/Group Filing
(Check Applicable Line)

Form filed by One Reporting Person
Form filed by More than One Reporting Person

* If the form is filed by more than one reporting person, see Instruction 4(b)(v).

SEC 1474 (02-23)

Potential 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.

(City)
1. Title of Security
(Instr. 3)

(State)

(Zip)
2.
Transaction
Date
(Month/
Day/ Year)

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
2A.
Deemed
Execution
Date, if
any

3.
Transaction
Code

4.
Securities Acquired (A)
or Disposed of (D)

(Instr. 8)

(Instr. 3, 4 and 5)

(Month/
Day/Year)

Code

V

Amount

(A) or
(D)

5.
Amount of
Securities
Beneficially
Owned
Following
Reported
Transaction
(s)
(Instr. 3 and 4)

Price

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
Page 2 of 4

6.
Ownership
Form:
Direct (D)
or Indirect
(I)
(Instr. 4)

7.
Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

FORM 4 (continued)
1.
Title of
Derivative
Security
(Instr. 3)

2.
Conversion or
Exercise
Price of
Derivative
Security

3.
Transaction
Date
(Month/
Day/
Year)

Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
3A.
Deemed
Execution
Date, if
any

4. Transaction
Code
(Instr. 8)

(Month/
Day/
Year)

5.
Number of
Derivative
Securities
Acquired
(A) or
Disposed
of (D)

6.
Date Exercisable
and Expiration
Date
(Month/
Day/Year)

7.
Title and
Amount of
Underlying
Securities

8.
Price of
Derivative
Security

(Instr. 3 and 4)

(Instr. 5)

(Instr. 3, 4,
and 5)
Code

V

(A)

(D)

9.
Number of
Derivative
Securities
Beneficially
Owned
following
Reported
Transactions
(Instr. 4)

Date
Exercis
-able

Expira
-tion
Date

Explanation of Responses:

Page 3 of 4

Title
No.

Amt
or
Shares

10.
Ownershi
p Form of
Derivative
Security:
Direct (D)
or Indirect
(I)
(Instr. 4)

11.
Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

** Intentional misstatements or omissions of
facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

**Signature of Reporting Person

Note: File three copies of this Form, one of which must be manually signed.
If space is insufficient, see Instruction 6 for procedure.
Potential 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 Number.

Page 4 of 4

Date