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United StatesSecurities and ExchangeCommission
FORM13H
LargeTraderRegistration
InformationRequiredofLargeTraders PursuantTo Section13(h)ofthe
Securities ExchangeActof1934 andRules Thereunder
INITIAL FILING: Date identifying transactions first effected (mm/dd/yyyy)Voluntary filing? / no / yes / Date of voluntary filing
ANNUALFILING:
Calendar year endingAMENDED 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. / ( ) / - / - / EmailThe 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.
NameofAuthorized Person (First, MiddleInitial,Last)
Title of Authorized Person
Relationship to Large Trader
Business Address of Authorized Person (Street, City, State, Zip, Country)
Authorized Person’s Telephone No. / ( ) / - / - / Facsimile No. / ( ) / - / -Authorized Person’s Email
ATTENTION
Intentional misstatements oromissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15U.S.C. 78ff(a). Intentional misstatements oromissions of facts may result in civil fines and othersanctions pursuant to the Securities ExchangeAct of1934.
The authorized person signingthis form represents that all information contained in the form, schedules, and continuation sheets is true, correct, andcomplete. It is understood that all information whethercontained in the form, schedules, orcontinuation sheets, is consideredanintegral part ofthis formand that anyamendment represents thatall unamended information remains true, correct,and complete.
Signature of Person Authorized to Submit this Form
FORM 13H
INFORMATION REQUIREDOFALLLARGETRADERS
ITEM 1.BUSINESSESOFTHELARGE TRADER(checkas manyas applicable)
(a)Businesses engaged in bythelargetraderand anyofthelargetrader’s affiliates (check as manyas applicable)
BrokerorDealer / Bank HoldingCompanyGovernment Securities BrokerorDealer / Non-Bank HoldingCompany
Municipal Securities BrokerorDealer / Bank
Investment Adviser / Pension Trustee
to RegisteredInvestment Companies / Non-Pension Trustee
to HedgeFunds orother Funds not registered undertheInvestment CompanyAct / InsuranceCompany
Futures CommissionMerchant
CommodityPool Operator / Other (specify)
(b)Describethenatureofthebusiness ofthelargetraderincluding adescription for each SecuritiesAffiliate:
ITEM 2.SECURITIESAND EXCHANGE COMMISSIONFILINGS
Does thelargetraderoranyofits Securities Affiliates file anyother formswith theCommission?
YesNo
Ifyes, specifythe entityand the forms filed:
Entity / Form(s)Filed / CIK NumberITEM 3CFTC REGISTRATION ANDFOREIGN REGULATORS
(a)Is thelargetraderor anyofits affiliates registeredwith theCommodityFutures TradingCommission in any capacity, includingasa“registered trader”pursuant to sections 4i and 9 oftheCommodityExchangeAct?
YesNo
Ifyes, identifyeachentityand specifytheregistration number:
Entity / Registration Number(b)Is thelargetraderor anyofits Securities Affiliates regulated byaforeign regulator?
YesNo
Ifyes, identifyeachentityand its primaryforeignregulator(s):
Entity / PrimaryForeign RegulatorITEM 4.ORGANIZATIONINFORMATION
(a)Attach an Organizational Chart that identifies thelargetrader, its parent company(if applicable), allSecurities
Affiliates, and all entitiesidentified inItem 3(a).
(b)Providethe followinginformation on all Securities Affiliates and all entities identified inItem 3(a):
Entity / MPID(s) / Description of Business / Relationship to the Large Trader(c)Ifanyaffiliates fileseparately, identifyeach entity
Entity / LTID / Suffix (if any)(d)Ifanyaffiliates havebeen assignedanLTIDsuffix, identifysuchentities and their correspondingsuffixes:
Entity / SuffixITEM 5.GOVERNANCE OFTHELARGE TRADER
(a)STATUSOFTHELARGE TRADER(checkas manyas apply)
Individual / PartnershipLimited Partnership
Trustee / Corporation
LimitedLiabilityCompany / Other (specify)
(b)Completethe followingfor eachgeneral partner, and in thecaseoflimited partnerships, each limited partnerthat is theownerofmorethan a10 percent financial interest in theaccounts ofthelargetrader:
Name / Status (check oneforeach)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
(c)Completethe followingfor each executiveofficer, director, ortrusteeofalargetrader corporation or trustee:
Name / Status (check oneforeach)ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
ExecutiveOfficer Director Trustee
(d)Jurisdiction in whichthelargetraderentityisincorporated ororganized:
(state and country)
ITEM 6.LIST OFBROKER-DEALERSAT WHICH THELARGETRADERORITS SECURITIES AFFILIATESHASANACCOUNT
Identifyeach broker-dealer at which thelargetraderor anyofits SecuritiesAffiliates has anaccount and thetypes of services provided.
NameofBroker-DealerPrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
PrimeBrokerExecuting BrokerClearingBroker
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