Checkboxifnolongersubjectto
Section16.Form4orForm5obliANNUALSTATEMENTOFCHANGESINBENEFICIALOWNERSHIPOF
tion1(b).
Form3HoldingsReportedForm4TransactionsReported
1. NameandAddressofReportingPerson* / 2. IssuerNameand TickerorTradingSymbol / 5. RelationshipofReportingPerson(s)toIssuer(Checkallapplicable)
Director10%Owner
Officer(giveOther(specify
titlebelow)
below)
(Last)(First)(Middle) / 3. StatementforIssuer'sFiscalYearEnded(Month//Day/Year) / 4. IfAmendment,DateOriginalFiled(Month/Day/Year)
(Street) / 6. IndividualorJoint/GroupReporting
(checkapplicableline)
FormFiledbyOneReportingPerson
FormFiledbyMorethanOneReportingPerson
(City)(State)(Zip) / TableI—Non-DerivativeSecuritiesAcquired,Disposedof,orBeneficiallyOwned
1. TitleofSecurity
(Instr.3) / 2. Trans-
action Date
(Month/ Day/ Year) / 2A.Deemed
Execu-tion Date, ifany
(Month/
Day/ Year) / 3. Trans-
action Code (Instr.8) / 4. SecuritiesAcquired(A)orDisposedof(D)
(Instr.3,4and5) / 5. AmountofSecuritiesBen-eficially OwnedatendofIssuer’sFiscalYear
(Instr.3and4) / 6. Owner-shipForm:Di-rect (D)
orIndi-rect (I)(Instr.4) / 7. NatureofIndirect Beneficial Ownership (Instr.4)
Amount / (A)or(D) / Price
Reminder:Reportonaseparatelineforeachclassofsecuritiesbeneficiallyowneddirectlyorindirectly.
(Over)
*Iftheformisfiledbymorethanonereportingperson,seeinstruction4(b)(v).Potential persons who are to respond to the collection of informa-SEC2270(11-11)
tion contained in this form are not required to respond unless the
form displays a currently valid OMB control number.
FORM5(continued)Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. TitleofDerivativeSecurity(Instr.3) / 2. Conver-
sionorExer-cise PriceofDeriva-tiveSe-curity / 3. Trans-
action Date(Month/ Day/
Year) / 3A.DeemedExecetionDate,if
any (Month/Day/Year) / 4. Transac-tion Code (Instr.8) / 5. NumberofDeriva-tiveSecuritiesAc-quired(A)orDis-posedof(D)
(Instr.3,4,and5) / 6. Date Exercis-ableandExpi-rationDate(Month/Day/
Year) / 7. TitleandAmountofUnderly-ingSecurities
(Instr.3and4) / 8. Priceof
De- riva- tive Secu- rity
(Instr.5) / 9. NumberofDe-rivative Securi- tiesBen-eficiallyOwned
atEndofIssuer'sFiscalYear
(Instr. 4) / 10. Owner- shipForm
ofDe-rivativeSecuri-ties:Direct
(D) orIndirect(I)
(Instr.4) / 11.NatureofIndirect Benefi- cialOwner- ship (Instr.4)
Date Exer- cisable / Expira- tion Date / Title / AmountorNumberofShares
(A) / (D)
ExplanationofResponses:
**IntentionalmisstatementsoromissionsoffactsconstituteFederalCriminalViolations.**SignatureofReportingPersonDate
See18U.S.C.1001and15U.S.C.78ff(a).
Note: FilethreecopiesofthisForm,oneofwhichmustbemanuallysigned.
Ifspaceprovidedisinsufficient,seeInstruction6forprocedure.
PotentialpersonswhoaretorespondtothecollectionofinformationcontainedinthisformarenotrequiredtorespondunlesstheformdisplaysacurrentlyvalidOMBnumber.
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