Name and address. State the name of the subject
company (or the issuer in the case of an issuer tender offer), and the address
and telephone number of its principal executive offices.
Securities. State the exact title and number of shares outstanding
of the subject class of equity securities as of the most recent practicable
date. This may be based upon information in the most recently available filing
with the Commission by the subject company unless the filing person has more
current information.
Trading market and price. Identify the principal
market in which the subject securities are traded and state the high and low
sales prices for the subject securities in the principal market (or, if there
is no principal market, the range of high and low bid quotations and the source
of the quotations) for each quarter during the past two years. If there is
no established trading market for the securities (except for limited or sporadic
quotations), so state.
Dividends. State the frequency and amount of any
dividends paid during the past two years with respect to the subject securities.
Briefly describe any restriction on the subject company's current or future
ability to pay dividends. If the filing person is not the subject company,
furnish this information to the extent known after making reasonable inquiry.
Prior public offerings. If the filing person has
made an underwritten public offering of the subject securities for cash during
the past three years that was registered under the Securities Act of 1933
or exempt from registration under Regulation
A, state the date of the offering, the amount of securities offered, the
offering price per share (adjusted for stock splits, stock dividends, etc.
as appropriate) and the aggregate proceeds received by the filing person.
Prior stock purchases. If the filing person purchased
any subject securities during the past two years, state the amount of the
securities purchased, the range of prices paid and the average purchase price
for each quarter during that period. Affiliates need not give information
for purchases made before becoming an affiliate.
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