SEC Form 3
|
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION |
|
||||||||
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement (Month/Day/Year) |
3. Issuer Name and Ticker or Trading Symbol |
|||||||||||||
|
4. Relationship of Reporting Person(s) to Issuer
|
5. If Amendment, Date of Original Filed (Month/Day/Year) |
||||||||||||||
|
6. Individual or Joint/Group Filing (Check Applicable Line)
|
|||||||||||||||
|
Table I - Non-Derivative Securities Beneficially Owned |
|||
|
1. Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
|
Table II - Derivative Securities Beneficially Owned |
|||||||
|
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
||
|
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
||||
|
Explanation of Responses: |
|
Remarks: |
|
|
|
No securities are beneficially owned. |
|
|
Brian Sandstrom on behalf of Peter B. Henry |
07/05/2016 |
|
|
** Signature of Reporting Person |
Date |
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
||
|
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). |
||
|
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
||
|
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
||
|
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
||