The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete. The reader should not assume that the information is accurate and complete. |
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM D
Notice of Exempt Offering of Securities
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OMB APPROVAL |
OMB Number: |
3235-0076 |
Estimated average burden |
hours per response: |
4.00 |
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1. Issuer's Identity
CIK (Filer ID Number) |
Previous Names |
|
Entity Type |
0001451787 |
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Corporation |
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Limited Partnership |
X |
Limited Liability Company |
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General Partnership |
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Business Trust |
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Other (Specify) |
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Name of Issuer |
Cypress Equipment Fund 16, LLC |
Jurisdiction of Incorporation/Organization |
CALIFORNIA |
Year of Incorporation/Organization |
|
Over Five Years Ago |
X |
Within Last Five Years (Specify Year) |
2008 |
|
Yet to Be Formed |
|
2. Principal Place of Business and Contact Information
Name of Issuer |
Cypress Equipment Fund 16, LLC |
Street Address 1 |
Street Address 2 |
188 The Embarcadero, Suite 420 |
City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
San Francisco |
CA |
94105 |
415-281-3020 |
3. Related Persons
Last Name |
First Name |
Middle Name |
Harwood |
Stephen |
Rogers |
Street Address 1 |
Street Address 2 |
188 The Embarcadero, Suite 420 |
City |
State/Province/Country |
ZIP/PostalCode |
San Francisco |
CA |
94105 |
Relationship: |
X |
Executive Officer |
X |
Director |
X |
Promoter |
Clarification of Response (if Necessary):
Officer and Director of LLC Manager
Last Name |
First Name |
Middle Name |
Cypress Equipment Management Corp IV |
NA |
Street Address 1 |
Street Address 2 |
188 The Embarcadero, Suite 420 |
City |
State/Province/Country |
ZIP/PostalCode |
San Francisco |
CA |
94105 |
Relationship: |
X |
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
LLC Manager
Last Name |
First Name |
Middle Name |
Park |
Kenneth |
Street Address 1 |
Street Address 2 |
188 The Embarcadero, Suite 420 |
City |
State/Province/Country |
ZIP/PostalCode |
San Francisco |
CA |
94105 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Officer of LLC Manager
Last Name |
First Name |
Middle Name |
Rael |
Daniel |
Street Address 1 |
Street Address 2 |
188 The Embarcadero, Suite 420 |
City |
State/Province/Country |
ZIP/PostalCode |
San Francisco |
CA |
94105 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Officer of LLC Manager
4. Industry Group
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Agriculture |
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Banking & Financial Services |
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Commercial Banking |
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Insurance |
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Investing |
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Investment Banking |
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Pooled Investment Fund |
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|
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Is the issuer registered as an investment company under the Investment Company Act of 1940? |
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|
X |
Other Banking & Financial Services |
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Business Services |
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Energy |
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|
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Health Care |
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Manufacturing |
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Real Estate |
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Retailing |
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Restaurants |
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Technology |
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Travel |
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Tourism & Travel Services |
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Other |
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5. Issuer Size
Revenue Range |
OR |
Aggregate Net Asset Value Range |
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No Revenues |
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No Aggregate Net Asset Value |
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$1 - $1,000,000 |
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$1 - $5,000,000 |
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$1,000,001 - $5,000,000 |
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$5,000,001 - $25,000,000 |
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$5,000,001 - $25,000,000 |
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$25,000,001 - $50,000,000 |
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$25,000,001 - $100,000,000 |
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$50,000,001 - $100,000,000 |
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Over $100,000,000 |
|
Over $100,000,000 |
X |
Decline to Disclose |
|
Decline to Disclose |
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Not Applicable |
|
Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
|
Rule 504(b)(1) (not (i), (ii) or (iii)) |
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Rule 505 |
|
Rule 504 (b)(1)(i) |
X |
Rule 506 |
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Rule 504 (b)(1)(ii) |
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Securities Act Section 4(5) |
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Rule 504 (b)(1)(iii) |
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Investment Company Act Section 3(c) |
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Section 3(c)(1) |
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Section 3(c)(9) |
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Section 3(c)(2) |
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Section 3(c)(10) |
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Section 3(c)(3) |
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Section 3(c)(11) |
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Section 3(c)(4) |
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Section 3(c)(12) |
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Section 3(c)(5) |
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Section 3(c)(13) |
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Section 3(c)(6) |
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Section 3(c)(14) |
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7. Type of Filing
|
New Notice |
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Date of First Sale |
2009-01-07 |
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|
First Sale Yet to Occur |
X |
Amendment |
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? |
|
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9. Type(s) of Securities Offered (select all that apply)
X |
Equity |
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Pooled Investment Fund Interests |
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Debt |
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Tenant-in-Common Securities |
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Option, Warrant or Other Right to Acquire Another Security |
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Mineral Property Securities |
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Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security |
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Other (describe) |
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10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? |
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|
Clarification of Response (if Necessary):
11. Minimum Investment
Minimum investment accepted from any outside investor |
$35,000
|
USD |
12. Sales Compensation
Recipient |
Recipient CRD Number |
|
None |
|
Cypress Capital Corporation |
42681 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Cypress Capital Corporation |
42681 |
Street Address 1 |
Street Address 2 |
188 The Embarcader, Suite 420 |
City |
State/Province/Country |
ZIP/Postal Code |
San Francisco |
CA |
94105 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
AR |
CA |
CO |
CT |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
MD |
MA |
MI |
MN |
MO |
NE |
NV |
NJ |
NY |
NC |
OH |
OR |
PA |
SC |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
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Berthel, Fisher and Company Financial Services, Inc. |
13609 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Berthel, Fisher and Company Financial Services, Inc. |
13609 |
Street Address 1 |
Street Address 2 |
701 Tama Street, Building B |
City |
State/Province/Country |
ZIP/Postal Code |
Marion |
IA |
52302 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Zachary L. Carey |
3110546 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Calton and Associates, Inc. |
20999 |
Street Address 1 |
Street Address 2 |
2716 West Oxford Loop |
Suite 179 |
City |
State/Province/Country |
ZIP/Postal Code |
Oxford |
MS |
38655 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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|
AL |
AR |
FL |
GA |
KY |
LA |
MS |
TN |
TX |
VA |
|
Recipient |
Recipient CRD Number |
|
None |
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Oliver B. Williamson |
4642029 |
(Associated) Broker or Dealer |
|
None |
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(Associated) Broker or Dealer CRD Number |
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None |
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Calton and Associates, Inc. |
20999 |
Street Address 1 |
Street Address 2 |
611 Hambley Blvd. |
City |
State/Province/Country |
ZIP/Postal Code |
Pikeville |
KY |
41501 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
FL |
IN |
KY |
MA |
NY |
NC |
OH |
PA |
SC |
TN |
VA |
|
Recipient |
Recipient CRD Number |
|
None |
|
Phillip D. King |
1839137 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Calton and Associates, Inc. |
20999 |
Street Address 1 |
Street Address 2 |
611 Hambley Blvd. |
City |
State/Province/Country |
ZIP/Postal Code |
Pikeville |
KY |
41501 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
CA |
FL |
GA |
IN |
KY |
MI |
NC |
OH |
SC |
TN |
VA |
|
Recipient |
Recipient CRD Number |
|
None |
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Maryellen Trotter |
862519 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Centaurus Financial, Inc. |
30833 |
Street Address 1 |
Street Address 2 |
1515 E. Cedar Avenue |
Suite C5 |
City |
State/Province/Country |
ZIP/Postal Code |
Flagstaff |
AZ |
86004 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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|
|
Recipient |
Recipient CRD Number |
|
None |
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Bryan D. Myers |
2527480 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
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None |
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Chapin, Davis |
28116 |
Street Address 1 |
Street Address 2 |
2 Village Square, Suite 200 |
City |
State/Province/Country |
ZIP/Postal Code |
Baltimore |
MD |
21210 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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Recipient |
Recipient CRD Number |
|
None |
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Commonwealth Financial Network |
8032 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
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Commonwealth Financial Network |
8032 |
Street Address 1 |
Street Address 2 |
29 Sawyer Road |
City |
State/Province/Country |
ZIP/Postal Code |
Waltham |
MA |
02453 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
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Crown Capital Securities, L.P. |
6312 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Crown Capital Securities, L.P. |
6312 |
Street Address 1 |
Street Address 2 |
725 Town and Country Road |
Suite 530 |
City |
State/Province/Country |
ZIP/Postal Code |
Orange |
CA |
92868 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
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David A. Harris |
500413 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
David Harris and Co., Inc. |
45670 |
Street Address 1 |
Street Address 2 |
222 Mamaroneck Avenue |
City |
State/Province/Country |
ZIP/Postal Code |
White Plains |
NY |
10605 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
CA |
CO |
CT |
FL |
HI |
IL |
ME |
MD |
MI |
NJ |
NY |
NC |
VA |
|
Recipient |
Recipient CRD Number |
|
None |
|
Donald G. Dewaay Jr. |
1297174 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Dewaay Financial Network, LLC |
30767 |
Street Address 1 |
Street Address 2 |
13001 University Avenue |
City |
State/Province/Country |
ZIP/Postal Code |
Clive |
IA |
50325 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
MA |
MI |
MN |
MO |
MT |
NE |
NV |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Joshua E. Cross |
4522751 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Dewaay Financial Network, LLC |
30767 |
Street Address 1 |
Street Address 2 |
13001 University Avenue |
City |
State/Province/Country |
ZIP/Postal Code |
Clive |
IA |
50325 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AZ |
FL |
HI |
IL |
IA |
KS |
KY |
MA |
MN |
MO |
NE |
NV |
NC |
OH |
TX |
WA |
WI |
|
Recipient |
Recipient CRD Number |
|
None |
|
NFP Securities, Inc. |
42046 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
NFP Securities, Inc. |
42046 |
Street Address 1 |
Street Address 2 |
1250 Capital of Texas Hwy S. , 2-125 |
City |
State/Province/Country |
ZIP/Postal Code |
Austin |
TX |
78746 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
H. Beck, Inc. |
1763 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
H. Beck, Inc. |
1763 |
Street Address 1 |
Street Address 2 |
11140 Rockville Pike |
Suite 400 |
City |
State/Province/Country |
ZIP/Postal Code |
Rockville |
MD |
20852 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Independent Financial Group, LLC |
7717 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Independent Financial Group, LLC |
7717 |
Street Address 1 |
Street Address 2 |
12636 High Bluff Drive, Suite 100 |
City |
State/Province/Country |
ZIP/Postal Code |
San Diego |
CA |
92130 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Lora J. Hoff |
3175071 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Investment Planners, Inc. |
18557 |
Street Address 1 |
Street Address 2 |
10440 N. Central Expressway |
Suite 1040 |
City |
State/Province/Country |
ZIP/Postal Code |
Dallas |
TX |
75231 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
LPL Financial Corporation |
6413 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
LPL Financial Corporation |
6413 |
Street Address 1 |
Street Address 2 |
One Beacon Street |
22nd Floor |
City |
State/Province/Country |
ZIP/Postal Code |
Boston |
MA |
02108 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Thomas J. Birch |
805540 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Mid Atlantic Capital Corporation |
10674 |
Street Address 1 |
Street Address 2 |
1683 Novato Blvd. |
Suite 2 |
City |
State/Province/Country |
ZIP/Postal Code |
Novato |
CA |
94949 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Howard W. Minor, Jr. |
1008244 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Next Financial Group, Inc. |
46214 |
Street Address 1 |
Street Address 2 |
413 Stuart Circle |
Suite 314 |
City |
State/Province/Country |
ZIP/Postal Code |
Richmond |
VA |
23220 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Dennis L. Freeman |
213683 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Okoboji Financial Services, Inc. |
33727 |
Street Address 1 |
Street Address 2 |
600 Fifth Street |
Suite 102 |
City |
State/Province/Country |
ZIP/Postal Code |
Ames |
IA |
50010 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Pacific West Securities, Inc. |
6390 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Pacific West Securities, Inc. |
6390 |
Street Address 1 |
Street Address 2 |
555 S. Renton Village Pl |
Suite 700 |
City |
State/Province/Country |
ZIP/Postal Code |
Renton |
WA |
98057 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
QA3 Financial Corp. |
14754 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
QA3 Financial Corp. |
14754 |
Street Address 1 |
Street Address 2 |
One Valmont Plaza, 4th Floor |
City |
State/Province/Country |
ZIP/Postal Code |
Omaha |
NE |
68154 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Norman G. Price |
2406981 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
RP Capital LLC |
134768 |
Street Address 1 |
Street Address 2 |
7191 Wagner Way NW, Suite 302 |
City |
State/Province/Country |
ZIP/Postal Code |
Gig Harbor |
WA |
98335 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Sagepoint Financial, Inc. |
133763 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Sagepoint Financial, Inc. |
133763 |
Street Address 1 |
Street Address 2 |
2800 N. Central Ave., Ste 2100 |
City |
State/Province/Country |
ZIP/Postal Code |
Phoenix |
AZ |
85004 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Ameritas Investment Corp. |
14869 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Ameritas Investment Corp. |
14869 |
Street Address 1 |
Street Address 2 |
5900 O Street |
City |
State/Province/Country |
ZIP/Postal Code |
Lincoln |
NE |
68510 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
William E. Riley, Jr. |
1493287 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Silver Oak Securities, Incorporated |
46947 |
Street Address 1 |
Street Address 2 |
512 Main Street |
Suite 1400 |
City |
State/Province/Country |
ZIP/Postal Code |
Forth Worth |
TX |
76102 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
John T. Dunn |
2448503 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
The Strategic Financial Alliance, Inc. |
126514 |
Street Address 1 |
Street Address 2 |
107 Weatherstone Drive |
Suite 520 |
City |
State/Province/Country |
ZIP/Postal Code |
Woodstock |
GA |
30188 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
VSR Financial Services, Inc. |
14503 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
VSR Financial Services, Inc. |
14503 |
Street Address 1 |
Street Address 2 |
8620 W 110th Street |
Suite 200 |
City |
State/Province/Country |
ZIP/Postal Code |
Overland Park |
KS |
66210 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Jack Thomas |
2773136 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
AFA Financial Group, LLC |
127648 |
Street Address 1 |
Street Address 2 |
950 W. Bannock Street, Suite 1100 |
City |
State/Province/Country |
ZIP/Postal Code |
Boise |
ID |
83702 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Jeffrey Rachlin |
823547 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Alternative Wealth Strategies, Inc. |
130933 |
Street Address 1 |
Street Address 2 |
380 N. Broadway, Suite 310 |
City |
State/Province/Country |
ZIP/Postal Code |
Jericko |
NY |
11753 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Richard L. Belline |
2432737 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
AXA Advisors, LLC |
6627 |
Street Address 1 |
Street Address 2 |
213 W. Monroe, Suite Q |
City |
State/Province/Country |
ZIP/Postal Code |
Lowell |
AR |
72745 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AR |
CO |
FL |
GA |
IL |
KS |
LA |
MO |
NC |
OH |
OK |
TN |
TX |
|
Recipient |
Recipient CRD Number |
|
None |
|
Burley A. Daye |
63064 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Centaurus Financial, Inc. |
30833 |
Street Address 1 |
Street Address 2 |
533 Airport Blvd., Suite 219 |
City |
State/Province/Country |
ZIP/Postal Code |
Burlingame |
CA |
94010 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Ty K. Bauer |
2150885 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Carlton & Associates, Inc. |
20999 |
Street Address 1 |
Street Address 2 |
1716 West Oxford Loop, Suite 179 |
City |
State/Province/Country |
ZIP/Postal Code |
Oxford |
MS |
38655 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
CA |
CO |
CT |
GA |
IL |
IN |
LA |
MS |
MO |
NV |
NM |
NY |
PA |
TN |
TX |
|
Recipient |
Recipient CRD Number |
|
None |
|
Joseph M. Gatt |
218745 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Girard Securities, Inc. |
18697 |
Street Address 1 |
Street Address 2 |
1455 East Tropicana Avenue |
Suite 275 |
City |
State/Province/Country |
ZIP/Postal Code |
Las Vegas |
NV |
89119 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Arthur J. Moss |
1409033 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
National Planning Corporation |
29604 |
Street Address 1 |
Street Address 2 |
7135 E. Camelback Road |
Ste 230 |
City |
State/Province/Country |
ZIP/Postal Code |
Scottsdale |
AZ |
85251 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
John P. Hannan |
1372033 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Private Asset Group, Inc. |
142541 |
Street Address 1 |
Street Address 2 |
3070 Bristol Street, Suite 500 |
City |
State/Province/Country |
ZIP/Postal Code |
Costa Mesa |
CA |
92626 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
CA |
FL |
HI |
MN |
NV |
NJ |
NY |
NC |
TX |
|
Recipient |
Recipient CRD Number |
|
None |
|
Edward T. Coda |
1776811 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
National Planning Corporation |
29604 |
Street Address 1 |
Street Address 2 |
1221 Kapiolani Blvd., Penthouse 30 |
City |
State/Province/Country |
ZIP/Postal Code |
Honolulu |
HI |
96814 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
CA |
CO |
FL |
HI |
NV |
NM |
NC |
OH |
PA |
TX |
VA |
WA |
|
Recipient |
Recipient CRD Number |
|
None |
|
Proequities, Inc. |
15708 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Proequities, Inc. |
15708 |
Street Address 1 |
Street Address 2 |
2801 Highway 280 South |
City |
State/Province/Country |
ZIP/Postal Code |
Birmingham |
AL |
35223 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
FSC Securities Corporation |
7461 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
FSC Securities Corporation |
7461 |
Street Address 1 |
Street Address 2 |
2300 Windy Ridge Parkway, Suite 1100 |
City |
State/Province/Country |
ZIP/Postal Code |
Atlanta |
GA |
30339 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
John P. Ochsner |
1502183 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Royal Alliance Associates, Inc. |
23131 |
Street Address 1 |
Street Address 2 |
3217 West Smith Street |
Suite 2 |
City |
State/Province/Country |
ZIP/Postal Code |
Seattle |
WA |
98199 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
David L. Goodman |
1429972 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Transam Securities, Inc. |
18923 |
Street Address 1 |
Street Address 2 |
1111 Douglas Avenue |
City |
State/Province/Country |
ZIP/Postal Code |
Altamonte Springs |
FL |
32714 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Charles C. Shafe |
1277113 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Transam Securities, Inc. |
18923 |
Street Address 1 |
Street Address 2 |
531 Versailles Drive |
Ste. 201 |
City |
State/Province/Country |
ZIP/Postal Code |
Maitland |
FL |
32751 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
CT |
FL |
GA |
IN |
MD |
MI |
NJ |
NY |
NC |
SC |
VA |
|
Recipient |
Recipient CRD Number |
|
None |
|
Woodbury Financial Services, Inc. |
421 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Woodbury Financial Services, Inc. |
421 |
Street Address 1 |
Street Address 2 |
7755 Third Street North |
City |
State/Province/Country |
ZIP/Postal Code |
Oakdale |
MN |
55128 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Questar Capital Corporation |
43100 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Questar Capital Corporation |
43100 |
Street Address 1 |
Street Address 2 |
5701 Golden Hills Drive |
City |
State/Province/Country |
ZIP/Postal Code |
Minneapolis |
MN |
55416 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
HI |
ID |
IL |
IN |
IA |
KS |
KY |
LA |
ME |
MD |
MA |
MI |
MN |
MS |
MO |
MT |
NE |
NV |
NH |
NJ |
NM |
NY |
NC |
ND |
OH |
OK |
OR |
PA |
SC |
SD |
TN |
TX |
UT |
VT |
VA |
WA |
WI |
WY |
|
Recipient |
Recipient CRD Number |
|
None |
|
Robert A. Horning |
2311640 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Centaurus Financial, Inc. |
30833 |
Street Address 1 |
Street Address 2 |
3 MacArthur Pl. |
Ste. 855 |
City |
State/Province/Country |
ZIP/Postal Code |
Santa Ana |
CA |
92707 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Mark C. Pedersen |
1283866 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Harrison Douglas, Inc. |
16515 |
Street Address 1 |
Street Address 2 |
5116 Saddle Horn Trail |
City |
State/Province/Country |
ZIP/Postal Code |
Matthews |
NC |
28104 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Richard E. Woollen |
1342719 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Harrison Douglas, Inc. |
16515 |
Street Address 1 |
Street Address 2 |
4301 Belknap Road |
City |
State/Province/Country |
ZIP/Postal Code |
Charlotte |
NC |
28211 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Paul L. White II |
4669396 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Heritage Financial Services, Inc. |
133019 |
Street Address 1 |
Street Address 2 |
150 Broad Hollow Road |
City |
State/Province/Country |
ZIP/Postal Code |
Melville |
NY |
11747 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Nathan L. Rewerts |
2913269 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Investment Planners, Inc. |
18557 |
Street Address 1 |
Street Address 2 |
5950 SW 28th Street |
City |
State/Province/Country |
ZIP/Postal Code |
Topeka |
KS |
66614 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Christopher M. Ingram |
3156210 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Next Financial Group, Inc. |
46214 |
Street Address 1 |
Street Address 2 |
23734 Valencia Blvd., Suite 301 |
City |
State/Province/Country |
ZIP/Postal Code |
Valencia |
CA |
91355 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Edmardo J. Tomei III |
4338243 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Next Financial Group, Inc. |
46214 |
Street Address 1 |
Street Address 2 |
2377 Gold Meadow Way, Suite 250 |
City |
State/Province/Country |
ZIP/Postal Code |
Gold River |
CA |
95670 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Paul D. Christ |
844080 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Royal Alliance Associates, Inc. |
23131 |
Street Address 1 |
Street Address 2 |
3805 W. Maple Road |
City |
State/Province/Country |
ZIP/Postal Code |
Bloomfield Hills |
MI |
48301 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
FL |
IL |
IN |
IA |
KS |
MD |
MI |
MN |
MO |
NV |
NY |
OH |
WA |
|
Recipient |
Recipient CRD Number |
|
None |
|
Edward J. Spanski Jr. |
2356329 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Royal Alliance Associates, Inc. |
23131 |
Street Address 1 |
Street Address 2 |
8207 Forest Shadow Circle |
City |
State/Province/Country |
ZIP/Postal Code |
Cornelius |
NC |
28031 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Daniel G. McPherson |
4964802 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Sammons Securities Company, LLC |
115368 |
Street Address 1 |
Street Address 2 |
1488 Midway Ave. |
City |
State/Province/Country |
ZIP/Postal Code |
Idaho Falls |
ID |
83406 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Noah P. Bergeron Jr. |
1056146 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Sigma Financial Corporation |
14303 |
Street Address 1 |
Street Address 2 |
35060 Michelle Dr. |
City |
State/Province/Country |
ZIP/Postal Code |
Romulus |
MI |
48174 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Peter J. Glaab Jr. |
222558 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
Sigma Financial Corporation |
14303 |
Street Address 1 |
Street Address 2 |
37229 Huron River Drive |
City |
State/Province/Country |
ZIP/Postal Code |
New Boston |
MI |
48164 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AZ |
CA |
CO |
FL |
IN |
MA |
MI |
NV |
ND |
SD |
TX |
UT |
|
Recipient |
Recipient CRD Number |
|
None |
|
Carl D. Cornaglia |
3067666 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
SII Investments, Inc. |
2225 |
Street Address 1 |
Street Address 2 |
344 North Main St. |
City |
State/Province/Country |
ZIP/Postal Code |
Marlborough |
CT |
06447 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
William N. Keen |
266061 |
(Associated) Broker or Dealer |
|
None |
|
(Associated) Broker or Dealer CRD Number |
|
None |
|
The Strategic Financial Alliance, Inc. |
126514 |
Street Address 1 |
Street Address 2 |
3830 East Jones Bridge Road, 155 |
City |
State/Province/Country |
ZIP/Postal Code |
Norcross |
GA |
30092 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
AL |
AK |
AZ |
AR |
CA |
CO |
CT |
DE |
DC |
FL |
GA |
IL |
IN |
KS |
KY |
LA |
MD |
MA |
MI |
MN |
MS |
MO |
NM |
NY |
NC |
OH |
OK |
OR |
PA |
SC |
TN |
TX |
VT |
VA |
WA |
WI |
|
13. Offering and Sales Amounts
Total Offering Amount |
$35,000,000
|
USD |
|
Total Amount Sold |
$32,200,624
|
USD |
Total Remaining to be Sold |
$2,799,376
|
USD |
|
Clarification of Response (if Necessary):
14. Investors
|
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering. |
|
|
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: |
|
15. Sales Commissions & Finder's Fees Expenses
Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions |
$2,975,000
|
USD |
|
Finders' Fees |
$0
|
USD |
|
Clarification of Response (if Necessary):
16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
Clarification of Response (if Necessary):
Signature and Submission
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission
In submitting this notice, each issuer named above is: |
- Notifying the SEC and/or each State in which this notice is filed of the offering of
securities described and undertaking to furnish them, upon written request, in the accordance with applicable
law, the information furnished to offerees.*
- Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator
or other legally designated officer of the State in which the issuer maintains its principal
place of business and any State in which this notice is filed, as its agents for service of
process, and agreeing that these persons may accept service on its behalf, of any notice,
process or pleading, and further agreeing that such service may be made by registered or
certified mail, in any Federal or state action, administrative proceeding, or arbitration
brought against the issuer in any place subject to the jurisdiction of the United States, if the
action, proceeding or arbitration (a) arises out of any activity in connection with the
offering of securities that is the subject of this notice, and (b) is founded, directly or
indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange
Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the
Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii)
the laws of the State in which the issuer maintains its principal place of business or any State
in which this notice is filed.
- Certifying that, if the issuer is claiming a Rule 505 exemption, the issuer is not disqualified
from relying on Rule 505 for one of the reasons stated in Rule 505(b)(2)(iii).
|
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
Issuer |
Signature |
Name of Signer |
Title |
Date |
Cypress Equipment Fund 16, LLC |
/s/ DANIEL RAEL |
Daniel Rael |
Vice President of Manager of Issuer |
2010-01-28 |
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.
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets
Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to
require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes
of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot
routinely require offering materials under this undertaking or otherwise and can require offering materials only to the
extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.