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. |
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM D
Notice of Exempt Offering of Securities
|
OMB APPROVAL |
OMB Number: |
3235-0076 |
Estimated average burden |
hours per response: |
4.00 |
|
|
1. Issuer's Identity
CIK (Filer ID Number) |
Previous Names |
|
Entity Type |
0001167612 |
KILICO VARIABLE SERIES III SEPARATE ACCOUNT |
KILICO Variable Series III Separate Account |
|
|
Corporation |
|
Limited Partnership |
|
Limited Liability Company |
|
General Partnership |
|
Business Trust |
X |
Other (Specify) |
Insurance Company Separate Account |
Name of Issuer |
ZALICO VARIABLE SERIES III SEPARATE ACCOUNT |
Jurisdiction of Incorporation/Organization |
ILLINOIS |
Year of Incorporation/Organization |
X |
Over Five Years Ago |
|
Within Last Five Years (Specify Year) |
|
|
Yet to Be Formed |
|
2. Principal Place of Business and Contact Information
Name of Issuer |
ZALICO VARIABLE SERIES III SEPARATE ACCOUNT |
Street Address 1 |
Street Address 2 |
1400 AMERICAN LANE |
City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
SCHAUMBURG |
ILLINOIS |
60196 |
425-577-5100 |
1. Issuer's Identity
CIK (Filer ID Number) |
Previous Names |
|
Entity Type |
0000351754 |
KEMPER INVESTORS LIFE INSURANCE CO |
Kemper Investors Life Insurance Company |
|
X |
Corporation |
|
Limited Partnership |
|
Limited Liability Company |
|
General Partnership |
|
Business Trust |
|
Other (Specify) |
|
Name of Issuer |
Zurich American Life Insurance Co |
Jurisdiction of Incorporation/Organization |
ILLINOIS |
Year of Incorporation/Organization |
X |
Over Five Years Ago |
|
Within Last Five Years (Specify Year) |
|
|
Yet to Be Formed |
|
2. Principal Place of Business and Contact Information
Name of Issuer |
Zurich American Life Insurance Co |
Street Address 1 |
Street Address 2 |
1400 AMERICAN LANE |
City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
SCHAUMBURG |
ILLINOIS |
60196 |
425-577-5100 |
3. Related Persons
Last Name |
First Name |
Middle Name |
Dietz |
David |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
President, Chief Executive Officer and Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Cummings-Fritz |
Dawn |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
X |
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director and Assistant Vice President of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Hauser |
Richard |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Noftke |
Paul |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Carty |
Patrick |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President, General Counsel and Corporate Secretary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Grilli |
Richard |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Senior Vice President and Chief Operating Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Horton |
Jeffrey |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President, Finance and Treasurer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Hall |
Cathy |
Street Address 1 |
Street Address 2 |
3003 77th Avenue SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President and Chief Compliance Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Rohwetter |
Michael |
Street Address 1 |
Street Address 2 |
One Libert Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President and Chief Investment Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Ehrlich |
Cathy |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President and Chief Actuary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Roberts |
Dennis |
Street Address 1 |
Street Address 2 |
2000 West Sam Houston Parkway |
City |
State/Province/Country |
ZIP/PostalCode |
Houston |
TEXAS |
77042 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Lodge |
Simon |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Senior Vice President ad Chief Financial Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Stuart |
Berman |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 30th Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Martin |
Audrey |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President, Human Resources of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
McInerney |
Elizabeth |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President and Chief Operations Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Labno |
Margaret |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Dampman |
David |
Street Address 1 |
Street Address 2 |
7045 College Boulevard |
City |
State/Province/Country |
ZIP/PostalCode |
Overland Park |
KANSAS |
66211 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Secretary of Zurich American Life Insurance Company.
Last Name |
First Name |
Middle Name |
Badgett |
Leeann |
Street Address 1 |
Street Address 2 |
3003 77th Avenue SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President of Zurich American Life Insurance Company.
Last Name |
First Name |
Middle Name |
Baltazar |
Lisa |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Secretary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Denning |
Mary |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President, Actuary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Nagel |
Jon |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Secretary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Broek |
Debra |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Ehlers |
Eileen |
Street Address 1 |
Street Address 2 |
7045 College Boulevard |
City |
State/Province/Country |
ZIP/PostalCode |
Overland Park |
KANSAS |
66211 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President, Underwriting of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Thomas |
Juanita |
Street Address 1 |
Street Address 2 |
1114 Georgia Street |
City |
State/Province/Country |
ZIP/PostalCode |
Louisiana |
MISSOURI |
63353 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Secretary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Gibson |
Robert |
Street Address 1 |
Street Address 2 |
3003 77th Ave SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
38a-1 Chief Compliance Officer of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Kleinman |
Ira |
Street Address 1 |
Street Address 2 |
1400 American Lande |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Patton |
John |
Street Address 1 |
Street Address 2 |
3003 77th Ave SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President, Claims of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Pietrolugo |
Louis |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
|
Executive Officer |
X |
Director |
|
Promoter |
Clarification of Response (if Necessary):
Director of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Chandler |
Eric |
Street Address 1 |
Street Address 2 |
3003 77th Ave SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Secretary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Wolf |
Matt |
Street Address 1 |
Street Address 2 |
One Liberty Plaza |
165 Broadway, 21st Floor |
City |
State/Province/Country |
ZIP/PostalCode |
New York |
NEW YORK |
10006 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President, Actuary of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Miskel |
John |
Street Address 1 |
Street Address 2 |
900 South Pine Island Road |
City |
State/Province/Country |
ZIP/PostalCode |
Plantation |
FLORIDA |
33324 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Gibbons |
Ryan |
Street Address 1 |
Street Address 2 |
1400 American Lane |
City |
State/Province/Country |
ZIP/PostalCode |
Schaumburg |
ILLINOIS |
60196 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Assistant Vice President-Tax of Zurich American Life Insurance Company
Last Name |
First Name |
Middle Name |
Henderson |
Judith |
Street Address 1 |
Street Address 2 |
3003 77th Ave SE |
City |
State/Province/Country |
ZIP/PostalCode |
Mercer Island |
WASHINGTON |
98040 |
Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Vice President, IT Operations of Zurich American Life Insurance Company
4. Industry Group
|
Agriculture |
|
Banking & Financial Services |
|
|
Commercial Banking |
X |
Insurance |
|
Investing |
|
Investment Banking |
|
Pooled Investment Fund |
|
|
|
Is the issuer registered as an investment company under the Investment Company Act of 1940? |
|
|
|
Other Banking & Financial Services |
|
|
Business Services |
|
Energy |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Health Care |
|
|
|
|
|
|
|
|
|
|
|
Manufacturing |
|
Real Estate |
|
|
|
|
|
|
|
|
|
|
|
|
Retailing |
|
Restaurants |
|
Technology |
|
|
|
|
|
|
|
Travel |
|
|
|
|
|
|
Tourism & Travel Services |
|
|
|
|
Other |
|
5. Issuer Size
Revenue Range |
OR |
Aggregate Net Asset Value Range |
|
No Revenues |
|
No Aggregate Net Asset Value |
|
$1 - $1,000,000 |
|
$1 - $5,000,000 |
|
$1,000,001 - $5,000,000 |
|
$5,000,001 - $25,000,000 |
|
$5,000,001 - $25,000,000 |
|
$25,000,001 - $50,000,000 |
|
$25,000,001 - $100,000,000 |
|
$50,000,001 - $100,000,000 |
|
Over $100,000,000 |
|
Over $100,000,000 |
X |
Decline to Disclose |
|
Decline to Disclose |
|
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)) |
| |
Rule 504 (b)(1)(i) |
| |
Rule 504 (b)(1)(ii) |
| |
Rule 504 (b)(1)(iii) |
| |
Rule 505 |
| |
Rule 506(b) |
| X |
Rule 506(c) |
| |
Securities Act Section 4(a)(5) |
|
X |
Investment Company Act Section 3(c) |
|
|
Section 3(c)(1) |
|
Section 3(c)(9) |
|
|
Section 3(c)(2) |
|
Section 3(c)(10) |
|
|
Section 3(c)(3) |
|
Section 3(c)(11) |
|
|
Section 3(c)(4) |
|
Section 3(c)(12) |
|
|
Section 3(c)(5) |
|
Section 3(c)(13) |
|
|
Section 3(c)(6) |
|
Section 3(c)(14) |
|
|
|
7. Type of Filing
|
New Notice |
|
Date of First Sale |
1997-09-25 |
|
|
First Sale Yet to Occur |
X |
Amendment |
8. Duration of Offering
Does the Issuer intend this offering to last more than one year? |
|
|
9. Type(s) of Securities Offered (select all that apply)
|
Equity |
|
Pooled Investment Fund Interests |
|
Debt |
|
Tenant-in-Common Securities |
|
Option, Warrant or Other Right to Acquire Another Security |
|
Mineral Property Securities |
|
Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security |
X |
Other (describe) |
|
Interests in ZALICO Variable Series III Separate Account pursuant to Series IV survivorship variable life insurance policies |
10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? |
|
|
Clarification of Response (if Necessary):
11. Minimum Investment
Minimum investment accepted from any outside investor |
$10,000
|
USD |
12. Sales Compensation
Recipient |
Recipient CRD Number |
|
None |
|
Wells Fargo Insurance Services Investment Advisors, Inc. |
35419 |
(Associated) Broker or Dealer |
X |
None |
|
(Associated) Broker or Dealer CRD Number |
X |
None |
|
None |
None |
Street Address 1 |
Street Address 2 |
301 South College Street |
19th Floor, Mail Code: D1053-190 |
City |
State/Province/Country |
ZIP/Postal Code |
Charlotte |
NORTH CAROLINA |
28202 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
Recipient |
Recipient CRD Number |
|
None |
|
Benefit Finance Securities |
45113 |
(Associated) Broker or Dealer |
X |
None |
|
(Associated) Broker or Dealer CRD Number |
X |
None |
|
None |
None |
Street Address 1 |
Street Address 2 |
6 City Place Drive, Suite 400 |
City |
State/Province/Country |
ZIP/Postal Code |
St. Louis |
MISSOURI |
63141 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
13. Offering and Sales Amounts
Total Offering Amount |
|
USD |
|
Total Amount Sold |
$2,549,522
|
USD |
Total Remaining to be Sold |
|
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 |
$98,532
|
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):
As issuer of the variable life insurance policies, Zurich American Life Insurance Company will receive amounts from charges deducted under the policies, but no executive officer, director or promoter will receive any portion of the gross offering proceedsSignature 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 Regulation D exemption for the offering, the issuer is not disqualified from relying on Regulation D for one of the reasons stated in Rule 505(b)(2)(iii) or Rule 506(d).
|
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.
X |
I also am a duly authorized representative of the other issuer(s) identified in Item 1 above and authorized to sign on their behalf. |
Issuer |
Signature |
Name of Signer |
Title |
Date |
ZALICO VARIABLE SERIES III SEPARATE ACCOUNT |
Richard W. Grilli- |
Richard W. Grilli |
Chief Operating Officer and Senior Vice President |
2016-11-17 |
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.