ITEM 1.
|
REPORT TO STOCKHOLDERS
|
Company
|
Market Value
|
Percentage of Equity Portfolio
|
||||||
Berkshire Hathaway Inc. B
|
$
|
6,115,500
|
16.3
|
%
|
||||
Diamond Hill Investment Group
|
$
|
2,628,147
|
7.0
|
%
|
||||
Franklin Resources, Inc.
|
$
|
1,779,630
|
4.7
|
%
|
||||
Paychex, Inc.
|
$
|
1,701,200
|
4.5
|
%
|
||||
T. Rowe Price Group Inc.
|
$
|
1,681,392
|
4.5
|
%
|
||||
Colgate-Palmolive Co.
|
$
|
1,652,160
|
4.4
|
%
|
||||
Illinois Tool Works Inc.
|
$
|
1,616,670
|
4.3
|
%
|
||||
eBay Inc.
|
$
|
1,549,119
|
4.1
|
%
|
||||
Markel Corp.
|
$
|
1,486,121
|
4.0
|
%
|
||||
Waters Corp.
|
$
|
1,401,900
|
3.7
|
%
|
2014
|
2015
|
2016
|
2017
|
2018
|
||||||||||||||||
Revenues:
|
$
|
654
|
$
|
666
|
$
|
633
|
$
|
646
|
$
|
688
|
||||||||||
Gross margin:
|
317
|
292
|
310
|
305
|
325
|
|||||||||||||||
Net profit (loss)
|
12
|
( 664
|
)
|
( 39
|
)
|
( 65
|
)
|
( 45
|
)
|
Luke E. Sims
|
David C. Sims, CFA
|
|
Email: luke@simscapital.com
|
Email: dave@simscapital.com
|
|
Phone: 414/530-5680
|
Phone: 414/765-1107
|
Assets
|
||||||||
Common stock--at market value (cost $19,183,580)
|
$
|
32,191,728
|
||||||
Money market funds
|
5,320,759
|
|||||||
Short-term interest receivable
|
7,477
|
|||||||
Dividends receivable
|
50,420
|
|||||||
Prepaid fees
|
13,999
|
|||||||
$
|
37,584,383
|
|||||||
Liabilities
|
||||||||
Accounts payable
|
$
|
5,847
|
||||||
Investment advisor fee payable
|
24,765
|
|||||||
Accrued expenses
|
23,500
|
|||||||
$
|
54,112
|
|||||||
Total net assets
|
$
|
37,530,271
|
||||||
Shareholders’ Equity
|
||||||||
Common stock- $0.001 par value per share; authorized
|
||||||||
50,000,000 shares, outstanding 4,074,321 shares
|
$
|
4,074
|
||||||
Paid-in capital
|
24,447,764
|
|||||||
Undistributed net investment income
|
70,285
|
|||||||
Unrealized appreciation on investments
|
13,008,148
|
|||||||
Shareholders’ equity
|
$
|
37,530,271
|
||||||
Net asset value per share
|
$
|
9.21
|
Investment Income
|
||||||||||||
Dividends
|
$
|
726,380
|
||||||||||
Interest
|
71,725
|
|||||||||||
Total investment income
|
$
|
798,105
|
||||||||||
Expenses
|
||||||||||||
Advisory fees
|
$
|
268,411
|
||||||||||
Legal fees
|
3,477
|
|||||||||||
Insurance
|
13,094
|
|||||||||||
Transfer agent
|
45,199
|
|||||||||||
Audit fees
|
23,500
|
|||||||||||
Directors’ fees and expenses
|
70,500
|
|||||||||||
Custodian fees
|
6,799
|
|||||||||||
Listing fee
|
15,000
|
|||||||||||
Other fees and expenses
|
13,561
|
|||||||||||
Total expenses
|
$
|
459,541
|
||||||||||
Net investment income
|
$
|
338,564
|
||||||||||
Realized Gain and Unrealized Appreciation on Investments
|
||||||||||||
Realized gain on investments:
|
||||||||||||
Proceeds from sale of investment securities
|
$
|
12,649,051
|
||||||||||
Less: cost of investment securities sold
|
10,757,341
|
|||||||||||
Net realized gain on investments
|
$
|
1,891,710
|
||||||||||
Unrealized appreciation on investments:
|
||||||||||||
Unrealized appreciation at end of period
|
$
|
13,008,148
|
||||||||||
Less: unrealized appreciation at beginning of period
|
8,616,600
|
|||||||||||
Net change in unrealized appreciation on investments
|
$
|
4,391,548
|
||||||||||
Net realized gain and unrealized appreciation on investments
|
$
|
6,283,258
|
||||||||||
Net increase from operations
|
$
|
6,621,822
|
Year Ended
December 31, 2018
|
Year Ended
December 31, 2019
|
|||||||
From Operations:
|
||||||||
Net investment income
|
$
|
366,198
|
$
|
338,564
|
||||
Net realized gain on investments
|
1,632,696
|
1,891,710
|
||||||
Net change in unrealized appreciation on investments
|
(3,588,439
|
)
|
4,391,548
|
|||||
Net increase (decrease) from operations
|
$
|
(1,589,545
|
)
|
$
|
6,621,822
|
|||
Distributions to Shareholders from:
|
||||||||
Net investment income
|
(343,086
|
)
|
(288,206
|
)
|
||||
Net realized gain from investment transactions
|
(1,632,696
|
)
|
(1,891,710
|
)
|
||||
Total distributions
|
$
|
(1,975,782
|
)
|
$
|
(2,179,916
|
)
|
||
From Capital Stock Transactions:
|
||||||||
Reinvested capital from distribution of shares
|
$
|
1,213,044
|
$
|
1,376,635
|
||||
Total Net Assets:
|
||||||||
Beginning of year
|
$
|
34,064,014
|
$
|
31,711,730
|
||||
End of period (including undistributed net investment income of $19,927 and $70,285)
|
$
|
31,711,730
|
$
|
37,530,271
|
||||
Shares:
|
||||||||
Shares at beginning of year
|
3,727,891
|
3,892,707
|
||||||
Shares issued to shareholders from the distribution
|
164,816
|
181,614
|
||||||
Shares at end of period
|
3,892,707
|
4,074,321
|
For the periods ended December 31:
|
2015
|
2016
|
2017
|
2018
|
2019
|
|||||||||||||||
Net asset value at beginning of year
|
$
|
9.00
|
$
|
8.52
|
$
|
8.26
|
$
|
9.14
|
$
|
8.15
|
||||||||||
Net investment income
|
$
|
0.04
|
$
|
0.01
|
$
|
-
|
$
|
0.10
|
$
|
0.09
|
||||||||||
Net realized gain and unrealized appreciation (loss) on investments
|
$
|
0.04
|
$
|
0.99
|
$
|
1.44
|
$
|
(0.52
|
)
|
$
|
1.61
|
|||||||||
Total from investment operations
|
$
|
0.08
|
$
|
1.00
|
$
|
1.44
|
$
|
(0.42
|
)
|
$
|
1.70
|
|||||||||
Distribution from:
|
||||||||||||||||||||
Net investment income
|
$
|
(0.05
|
)
|
$
|
(0.01
|
)
|
$
|
-
|
$
|
(0.09
|
)
|
$
|
(0.07
|
)
|
||||||
Realized gains
|
$
|
(0.45
|
)
|
$
|
(1.18
|
)
|
$
|
(0.51
|
)
|
$
|
(0.44
|
)
|
$
|
(0.49
|
)
|
|||||
Total distributions
|
$
|
(0.50
|
)
|
$
|
(1.19
|
)
|
$
|
(0.51
|
)
|
$
|
(0.53
|
)
|
$
|
(0.56
|
)
|
|||||
Dilution from share issuance
|
$
|
(0.06
|
)
|
$
|
(0.07
|
)
|
$
|
(0.05
|
)
|
$
|
(0.04
|
)
|
$
|
(0.08
|
)
|
|||||
Net asset value at end of period
|
$
|
8.52
|
$
|
8.26
|
$
|
9.14
|
$
|
8.15
|
$
|
9.21
|
||||||||||
Per share market price, end of period (A)
|
$
|
7.59
|
$
|
7.35
|
$
|
7.94
|
$
|
7.30
|
$
|
8.02
|
Total Investment Return:
|
||||||||||||||||||||
Average annual return, based on market value:
|
||||||||||||||||||||
1 Year
|
(6.65
|
%)
|
12.06
|
%
|
15.02
|
%
|
(1.44
|
%)
|
18.13
|
%
|
||||||||||
5 Year
|
11.67
|
%
|
9.89
|
%
|
11.58
|
%
|
5.62
|
%
|
6.97
|
%
|
||||||||||
10 Year
|
6.30
|
%
|
7.08
|
%
|
7.39
|
%
|
11.84
|
%
|
10.88
|
%
|
||||||||||
From inception
|
8.55
|
%
|
8.68
|
%
|
8.91
|
%
|
8.52
|
%
|
8.84
|
%
|
||||||||||
Average annual return, based on net asset value:
|
||||||||||||||||||||
1 Year
|
1.30
|
%
|
12.19
|
%
|
17.82
|
%
|
(4.41
|
%)
|
21.35
|
%
|
||||||||||
5 Year
|
10.56
|
%
|
12.11
|
%
|
13.19
|
%
|
6.70
|
%
|
9.20
|
%
|
||||||||||
10 Year
|
6.50
|
%
|
6.44
|
%
|
8.45
|
%
|
11.55
|
%
|
11.29
|
%
|
||||||||||
From inception
|
9.06
|
%
|
9.18
|
%
|
9.49
|
%
|
8.96
|
%
|
9.37
|
%
|
||||||||||
Net assets, end of year (000s omitted)
|
$
|
27,788
|
$
|
29,641
|
$
|
34,064
|
$
|
31,712
|
$
|
37,530
|
||||||||||
Ratios to average net assets (B):
|
||||||||||||||||||||
Expenses to average net assets
|
1.43
|
%
|
1.41
|
%
|
1.36
|
%
|
1.34
|
%
|
1.29
|
%
|
||||||||||
Net investment income to average net assets
|
0.42
|
%
|
0.17
|
%
|
0.00
|
%
|
1.10
|
%
|
0.95
|
%
|
||||||||||
Portfolio turnover
|
26
|
%
|
59
|
%
|
50
|
%
|
42
|
%
|
26
|
%
|
||||||||||
Average commission paid per share
|
$
|
0.01
|
$
|
0.01
|
$
|
0.04
|
$
|
0.05
|
$
|
0.05
|
Common Stock (85.8% of total investments)
|
LEVEL ONE
|
|||||||||||||||
Industry
|
Shares
|
Cost
|
Market Value
|
% of Total Investments
|
||||||||||||
Automotive
|
||||||||||||||||
General Motors Company
|
10,000
|
$
|
368,800
|
$
|
366,000
|
|||||||||||
$
|
366,000
|
1.0
|
%
|
|||||||||||||
Brokerage
|
||||||||||||||||
Charles Schwab Corp.
|
10,000
|
435,800
|
$
|
475,600
|
||||||||||||
$
|
475,600
|
1.3
|
%
|
|||||||||||||
Consumer
|
||||||||||||||||
Colgate-Palmolive Co.
|
24,000
|
810,965
|
$
|
1,652,160
|
||||||||||||
Kimberly-Clark Corp.
|
3,500
|
352,236
|
481,425
|
|||||||||||||
Procter & Gamble Company
|
2,000
|
145,879
|
249,800
|
|||||||||||||
$
|
2,383,385
|
6.4
|
%
|
|||||||||||||
Data Processing
|
||||||||||||||||
Automatic Data Processing, Inc.
|
6,000
|
169,333
|
$
|
1,023,000
|
||||||||||||
Paychex, Inc.
|
20,000
|
628,288
|
1,701,200
|
|||||||||||||
$
|
2,724,200
|
7.3
|
%
|
|||||||||||||
Drug/Medical Device
|
||||||||||||||||
Johnson & Johnson
|
4,000
|
45,500
|
$
|
583,480
|
||||||||||||
Stryker Corp.
|
6,400
|
27,100
|
1,343,616
|
|||||||||||||
$
|
1,927,096
|
5.1
|
%
|
|||||||||||||
Food
|
||||||||||||||||
Kraft Heinz Company
|
29,000
|
772,000
|
$
|
931,770
|
||||||||||||
PepsiCo, Inc.
|
10,000
|
168,296
|
1,366,700
|
|||||||||||||
$
|
2,298,470
|
6.1
|
%
|
|||||||||||||
Industrial
|
||||||||||||||||
Illinois Tool Works Inc.
|
9,000
|
379,352
|
$
|
1,616,670
|
||||||||||||
Waters Corp.*
|
6,000
|
302,341
|
1,401,900
|
|||||||||||||
$
|
3,018,570
|
8.0
|
%
|
|||||||||||||
Insurance
|
||||||||||||||||
Berkshire Hathaway Inc. B*
|
27,000
|
4,422,265
|
$
|
6,115,500
|
||||||||||||
Markel Corp.*
|
1,300
|
831,360
|
1,486,121
|
|||||||||||||
$
|
7,601,621
|
20.3
|
%
|
|||||||||||||
Mutual Fund Managers
|
||||||||||||||||
Diamond Hill Investment Group
|
18,711
|
3,067,845
|
$
|
2,628,147
|
||||||||||||
Franklin Resources, Inc.
|
68,500
|
2,097,546
|
1,779,630
|
|||||||||||||
T. Rowe Price Group Inc.
|
13,800
|
960,374
|
1,681,392
|
|||||||||||||
$
|
6,089,169
|
16.2
|
%
|
|||||||||||||
Restaurant
|
||||||||||||||||
Starbucks Corp.
|
15,000
|
735,540
|
$
|
1,318,800
|
||||||||||||
$
|
1,318,800
|
3.5
|
%
|
|||||||||||||
Retail
|
||||||||||||||||
AutoZone Inc.*
|
750
|
398,783
|
$
|
893,483
|
||||||||||||
eBay Inc.
|
42,900
|
1,072,754
|
1,549,119
|
|||||||||||||
O’Reilly Automotive Inc.*
|
2,000
|
407,379
|
876,520
|
|||||||||||||
$
|
3,319,122
|
8.8
|
%
|
|||||||||||||
Software
|
||||||||||||||||
Alphabet, Inc. A*
|
500
|
583,844
|
$
|
669,695
|
||||||||||||
$
|
669,695
|
1.8
|
%
|
|||||||||||||
Total common stock investments
|
$
|
32,191,728
|
Money Market Funds (14.2% of total investments)
|
LEVEL ONE
|
|||||||
Market Value
|
% of Total Investments
|
|||||||
Morgan Stanley Inst. Liquidity Fund, Treasury, 1.51%
|
$
|
5,320,759
|
||||||
$
|
5,320,759
|
14.2
|
%
|
|||||
Total investments
|
$
|
37,512,487
|
||||||
All other assets
|
71,896
|
|||||||
Accrued investment advisory fees
|
(24,765
|
)
|
||||||
All other liabilities
|
(29,347
|
)
|
||||||
Total net assets
|
$
|
37,530,271
|
||||||
*Non-dividend paying security
|
(1) |
Organization.
|
(2) |
Significant Accounting Policies.
|
Gross unrealized appreciation
|
$
|
13,793,231
|
||
Gross unrealized depreciation
|
(785,083
|
)
|
||
Net unrealized appreciation
|
$
|
13,008,148
|
||
Federal income tax basis
|
$
|
19,183,580
|
(3) |
Certain Service Providers Arrangements
|
(4) |
Dividend Reinvestment and Cash Purchase Plan.
|
(5) |
Distributions to Shareholders
|
2018
|
2019
|
|||||||
Distributions paid from:
|
||||||||
Net investment income:
|
$
|
343,086
|
$
|
288,206
|
||||
Long-term capital gains:
|
1,632,696
|
1,891,710
|
Undistributed ordinary income:
|
$
|
70,285
|
||
Net unrealized appreciation:
|
$
|
13,008,148
|
(6) |
Fund Investment Transactions
|
(7) |
Financial Highlights.
|
Name,
Address and
Age
|
Position(s)
Held with
Fund
|
Term of
Office and
Length of
Time Served
|
Principal Occupation(s) During Past 5
Years (in addition to positions held in
the Fund)
|
Number of
Portfolios in
Fund
Complex
Overseen by
Director or
Nominee for
Director
|
Other
Directorships
Held by Director
or Nominee for
Director
(Public
Companies)
|
||||||
David C.
Sims*, age 38
|
CFO, CCO, Treasurer, Secretary and Director
|
Term of office expires 2021 (Class II). Served as a director since 2015.
|
President of Sims Capital Management LLC (investment advisor to the Fund); Manager of Peregrine Investment Fund LLC (private investment fund); and roles with the Fund as previously identified.
|
One
|
None
|
||||||
Luke E.
Sims**, age
70
|
President, CEO and Director
|
Term of office expires 2022 (Class III). Served as a director since 2002.
|
President and Chief Executive Officer of the Fund; Chairman of Sims Capital Management LLC (the Advisor to the Fund); and Retired Partner of Foley & Lardner LLP (national law firm) where he was affiliated from 1976 through 2010.
|
One
|
None
|
Name, Address
and Age*
|
Position(s)
Held with
Fund
|
Term of Office
and Length of
Time Served
|
Principal Occupation(s) During Past
Five Years
|
Number of
Portfolios in Fund
Complex Overseen
by Director or
Nominee for
Director
|
Other Directorships
Held by Director or
Nominee for
Director
(Public
Companies)
|
||||||
Robert M. Bilkie, Jr., age 59
|
Chairman; Director
|
Term of office expires 2020 (Class I); nominee for director. Served as a director since 2006.
|
President and Chief Executive Officer of Sigma Investment Counselors, Inc. (a registered investment advisor) since 1987; member of the NAIC/Better Investing Securities Review Committee and of the NAIC/Better Investing Editorial Advisory
Committee (non-remunerative).
|
One
|
None
|
||||||
Phillip J. Hanrahan, age 80
|
Director
|
Term of office expires 2020 (Class I); nominee for director. Served as a director since 2008.
|
Retired partner of Foley & Lardner LLP (law firm) since February 2007 and, prior thereto, active partner of that firm since 1973.
|
One
|
None
|
||||||
Carl A. Holth,
age 87
|
Director
|
Term of office expires 2021 (Class II). Served as a director since 1989.
|
Retired.
|
One
|
None
|
||||||
Peggy L. Schmeltz,
age 92
|
Director
|
Term of office expires 2021 (Class II). Served as a director since 1989.
|
Retired; Former Trustee of NAIC.
|
One
|
None
|
||||||
Donald G. Tyler,
age 67
|
Director
|
Term of office expires 2022 (Class III). Served as a director since 2010.
|
Retired. Director of Administrative Services, County of Milwaukee, 2012 to 2014. Retired Interim President & Executive Director, Milwaukee Symphony Orchestra 2010; Vice President of Investment Products and Services, Northwestern
Mutual, 2003-2010.
|
One
|
None
|
||||||
Neal F. Zalenko, age 74
|
Director
|
Term of office expires 2022 (Class III). Served as a director since 2008.
|
Retired; Founder and Managing partner of Zalenko & Associates, P.C. (accounting firm), that merged with Baker Tilly in early 2005.
|
One
|
None
|
Name, Position
|
Aggregate
Compensation
From Fund
|
Pension or Retirement
Benefits Accrued as
part of Fund
Expenses
|
Estimated
Annual
Benefits upon
Retirement
|
Total
Compensation
from Fund and
Complex paid
to Directors
|
|
David C. Sims,
|
|||||
Director, CFO, CCO,
|
|||||
Treasurer, Secretary
|
None
|
None
|
None
|
None
|
|
Luke E. Sims,
|
|||||
Director, President,
|
|||||
CEO
|
None
|
None
|
None
|
None
|
Name, Position
|
Aggregate
Compensation
From Fund
|
Pension or Retirement
Benefits Accrued as
part of Fund
Expenses
|
Estimated
Annual
Benefits upon
Retirement
|
Total
Compensation
from Fund and
Complex paid
to Directors
|
||||||
Robert M. Bilkie, Jr.,
|
||||||||||
Director
|
$
|
11,000
|
None
|
None
|
$
|
11,000
|
||||
Phillip J. Hanrahan,
|
||||||||||
Director
|
$
|
12,000
|
None
|
None
|
$
|
12,000
|
||||
Carl A. Holth,
|
||||||||||
Director
|
$
|
12,000
|
None
|
None
|
$
|
12,000
|
||||
Peggy L. Schmeltz,
|
||||||||||
Director
|
$
|
11,000
|
None
|
None
|
$
|
11,000
|
||||
Donald G. Tyler,
|
||||||||||
Director
|
$
|
12,000
|
None
|
None
|
$
|
12,000
|
||||
Neal F. Zalenko,
|
||||||||||
Director
|
$
|
12,500
|
None
|
None
|
$
|
12,500
|
Robert M. Bilkie, Jr.
Chairman of the Board
Northville, MI
|
Carl A. Holth
Director
Dearborn, MI
|
Phillip J. Hanrahan
Director
Whitefish Bay, WI
|
Peggy L. Schmeltz
Director
Bowling Green, OH
|
Luke E. Sims
Milwaukee, WI
President & CEO
|
David C. Sims
CFO, CCO, Treasurer,
Secretary & Director
Milwaukee, WI
|
Donald G. Tyler
Director
Shorewood, WI
|
Neal F. Zalenko
Director
Birmingham, MI
|
/s/ Luke E. Sims
|
|
Luke E. Sims
|
|
President and Chief Executive Officer (principal executive officer)
|
|
/s/ David C. Sims
|
|
David C. Sims
|
|
Chief Financial Officer (principal financial officer)
|
By: /s/ Luke E. Sims
|
Luke E. Sims
|
President and Chief Executive Officer (principal executive officer)
|
Dated: June 5, 2020
|
By: /s/ David C. Sims
|
David C. Sims
|
Chief Financial Officer (principal financial officer)
|
Dated: June 5, 2020
|
I. |
Applicability
|
II. |
Statement of Principles
|
◾ |
Engage in and promote honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships;
|
◾ |
Take all reasonable measures to protect the confidentiality of non-public information about the Fund, and to prevent the unauthorized disclosure of such information unless required by applicable law or regulation or a legal or regulatory
process;
|
◾ |
Comply with applicable government laws, rules and regulations; and
|
◾ |
Promptly report any violation of the Code of Ethics to the President of the Fund, and provide a copy of the report to the Chief Compliance Officer of the Fund.
|
III. |
Standards of Business Conduct
|
◾ |
Accepting special favors as a result of the position of an Access Person with the Fund from any person or organization with which the Fund or Advisor has a current or potential business relationship;
|
◾ |
Directing business to or receiving business from a supplier or broker owned or managed by, or which employs, the Access Person, a relative or a friend.
|
IV. |
Enforcement
|
V. |
Blackout Period
|
VI. |
Prohibited Transactions
|
VII. |
Prohibited Recommendations
|
VIII. |
Acknowledgment and Reporting Requirements
|
IX. |
Handling of Disgorged Profits
|
X. |
Confidentiality
|
XI. |
Other Laws, Rules and Statements of Policy
|
XII. |
Retention of Records
|
XIII. |
Monitoring
|
XIV. |
Exceptions to the Code of Ethics
|
XV. |
Board Review
|
XVI. |
Amendments
|
Name (Print):
|
|||
Signature:
|
Date:
|
, 20 |
☐ |
I do not have a direct or indirect beneficial interest in any account(s) with any financial services firm.
|
☐ |
I maintain account(s) with the financial services firm(s) listed below. Please include the information required below for any broker, dealer or bank where an account is maintained which holds securities for your direct or indirect benefit
as of the date you became an Access Person.
|
Name of Financial Services Firm(s)
|
Company
|
Symbol
|
Purchase/
|
Trade
|
Settle
|
CUSIP
|
Quantity
|
Unit
|
Principal
|
Commissions
|
Fees
|
Net
|
Broker
|
Sale
|
Date
|
Date
|
Price
|
Proceeds
|
Proceeds
|
|||||||
☐ |
I have no securities holdings to report.
|
Signature:
|
Date:
|
|
, 20 |
Company
|
Symbol
|
Purchase/
|
Trade
|
Settle
|
CUSIP
|
Quantity
|
Unit
|
Principal
|
Commissions
|
Fees
|
Net
|
Broker
|
Sale
|
Date
|
Date
|
Price
|
Proceeds
|
Proceeds
|
|||||||
☐ |
I have no securities transactions to report.
|
☐ |
I did not establish any account(s) with any financial services firm during the calendar quarter in which any securities were held in which I had a direct or indirect beneficial interest.
|
☐ |
I established account(s) during the calendar quarter with the financial services firm(s) listed below. Please include the information required below for any broker, dealer or bank where an account was established during the calendar
quarter which held securities for your direct or indirect benefit during the calendar quarter.
|
Name of Financial Services Firm(s)
|
Date Account Established
|
Signature:
|
Date:
|
, 20 |
☐ |
I did not have a direct or indirect beneficial interest in any account(s) with any financial services firm as of the end of the referenced year.
|
☐ |
I maintained account(s) with the financial services firm(s) listed below as of the end of the referenced year. Please include the information required below for any broker, dealer or bank where an account was maintained which held
securities for your direct or indirect benefit as of such date.
|
Name of Financial Services Firm(s)
|
Company
|
Symbol
|
Purchase/
|
Trade
|
Settle
|
CUSIP
|
Quantity
|
Unit
|
Principal
|
Commissions
|
Fees
|
Net
|
Broker
|
Sale
|
Date
|
Date
|
Price
|
Proceeds
|
Proceeds
|
|||||||
☐ |
I have no securities holdings to report.
|
Signature:
|
|
Date:
|
, 20 |
◾ |
Accepting special favors as a result of your position with the Fund from any person or organization with which the Fund has a current or potential business relationship.
|
◾ |
Directing business to a supplier or broker owned or managed by, or which employs, a relative or friend.
|
Please sign here:
|
Date:
|
Please print your name:
|
|
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