Form 102a - Annual Report

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2875.9930 FORM 102A: ANNUAL REPORT
DEPARTMENT OF COMMERCE
STATE OF MINNESOTA, ST. PAUL, MINNESOTA
[ANNUAL REPORT]
(Pursuant to Minn. Stat., section 80A.12, subdivision 10)
ANNUAL REPORT FEE $100
(1) For the fiscal year _______________________________ Date of Report ____________________________
(2a) ________________________________________________________________________________________
(Exact name of issuer)
(2b) ________________________________________________________________________________________
(Exact name of security registered)
(3)_______________________________________________
___________________________
(State or other jurisdiction of incorporation or organization)
(Minnesota File Number)
(4)_______________________________________________
___________________________
(Address of principal executive offices)
Zip Code
(5) Issuer's telephone number, including area code_____________________________________
(6a) Number of shares or other units outstanding at end of last fiscal year __________________
(b) Number of shares or other units outstanding at the end of this fiscal year ________________
(c) Explanation of increase or decrease in outstanding shares or units during this fiscal year:
d) Number of
Date
Number of
Consideration
Exemption Claimed
Issued
shares/units
received
(Minnesota Statute)
______
_________
_____________
___________________
______
_________
_____________
___________________
______
_________
_____________
___________________
______
_________
_____________
___________________
e) Explanation of other securities of the issuer which were issued during this fiscal year:
f) Type of
Date
Consideration
Exemption Claimed
security
issued
received
(Minnesota Statute)
________
______
_____________
___________________
________
______
_____________
___________________
________
______
_____________
___________________
g) The persons or class of persons to whom any securities were sold:
h) The name of any broker-dealer or agent participating in any sales and the amount of commissions or other
remuneration paid, if applicable:
(7) A description of all securities of the registrant repurchased or otherwise reacquired by the registrant within the
fiscal year covered by the report:
(8) The names and addresses of all officers and directors, or persons occupying similar status or performing similar
functions:
(9) A description of the business of the registrant, including its products and services, competitive conditions,
sources of supply, the number and general function of employees, its market area, and any other factors which
materially affect the business or operations of the registration:
(10) A summary of operations for the fiscal year covered by the report including, without limitation, gross revenues,
cost of goods sold or services provided, net income, debt service and earnings per share of each class of equity
security outstanding, together with a comparison of similar figures for the fiscal year immediately preceding the
fiscal year covered by the report. The comparison required by this paragraph may be presented in columnar form:
(11) A brief description of the location and general character of plants, mines, and other materially important
physical properties of the registrant:
(12) A description of any material legal proceedings pending against the company:
(13) A description of all parents and subsidiaries of the registrant, and an explanation of the manner in which each is
affiliated with the registrant:

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