Form Pf - Reporting Form For Investment Advisers To Private Funds And Certain Commodity Pool Operators And Commodity Trading Advisors Page 17
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64Page 6 of 43
Form PF
Information about the private funds you advise
(to be completed by all Form PF filers)
Section 1b
categorization of assets and liabilities using a fair value hierarchy similar to that established
under U.S. GAAP, then respond to this question using the fair value hierarchy established
under the applicable accounting standard.)
(This question requires the use of fair values and cost-based measurements, which may be
different from the values contemplated by Instruction 15. You are only required to respond to
this question if you are filing an annual update or a quarterly update for your fourth fiscal
quarter.)
Fair value
Cost-based
Level 1
Level 2
Level 3
Assets
$
$
$
$
Liabilities
$
$
$
$
15.
Specify the approximate percentage of the reporting fund's equity that is beneficially
owned by the five beneficial owners having the largest equity interests in the
reporting fund.
(For purposes of this question, if you know that two or more beneficial owners of the reporting
fund are affiliated with each other, you should treat them as a single beneficial owner.)
16.
Specify the approximate percentage of the reporting fund's equity that is beneficially owned by
the following groups of investors.
(Include each investor in only one group. The total should add up to approximately 100%.
With respect to beneficial interests outstanding prior to March 31, 2012, that have not been
transferred on or after that date, you may respond to this question using good faith estimates
based on data currently available to you.)
(a) Individuals that are United States persons (including their trusts) ............................
(b) Individuals that are not United States persons (including their trusts) ......................
(c) Broker-dealers ...........................................................................................................
(d) Insurance companies ..................................................................................................
(e) Investment companies registered with the SEC .........................................................
(f) Private funds ..............................................................................................................
(g) Non-profits.................................................................................................................
(h) Pension plans (excluding governmental pension plans) ............................................
(i) Banking or thrift institutions (proprietary) ................................................................
(j) State or municipal government entities (excluding governmental pension plans) ....
(k) State or municipal governmental pension plans ........................................................
(l) Sovereign wealth funds and foreign official institutions ...........................................
(m) Investors that are not United States persons and about which the foregoing
beneficial ownership information is not known and cannot reasonably be obtained
because the beneficial interest is held through a chain involving one or more third-
party intermediaries ...................................................................................................
(n) Other ..........................................................................................................................
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