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Annual Report 102A - Minnesota

Annual Report Form. This is a Minnesota form and can be used in General Blue Sky Secretary Of State .
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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) Issuers 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 fis cal 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 duri ng 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 an d the amount of commissions or other remuneration paid, if applicable: (7) A description of all securities of the registrant repurchased or o therwise reacquired by the registrant within thefiscal year covered by the report: (8) The names and addresses of all officers and directors, or persons occupying similar status or performing similarfunctions: (9) A description of the business of the registrant, including its pro ducts and services, competitive conditions,sources of supply, the number and general function of employees, its mar ket 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 ea rnings per share of each class of equitysecurity outstanding, together with a comparison of similar figures for the fiscal year immediately preceding thefiscal year covered by the report. The comparison required by this parag raph may be presented in columnar form: (11) A brief description of the location and general character of plan ts, mines, and other materially important physical properties of the registrant: (12) A description of any material legal proceedings pending against t he company: (13) A description of all parents and subsidiaries of the registrant, and an explanation of the manner in which each isaffiliated with the registrant: American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2(14) The approximate number of holders of record of each outstanding c lass of equity securities: (15) A list in tabular form of the name and address of each officer, a nd any person known to the registrant who beneficially owns ten percent or more of any class of outstanding voting securities of the registrant, showing foreach the title of the class owned, the type of ownership, the amount own ed, and the percent of class owned: (16) A list in tabular form of the amount of remuneration received and the capacity in which such remuneration wasreceived for each officer and director (in the case of officers, only t hose officers who received in excess of $25,000during this fiscal year need be listed): (17) A list and description of the number and exercise price of all op tions outstanding which are beneficially ownedby any officer or director: (18) A description of any transactions in the last fiscal year or any currently pending transaction to which the issueror any of its subsidiaries was a party and in which any director, office r, ten percent shareholder, or any affiliate hador will have a direct or indirect material interest, and a description o f the nature of such interest. (19) Financial statements certified by an independent accountant compl ying with the requirements of parts 2875.0970 and 2875.0980. ___________________________ Authorized Signature ___________________________ Position American LegalNet, Inc. www.USCourtForms.com
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