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Form X-17A-5 Focus Report Part IIB OTC Derivates Dealer (SEC2430) X-17A-5 - Official Federal Forms
| Form X-17A-5 Focus Report Part IIB OTC Derivates Dealer (SEC2430) Form. This is a national form and can be used in Securities And Exchange Commission . |
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM X-17A-5 OMB APPROVAL OMB Number: 3235-0498 Expires: March 31, 2016 Estimated average burden hours per response. . . . . . . . 20 FOCUS REPORT (Financial and Operational Combined Uniform Single Report) PART IIB 11 OTC DERIVATIVES DEALER (PLEASE READ INSTRUCTIONS BEFORE PREPARING FORM.) THIS REPORT IS BEING FILED PURSUANT TO (Check Applicable Block(s)): 1) Rule 17a-12 16 2) Rule 17a-11 18 3) Other 26 ___________________________________________________________________________ 13 (Name of Dealer) ________________________________________________________________________ ____ 20 (Address of Principal Place of Business (DO NOT USE P.O. Box No.)) ________________________________21_______________22________________________ 23 (City) (State) (Zip Code) ______________________________________________14 (SEC File No.) ______________________________________________15 (Firm I.D. No.) ______________________________________________24 (For Period Beginning (MM/DD/YYYY)) ______________________________________________25 (For Period Ending (MM/DD/YYYY)) NAME AND TELEPHONE NO. OF PERSON TO CONTACT IN REGARD TO THIS REPORT: ___________________________________________________________________________ 30 (Name) NAME(s) OF SUBSIDIARIES OR AFFILIATES CONSOLIDATED IN THIS REPORT: ________________________________________________________________________ ____ 32 ________________________________________________________________________ ____ 34 ________________________________________________________________________ ____ 36 ________________________________________________________________________ ____ 38 ______________________________________________31 ((Area Code) - (Telephone No.) OFFICIAL USE ______________________________________________33 ______________________________________________35 ______________________________________________37 ______________________________________________39 Yes 40 N0 41 42 [Does respondent carry its own customer accounts?] Check here if respondent is filing an audited report: EXECUTION: The registrant/dealer submitting this Form and its attachments and the person(s) by whom it is executed represent hereby that all information contained therein is true, correct and complete. It is understood that all required items, statements, and schedules are considered integral parts of this Form and that the submission of any amendment represents that all unamended items, statements and schedules remain true, correct and complete as previously submitted. Dated the ________________ day of ______________________________, ________ MANUAL SIGNATURES OF: 1) _________________________________________________________________________ (Principal Executive Officer or Managing Partner) 2) _________________________________________________________________________ (Principal Financial Officer or Partner) 3) _________________________________________________________________________ (Principal Operations Officer or Partner) ATTENTION -- Intentional misstatements or omissions of facts constitute Federal Criminal Violations. (See 18 U.S.C. 1001 and 15 U.S.C. 78:f(a)) American LegalNet, Inc. www.FormsWorkFlow.com SEC 2430 (2-02) Page 1 of 28 FOR SEC USE ONLY TO BE COMPLETED WITH THE ANNUAL AUDIT REPORT ONLY: CERTIFIED PUBLIC ACCOUNTANT whose opinion is contained in this report: ____________________________________________________________________________________________________________ 70 ((Name) If Individual, give last, first, middle name) ____________________________________________________________________________________________________________ 71 ((Address) DO NOT USE P.O. Box No.) __________________________________________ 72________________________________ 73 ____________________________ 74 (City) (State) (Zip Code) DO NOT WRITE UNDER THIS LINE FOR SEC USE ONLY WORK LOCATION 50 REPORT DATE (MM/DD/YYYY) 51 DOC. SEQ. NO. 52 CARD 53 SEC 2430 (2-02) Page 2 of 28 American LegalNet, Inc. www.FormsWorkFlow.com FINANCIAL AND OPERATIONAL COMBINED UNIFORM SINGLE REPORT PART IIB _________________________________________________________________________ __N 2 (Name of Dealer) 100 STATEMENT OF FINANCIAL CONDITION FOR OTC DERIVATIVES DEALERS Consolidated Unconsolidated 198 199 __________________________________________99 As of (MM/DD/YYYY) ____________________________________________98 (SEC File No.) ASSETS Assets Allowable Non-Allowable Total $ _____________________750 ____________________ 760 1. Cash .............................................................. $ ____________________ 200 2. Cash segregated in compliance with federal and other regulations ...................... 3. Receivable from broker/dealers and clearing organizations: A. Failed to deliver ..................................... B. Securities borrowed............................... C. Omnibus accounts ................................ D. Clearing organization ............................ E. Contracts: 1. Interest Rate ...................................... 2. Currency & Foreign Exchange ......... 3. Equity ............................................... 4. Commodity ...................................... 5. Other ................................................ F. Other .................................................... 4. Receivable from customers: A. Securities accounts: 1. Cash and fully secured accounts..... 2. Partly secured accounts .................. 3. Unsecured accounts ....................... B. Commodity accounts .......................... C. Allowance for doubtful accounts ........ _____________________310 _____________________320 ............................................ _____________________330 (___________________)_335 ________________ 560 ________________ 570 ________________ 580 (_______________) 590 _____________________291 _____________________292 _____________________293 _____________________294 _____________________295 _____________________300 $ ___________________550 _____________________230 _____________________250 _____________________270 _____________________290 ____________________210 ____________________ 770 ____________________ 780 ____________________ 790 ____________________ 800 ____________________ 801 ____________________ 802 ____________________ 803 ____________________ 804 ____________________ 805 ____________________ 810 ____________________ 820 OMIT PENNIES SEC 2430 (2-02) Page 3 of 28 American LegalNet, Inc. www.FormsWorkFlow.com FINANCIA
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