Form SI-PT "Corporate Disclosure Statement (Domestic Stock and Foreign Corporations)" - California

What Is Form SI-PT?

This is a legal form that was released by the California Secretary of State - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the California Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SI-PT by clicking the link below or browse more documents and templates provided by the California Secretary of State.

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Download Form SI-PT "Corporate Disclosure Statement (Domestic Stock and Foreign Corporations)" - California

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Secretary of State
Statement of Information
1500 11th Street
(916) 657-5448
P.O. Box 944230
Business Programs Division
Sacramento, CA 94244-2300
Corporate Disclosure Statement
General Information
Due Date: Every registered domestic and foreign publicly traded corporation must file with the
Secretary of State a Corporate Disclosure Statement (Form SI-PT) annually, within 150 days after the
end of its fiscal year.
Publicly Traded Corporation: A publicly traded corporation is a California or foreign corporation, as
defined in California Corporations Code section
162 or
171, respectively, that is an issuer as defined in
Section 3 of the Securities Exchange Act of 1934, as amended (United States Code, title 15, section
78c), and has at least one class of securities listed or admitted for trading on a national securities
exchange, on the OTC-Bulletin Board, or on the electronic service operated by Pink OTC Markets Inc.
Legal Authority: Statutory filing provisions are found in California Corporations Code sections
1502.1
and 2117.1, unless otherwise indicated.
Definitions: The following definitions apply to the Corporate Disclosure Statement:
“Independent auditor” means an auditor that meets the requirements for auditor
independence stated in the Code of Federal Regulations, title 17, section 210.2-01.
“Compensation” includes all plan and nonplan compensation awarded to, earned by,
or paid to the person for all services rendered in all capacities to the corporation and
to its subsidiaries, as the compensation is specified by Item 402 of Regulation S-K of
the Securities and Exchange Commission (Code of Federal Regulations, title 17,
section 229.402).
“Executive officer” means the chief executive officer, president, any vice president in
charge of a principal business unit, division, or function, any other officer of the
corporation who performs a policymaking function, or any other person who performs
similar policymaking functions for the corporation.
“Loan” excludes an advance for expenses, the corporation’s payment of life insurance
premiums and an advance of litigation expenses as permitted according to the
applicable laws of the state or place of incorporation. For California corporations, see
California Corporations Code sections
315(d), 315(e) and
317, respectively.
Fee: There is no fee for filing the Corporate Disclosure Statement.
Where to file: For easier completion, the Corporate Disclosure Statement is available on the
Secretary of State's website at www.sos.ca.gov/business/be/statements and can be viewed, filled in
and printed from your computer.
The completed form can be mailed to Secretary of State,
Statement of Information Unit, P.O. Box 944230, Sacramento, CA 94244-2300 or delivered in person
(drop off) to the Sacramento office, 1500 11th Street, Sacramento, CA 95814.
If you are not
completing the form online, please type or legibly print in black or blue ink.
Additional Filing Requirements: In addition to the Corporate Disclosure Statement, all publicly
traded corporations also must file, during their applicable filing period, a
Statement of Information
as
required by California Corporations Code section
1502
or 2117. For faster processing, the Statement
of Information can be filed online at https://businessfilings.sos.ca.gov.
SI-PT INFO (REV 10/2010)
Secretary of State
Statement of Information
1500 11th Street
(916) 657-5448
P.O. Box 944230
Business Programs Division
Sacramento, CA 94244-2300
Corporate Disclosure Statement
General Information
Due Date: Every registered domestic and foreign publicly traded corporation must file with the
Secretary of State a Corporate Disclosure Statement (Form SI-PT) annually, within 150 days after the
end of its fiscal year.
Publicly Traded Corporation: A publicly traded corporation is a California or foreign corporation, as
defined in California Corporations Code section
162 or
171, respectively, that is an issuer as defined in
Section 3 of the Securities Exchange Act of 1934, as amended (United States Code, title 15, section
78c), and has at least one class of securities listed or admitted for trading on a national securities
exchange, on the OTC-Bulletin Board, or on the electronic service operated by Pink OTC Markets Inc.
Legal Authority: Statutory filing provisions are found in California Corporations Code sections
1502.1
and 2117.1, unless otherwise indicated.
Definitions: The following definitions apply to the Corporate Disclosure Statement:
“Independent auditor” means an auditor that meets the requirements for auditor
independence stated in the Code of Federal Regulations, title 17, section 210.2-01.
“Compensation” includes all plan and nonplan compensation awarded to, earned by,
or paid to the person for all services rendered in all capacities to the corporation and
to its subsidiaries, as the compensation is specified by Item 402 of Regulation S-K of
the Securities and Exchange Commission (Code of Federal Regulations, title 17,
section 229.402).
“Executive officer” means the chief executive officer, president, any vice president in
charge of a principal business unit, division, or function, any other officer of the
corporation who performs a policymaking function, or any other person who performs
similar policymaking functions for the corporation.
“Loan” excludes an advance for expenses, the corporation’s payment of life insurance
premiums and an advance of litigation expenses as permitted according to the
applicable laws of the state or place of incorporation. For California corporations, see
California Corporations Code sections
315(d), 315(e) and
317, respectively.
Fee: There is no fee for filing the Corporate Disclosure Statement.
Where to file: For easier completion, the Corporate Disclosure Statement is available on the
Secretary of State's website at www.sos.ca.gov/business/be/statements and can be viewed, filled in
and printed from your computer.
The completed form can be mailed to Secretary of State,
Statement of Information Unit, P.O. Box 944230, Sacramento, CA 94244-2300 or delivered in person
(drop off) to the Sacramento office, 1500 11th Street, Sacramento, CA 95814.
If you are not
completing the form online, please type or legibly print in black or blue ink.
Additional Filing Requirements: In addition to the Corporate Disclosure Statement, all publicly
traded corporations also must file, during their applicable filing period, a
Statement of Information
as
required by California Corporations Code section
1502
or 2117. For faster processing, the Statement
of Information can be filed online at https://businessfilings.sos.ca.gov.
SI-PT INFO (REV 10/2010)
Instructions for Completing Form SI-PT
Every domestic stock and foreign publicly traded corporation must file a Corporate Disclosure Statement (Form SI-PT) annually, within 150
days after the end of its fiscal year.
Legal Authority: Statutory filing provisions are found in California Corporations Code sections 1502.1 and 2117.1, unless otherwise indicated.
Fees: There is no fee for filing the Corporate Disclosure Statement.
Copies: To get a copy of the filed statement, include a separate request and payment for copy fees when the statement is submitted. Copy
fees are $1.00 for the first page and $.50 for each additional page. For certified copies, there is an additional $5.00 certification fee, per copy.
Complete Corporate Disclosure Statement (Form SI-PT) as follows:
Item 1.
Enter the name of the corporation exactly as it is of record with the California Secretary of State.
Item 2.
Enter the name of the independent auditor that prepared the most recent auditor’s report on the corporation’s annual financial
statements.
Item 3.
Enter a description of other services, if any, performed for the corporation during its two most recent fiscal years and the period
between the end of its most recent fiscal year and the date of the statement by the independent auditor named in Item 2, by its
parent corporation, or by a subsidiary or corporate affiliate of the independent auditor or its parent corporation. If more space is
needed, enter the additional information in Item D of the Attachment (Form SI-PTA).
Item 4.
Enter the name of the independent auditor employed by the corporation on the date of this statement, if different from the individual
named in Item 2.
Item 5.
Enter the name of each director and the compensation (in U.S. dollars) paid to each director for the most recent fiscal year,
including the number of any shares issued, options for shares granted, and similar equity-based compensation granted to each
director.
Check YES or NO to indicate whether or not an order for relief has been entered in a bankruptcy case during the 10 years
preceding the date of this statement with respect to each director.
Check YES or NO to indicate whether or not each director has been convicted of fraud during the 10 years preceding the date of
this statement, if the conviction has not been overturned or expunged.
If the corporation has additional directors, complete Item B of the Attachment (Form SI-PTA).
Item 6a.
Enter the names of the five most highly compensated executive officers of the corporation, excluding any executive officer who is
also a member of the board of directors. Enter the compensation (in U.S. dollars) paid to each executive officer for the most recent
fiscal year, including the number of any shares issued, options for shares granted, and similar equity-based compensation granted
to each executive officer
Check YES or NO to indicate whether or not an order for relief has been entered in a bankruptcy case during the 10 years
preceding the date of this statement with respect to each executive officer.
Check YES or NO to indicate whether or not each executive officer has been convicted of fraud during the 10 years preceding the
date of this statement, if the conviction has not been overturned or expunged.
Item 6b.
Complete Item 6b if the information regarding the chief executive officer is not included in Item 6a.
Item 6c.
Enter the names and check any of the applicable boxes for additional executive officers who have had an order for relief entered in
a bankruptcy case or who have been convicted of fraud during the 10 years preceding the date of this statement, if the conviction
has not been overturned or expunged.
If more space is needed, enter the additional information in Item D of the Attachment (Form SI-PTA).
Item 7.
Enter a description of each loan made to a director by the corporation during the corporation’s two most recent fiscal years at an
interest rate lower than the interest rate available from unaffiliated commercial lenders generally to a similarly situated borrower.
Include the name of the director receiving the loan, the amount of the loan (in U.S. dollars) and the terms of the loan. If more
space is needed for the description of the loan, enter the additional information in Item D of the Attachment (Form SI-PTA). If no
such loans were made, the field should be left blank.
If the corporation has made additional loans to directors, complete Item C of the Attachment (Form SI-PTA).
Item 8.
Check YES or NO to indicate whether or not an order for relief has been entered in a bankruptcy case during the 10 years
preceding the date of this statement with respect to the corporation.
Item 9.
Check YES or NO to indicate whether or not the corporation or any of its subsidiaries has been a party to, or any of their property
has been subject to, any material pending legal proceeding, other than ordinary routine litigation incidental to the business, as
specified by Item 103, Part 229 of Regulation S-K of the Securities Exchange Commission (17 C.F.R. Sec. 229.103). If yes, attach
a description.
Item 10.
Check YES or NO to indicate whether or not the corporation has been found, in any material legal proceeding, legally liable by
entry of a final judgment or final order (that was not overturned on appeal) during the five years preceding the date of this
statement. If yes, attach a description.
Item 11.
Type or print the name and title of the person completing this form and enter the date this form was completed. By submitting this
Corporate Disclosure Statement to the Secretary of State, the corporation certifies the information contained herein, including any
attachments, is true and correct.
D
State of California
Secretary of State
Corporate Disclosure Statement
(Domestic Stock and Foreign Corporations)
There is no fee for filing the Corporate Disclosure Statement.
IMPORTANT — PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
Clear Item 1
1. CORPORATE NAME
This Space For Filing Use Only
Independent Auditor
Clear Item 2
Clear Item 3
Clear Item 4
2.
NAME OF THE INDEPENDENT AUDITOR THAT PREPARED THE MOST RECENT AUDITOR’S REPORT
3.
DESCRIPTION OF OTHER SERVICES, IF ANY, PERFORMED BY THE INDEPENDENT AUDITOR NAMED IN ITEM 2
4.
NAME OF THE INDEPENDENT AUDITOR EMPLOYED BY THE CORPORATION ON THE DATE OF THIS STATEMENT, IF DIFFERENT FROM ITEM 2
Directors and Executive Officers
Clear Item 5
Clear Item 6a
Clear Item 6b
Clear Item 6c
5.
NAMES OF DIRECTORS
COMPENSATION
SHARES
OPTIONS
BANKRUPTCY
FRAUD
1)
YES
NO
YES
NO
2)
YES
NO
YES
NO
3)
YES
NO
YES
NO
IF THE CORPORATION HAS ADDITIONAL DIRECTORS, COMPLETE ITEM B OF THE ATTACHMENT (FORM SI-PTA).
6a.
NAMES OF EXECUTIVE OFFICERS
COMPENSATION
SHARES
OPTIONS
BANKRUPTCY
FRAUD
1)
YES
NO
YES
NO
2)
YES
NO
YES
NO
3)
YES
NO
YES
NO
4)
YES
NO
YES
NO
5)
YES
NO
YES
NO
6b.
CHIEF EXECUTIVE OFFICER (if not named in 6a)
COMPENSATION
SHARES
OPTIONS
BANKRUPTCY
FRAUD
YES
NO
YES
NO
6c. ADDITIONAL EXECUTIVE OFFICERS (if not named in 6a or 6b)
1)
BANKRUPTCY
FRAUD
2)
BANKRUPTCY
FRAUD
3)
BANKRUPTCY
FRAUD
IF MORE SPACE IS NEEDED, ENTER ADDITIONAL INFORMATION IN ITEM D OF THE ATTACHMENT (FORM SI-PTA).
Loans to Members of the Board of Directors
Clear Item 7
7.
NAMES OF DIRECTORS
DESCRIPTION OF LOAN (INCLUDING AMOUNT AND TERMS)
1)
2)
3)
IF THE CORPORATION HAS MADE ADDITIONAL LOANS TO DIRECTORS, COMPLETE ITEM C OF THE ATTACHMENT (FORM SI-PTA).
Additional Statutory Disclosures
Clear Items 8-11
Has an order for relief been entered in a bankruptcy case with respect to the corporation during the preceding 10 years?
YES
NO
8.
Has the corporation or any of its subsidiaries been a party to, or any of their property been subject to, any material
9.
YES
NO
pending legal proceedings, as specified by Item 103, Part 229 of SEC Regulation S-K? If yes, attach a description
.
Has the corporation been found legally liable in any material legal proceeding during the preceding five years? If
10.
YES
NO
yes, attach a description.
By submitting this Corporate Disclosure Statement to the Secretary of State, the corporation certifies the information contained herein,
11.
including any attachments, is true and correct.
TYPE OR PRINT NAME OF PERSON COMPLETING THE FORM
SIGNATURE
TITLE
DATE
SI-PT (REV 01/2013)
APPROVED BY SECRETARY OF STATE
Clear Form
Print Form
Instructions For Completing Form SI-PTA
For easier completion, this form is available on the Secretary of State's website at
http://www.sos.ca.gov/business/ and can be viewed, filled in and printed from your computer.
Completed forms along with the applicable fees can be mailed to Secretary of State, Statement of
Information Unit, P.O. Box 944230, Sacramento, CA
94244-2300 or delivered in person to the
Sacramento office, 1500 11th Street, Sacramento, CA 95814. If you are not completing this form
online, please type or legibly print in black or blue ink. This form should not be altered.
Legal Authority: Statutory filing provisions are found in California Corporations Code sections 1502.1
and 2117.1, unless otherwise indicated.
Use this form to add additional directors’ names and information; additional loans made to directors;
and any additional information that does not fit on the Corporate Disclosure Statement (Form SI-PT).
Copies: To get a copy of the filed statement, include a separate request and payment for copy fees
when the statement is submitted. Copy fees are $1.00 for the first page and $.50 for each additional
page. For certified copies, there is an additional $5.00 certification fee, per copy.
Complete Attachment to Corporate Disclosure Statement (Form SI-PTA) as follows:
Item A. Enter the name of the corporation exactly as it is of record with the California Secretary of
State.
Item B. If this attachment adds additional directors:
Enter the name of each director and the compensation (in U.S. dollars) paid to each
director for the most recent fiscal year, including the number of any shares issued, options
for shares granted, and similar equity-based compensation granted to each director.
Check YES or NO to indicate whether or not an order for relief has been entered in a
bankruptcy case during the 10 years preceding the date of this statement with respect to
each director.
Check YES or NO to indicate whether or not each director has been convicted of fraud
during the 10 years preceding the date of this statement, if the conviction has not been
overturned or expunged.
Attach additional pages as needed.
Item C. Enter a description of each loan made to a director by the corporation during the
corporation’s two most recent fiscal years at an interest rate lower than the interest rate
available from unaffiliated commercial lenders generally to a similarly situated borrower.
Include the name of the director receiving the loan, the amount of the loan (in U.S. dollars)
and the terms of the loan.
Attach additional pages as needed.
Item D. If extra space is needed to complete the information requested on the Corporate Disclosure
Statement
(Form SI-PT) or this Attachment to Corporate Disclosure Statement (Form
SI-PTA), please enter the additional information in Item D.
Please reference the item
number from Form SI-PT or Form SI-PTA, as applicable, that corresponds with each item of
additional information.
State of California
Secretary of State
Attachment to
Corporate Disclosure Statement
(Domestic Stock and Foreign Corporations)
This Space For Filing Use Only
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
Clear Item A
A. CORPORATE NAME
Clear Item B
B. Additional Directors (Continued from Item 5 on Form SI-PT)
NAMES OF DIRECTORS
COMPENSATION
SHARES
OPTIONS
BANKRUPTCY
FRAUD
4)
YES
NO
YES
NO
5)
YES
NO
YES
NO
6)
YES
NO
YES
NO
7)
YES
NO
YES
NO
8)
YES
NO
YES
NO
9)
YES
NO
YES
NO
10)
YES
NO
YES
NO
11)
YES
NO
YES
NO
12)
YES
NO
YES
NO
13)
YES
NO
YES
NO
14)
YES
NO
YES
NO
15)
YES
NO
YES
NO
16)
YES
NO
YES
NO
17)
YES
NO
YES
NO
18)
YES
NO
YES
NO
IF THE CORPORATION HAS ADDITIONAL DIRECTORS, ATTACH ADDITIONAL PAGES AS NEEDED.
Clear Item C
C. Additional Loans to Members of the Board of Directors (Continued from Item 7 on Form SI-PT)
NAMES OF DIRECTORS
DESCRIPTION OF LOAN (INCLUDING AMOUNT AND TERMS)
4)
5)
6)
7)
8)
IF THE CORPORATION HAS MADE ADDITIONAL LOANS TO DIRECTORS, ATTACH ADDITIONAL PAGES AS NEEDED.
Clear Item D
D. Additional Information (Please reference item number from Form SI-PT or Form SI-PTA, as applicable)
SI-PTA (REV 01/2013)
APPROVED BY SECRETARY OF STATE
Clear Form
Print Form
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