SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement (Month/Day/Year) |
3. Issuer Name and Ticker or Trading Symbol |
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4. Relationship of Reporting Person(s) to Issuer
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5. If Amendment, Date of Original Filed (Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned |
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1. Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock |
0 (1) |
D |
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Common Stock |
0 (1) |
I |
No securities are beneficially owned. |
Table II - Derivative Securities Beneficially Owned |
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1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
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Explanation of Responses: |
1. No securities are beneficially owned. |
Remarks: |
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Eliza W. Fraser on behalf of Marinus Dekkers |
06/20/2012 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
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* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). |
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** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |