Federal Trade Commission v. DR Phone Communication, Inc et al

Filing 16

Order by Hon. Samuel Conti granting 15 Motion to Continue and stipulation of preliminary injunction and other equitable relief.(sclc1, COURT STAFF) (Filed on 6/7/2012)

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1 WILLARD K. TOM General Counsel 2 3 4 5 6 7 8 ROBERT J. SCHROEDER Regional Director LAURA M. SOLIS, WA State Bar No. 36005 NADINE S. SAMTER, WA State Bar No. 23881 Federal Trade Commission 915 Second Avenue, Suite 2896 Seattle, WA 98174 Phone: (206) 220-4544 (Solis) Phone: (206) 220-4479 (Samter) Facsimile: (206) 220-6366 Email: lsolis@ftc.gov nsamter@ftc.gov 9 10 11 12 13 14 KERRY O’BRIEN, CA State Bar No. 149264 Federal Trade Commission 901 Market Street, Suite 570 San Francisco, CA 94103 Phone: (415) 848-5189 Facsimile: (415) 848-5142 Email: kobrien@ftc.gov Attorneys for Plaintiff Federal Trade Commission 15 UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA San Francisco Division 16 17 18 FEDERAL TRADE COMMISSION, 19 20 Plaintiff, v. 21 22 23 DR PHONE COMMUNICATIONS, INC., also d/b/a DR Phone Communications Company, Inc., Phone Communications, Inc., and DRphonecom.com, and 24 25 26 DAVID ROSENTHAL, individually and as an officer of DR Phone Communications, Inc., Defendants. 27 28 Stipulated Preliminary Injunction - Page 1 Case No. C-12-2631-SC Case No. C-12-2631-SC [PROPOSED] STIPULATED ORDER OF PRELIMINARY INJUNCTION AND OTHER EQUITABLE RELIEF 1 Plaintiff, the Federal Trade Commission (“FTC” or the “Commission”), pursuant to 2 Section 13(b) of the Federal Trade Commission Act (“FTC Act”), 15 U.S.C. § 53(b), has filed a 3 Complaint for Injunctive and Other Equitable Relief (“Complaint”) and has moved, pursuant to 4 Federal Rule of Civil Procedure 65, for a Temporary Restraining Order (“TRO”) and 5 Preliminary Injunction With Other Equitable Relief against the defendants, DR Phone 6 Communications, Inc., and David Rosenthal (collectively “Defendants”). 7 NOW, THEREFORE, the Commission and Defendant David Rosenthal, having 8 requested the Court to enter this Stipulated Preliminary Injunction, it is ordered, adjudged, and 9 decreed as follows: FINDINGS 10 11 12 13 14 1. This is an action by the FTC under Section 13(b) of the FTC Act, 15 U.S.C. § 53(b). Pursuant to this section, the FTC has the authority to seek the relief granted herein. 2. This Court has jurisdiction over the subject matter of this case and there is good cause to believe that it will have jurisdiction over all parties hereto. 15 3. Venue in the Northern District of California and service of process are proper. 16 4. The acts and practices of the Defendants are in or affecting commerce, as 17 18 defined in Section 4 of the FTC Act, 15 U.S.C. § 44. 5. This Court has the authority to grant a preliminary injunction and other 19 appropriate relief pursuant to Section 13(b) of the FTC Act, 15 U.S.C. § 53(b), and Rule 65 of 20 the Federal Rules of Civil Procedure. 21 22 23 6. Plaintiff and Defendant Rosenthal agree that relief set forth herein shall remain in effect until further order of this Court. 7. This Order does not constitute, and shall not be interpreted to constitute, either 24 an admission by Defendants of any of Plaintiff’s allegations, or a finding by the Court that 25 Defendants have engaged in any violation of the FTC Act. 26 27 8. No security is required of any agency of the United States for issuance of a restraining order. Fed. R. Civ. P. 65(c). 28 Stipulated Preliminary Injunction - Page 2 Case No. C-12-2631-SC 1 DEFINITIONS 2 For the purpose of this Order, the following definitions shall apply: 3 1. “Stipulating Defendant” means David Rosenthal, individually and as an 4 officer, director, manager, member, shareholder, agent, servant, or employee of DR Phone 5 Communications, Inc., d/b/a DRphonecom.com, and its divisions, subsidiaries, affiliates, 6 predecessors, successors, and assigns. Furthermore, any person or entity in active concert or 7 participation with David Rosenthal, including any person acting in the capacity of an officer, 8 director, manager, member, shareholder, agent, servant, or employee of DR Phone 9 Communications, Inc. and its divisions, subsidiaries, affiliates, predecessors, successors, and 10 assigns, who receives actual notice of this Order by personal service or otherwise, is bound to 11 comply with this Order, see Fed. R. Civ. P. 65(d), whether these persons or entities are acting 12 directly or through a trust, corporation, subsidiary, division, or other device. 13 2. “Document” is synonymous in meaning and equal in scope to the usage of the 14 term in Federal Rule of Civil Procedure 34(a), and encompasses both paper documents and 15 electronically stored information – including writings, drawings, graphs, charts, photographs, 16 sound recordings, images, and other data or data compilations – stored in any medium from 17 which information can be obtained either directly or, if necessary, after translation by 18 Defendants into a reasonably usable form. A draft or non-identical copy is a separate document 19 within the meaning of the term. 20 21 3. “Clear and prominent” shall mean as follows: A. In a print advertisement or other promotional materials, the disclosure 22 shall be in a type size and location sufficiently noticeable for an ordinary consumer to read and 23 comprehend it, in print that contrasts with the background against which it appears. In multi- 24 page documents, the disclosure shall appear on the cover or, alternatively, on the first page 25 where any price representation or representation regarding calling time is made. 26 27 B. In an advertisement communicated through an electronic medium (such as television, video, radio, and interactive media such as the Internet and online services), the 28 Stipulated Preliminary Injunction - Page 3 Case No. C-12-2631-SC 1 disclosure shall be presented simultaneously in both the audio and video portions of the 2 advertisement. Provided, however, that in any advertisement presented solely through video or 3 audio means, the disclosure may be made through the same means in which the advertisement 4 is presented. The audio disclosure shall be delivered in a volume and cadence sufficient for an 5 ordinary consumer to hear and comprehend it. The video disclosure shall be of a size and 6 shade, and shall appear on the screen for a duration sufficient for an ordinary consumer to read 7 and comprehend it. In addition to the foregoing, in interactive media, the disclosure shall also 8 be unavoidable and shall be presented prior to the consumer incurring any financial obligation. C. 9 On a product label or prepaid calling card, the disclosure shall be in a 10 type size and location on the principal display panel sufficiently noticeable for an ordinary 11 consumer to read and comprehend it, in print that contrasts with the background against which 12 it will appear. D. 13 The disclosure shall be in understandable language and syntax. Nothing 14 contrary to, inconsistent with, or in mitigation of the disclosure shall be used in any 15 advertisement or calling card label. 16 17 18 4. “PIN” means a unique personal identification number assigned to a Prepaid Calling Card to access the value of the Prepaid Calling Card. 5. “Fees and Charges” means any fees or charges assessed in connection with the 19 use of a Prepaid Calling Card, including, but not limited to, any maintenance fee, weekly fee, 20 monthly fee, connection fee, payphone fee, cell phone fee, access number fee, service fee, 21 hang-up fee, or expiration date. 22 6. “Marketing Materials” means any poster, sign, bulletin, Internet website, 23 advertisement, in-store display, packaging, prepaid calling card, offer of sale, or other 24 promotional material. 25 7. “Prepaid Calling Card” means a card or information providing the right to 26 make one or more telephone calls that are paid for in advance. Such right to make prepaid 27 telephone calls may be embodied on a card or other physical object or may be purchased by an 28 Stipulated Preliminary Injunction - Page 4 Case No. C-12-2631-SC 1 electronic means, such as over the Internet, through which the purchaser obtains information, 2 such as access and authorization codes, that are not physically located on a card or other object. 3 ORDER 4 I. 5 MISREPRESENTATIONS 6 IT IS HEREBY ORDERED that Stipulating Defendant, directly or indirectly through 7 any corporation, partnership, subsidiary, distributor, agent, or other device, and those persons in 8 active concert or participation with him who receive actual notice of this Order by personal 9 service or otherwise, in connection with the marketing, advertising, promotion, distribution, 10 offer for sale, or sale of Prepaid Calling Cards, are hereby restrained and enjoined from falsely 11 representing, expressly or by implication, the number of calling minutes a consumer will obtain 12 by using a Prepaid Calling Card. 13 II. 14 FAILURE TO DISCLOSE 15 IT IS FURTHER ORDERED that Stipulating Defendant, directly or indirectly 16 through any corporation, partnership, subsidiary, distributor, agent, or other device, and those 17 persons in active concert or participation with him who receive actual notice of this Order by 18 personal service or otherwise, in connection with the marketing, advertising, promotion, 19 distribution, offer for sale, or sale of Prepaid Calling Cards, are hereby restrained and enjoined 20 from making any representations, expressly or by implication, regarding the number of calling 21 minutes provided and/or the value of a Prepaid Calling Card, while failing to make a clear and 22 prominent disclosure of all material limitations on the use of such Prepaid Calling Card, 23 including, but not limited to, the existence and specific amount of any Fees and Charges that 24 will be assessed in connection with the use of such Prepaid Calling Card. 25 26 27 28 Stipulated Preliminary Injunction - Page 5 Case No. C-12-2631-SC 1 III. 2 ADVERTISING AND MARKETING MATERIALS 3 IT IS FURTHER ORDERED that, for Marketing Materials that Defendants 4 disseminated to retailers or distributors prior to the date of entry of this Order, Stipulating 5 Defendant shall take reasonable actions within his power to ensure that any such materials used 6 to market or sell Defendants’ prepaid calling cards that are not in compliance with Sections I 7 and II of this Order are removed or replaced. Such actions shall include providing the notice 8 required by Section VII of this Order and refusing to sell product to retailers and distributors 9 that Stipulating Defendant knows or should know are using Marketing Materials in violation of 10 Section I or II of this Order. 11 IV. 12 PRESERVATION OF RECORDS 13 IT IS FURTHER ORDERED that Stipulating Defendant and his successors, assigns, 14 agents, servants, employees, and attorneys, and those persons in active concert or participation 15 with any of them who receive actual notice of this Order by personal service, facsimile 16 transmission, email, or otherwise, whether acting directly or through any corporation, 17 subsidiary, division, or other device, are hereby temporarily restrained and enjoined from: 18 A. Destroying, erasing, mutilating, concealing, altering, transferring, falsifying, 19 writing over, or otherwise disposing of, in any manner, directly or indirectly, any Documents or 20 records of any kind that relate to the business practices or business or personal finances of 21 Defendants or other entity directly or indirectly under the control of Defendants, including, but 22 not limited to, any and all Marketing Materials, World Wide Web pages, consumer complaints, 23 rate decks, call detail records, telephone logs, telephone scripts, contracts, correspondence, 24 email, corporate books and records, accounting data, financial statements, receipt books, 25 ledgers, personal and business canceled checks and check registers; bank statements, calendars, 26 appointment books, and tax returns; and 27 28 Stipulated Preliminary Injunction - Page 6 Case No. C-12-2631-SC 1 B. Failing to create and maintain books, records, and accounts which, in reasonable 2 detail, accurately, fairly, and completely reflect the incomes, assets, disbursements, 3 transactions, and use of monies by any Defendant or other entity directly or indirectly under the 4 control of any Defendant. V. 5 FINANCIAL AND BUSINESS ACCOUNTING 6 7 8 9 IT IS FURTHER ORDERED that within twenty (20) calendar days after service of this Order: A. Stipulating Defendant shall complete and deliver to the FTC: (1) the Financial Statement captioned “Financial Statement of Individual 10 11 Defendant,” a copy of which is attached hereto as Attachment A, and any tax returns, bank 12 statements, or other documentation supporting the financial information provided therein; and (2) the Financial Statement captioned “Financial Statement of Corporate 13 14 Defendant,” a copy of which is attached hereto as Attachment B, and any tax returns, bank 15 statements, or other documentation supporting the financial information provided therein; and 16 B. Stipulating Defendant also shall provide the FTC with the following 17 information, from January 1, 2010, to the date of Stipulating Defendant’s full and complete 18 compliance with this Order, concerning Defendant DR Phone Communications, Inc.: (1) total 19 gross sales revenues on a monthly basis derived from the sale of prepaid calling cards; (2) an 20 itemization of total gross operating expenses on a monthly basis; (3) gross operating 21 expenditures on a monthly basis per category, including but not limited to payroll, advertising, 22 marketing, utilities, and property leases; and (4) gross capital expenditures. 23 VI. 24 NOTIFICATION OF CHANGE IN BUSINESS STRUCTURE 25 IT IS FURTHER ORDERED that Stipulating Defendant shall notify the Commission 26 of any changes in the structure of Defendant DR Phone Communications, Inc. that may affect 27 Stipulating Defendant’s compliance obligations arising under this Order, including but not 28 Stipulated Preliminary Injunction - Page 7 Case No. C-12-2631-SC 1 limited to: the dissolution, assignment, sale, merger, or other similar action involving 2 Defendant DR Phone Communications, Inc.; the creation or dissolution of a subsidiary, parent, 3 or affiliate of Defendant DR Phone Communications, Inc. that engages in any acts or practices 4 subject to this Order; a change in the business name or address of Defendant DR Phone 5 Communications, Inc.,; or a change in Stipulating Defendant’s control over Defendant DR 6 Phone Communications, Inc., at least thirty (30) days prior to such change. 7 VII. 8 DISTRIBUTION OF ORDER BY DEFENDANT 9 IT IS FURTHER ORDERED that Stipulating Defendant shall immediately provide a 10 copy of this Order to each distributor, sub-distributor, subsidiary, telecommunications service 11 provider, division, sales entity, successor, assign, officer, director, member, manager, 12 employee, independent contractor, client retailer, client company, agent, and attorney of 13 Defendants, and shall, within ten (10) days from the date of entry of this Order, provide the 14 FTC with a sworn statement that this provision of the Order has been satisfied, which statement 15 shall include the names, physical addresses, phone number, and email addresses, of each such 16 person or entity who received a copy of the Order. 17 VIII. 18 CONSUMER REPORTS 19 IT IS FURTHER ORDERED that pursuant to Section 604(1) of the Fair Credit 20 Reporting Act, 15 U.S.C. § 1681b(1), any consumer reporting agency may furnish a consumer 21 report concerning Stipulating Defendant to the FTC. 22 IX. 23 SERVICE OF THIS ORDER BY PLAINTIFF 24 IT IS FURTHER ORDERED that copies of this Order may be served by electronic 25 26 27 mail, facsimile transmission, personal or overnight delivery, or U.S. Mail, by agents and employees of the Commission or any state or federal law enforcement agency, on (1) 28 Stipulated Preliminary Injunction - Page 8 Case No. C-12-2631-SC 7th June FEDERAL TRADE COMMISSION FINANCIAL STATEMENT OF INDIVIDUAL DEFENDANT Instructions: 1. Complete all items. Enter “None” or “N/A” (“Not Applicable”) where appropriate. If you cannot fully answer a question, explain why. 2. The font size within each field will adjust automatically as you type to accommodate longer responses. 3. “Dependents” include your live-in companion, dependent children, or any other person, whom you or your spouse (or your children’s other parent) claimed or could have claimed as a dependent for tax purposes at any time during the past five years. 4. “Assets” and “Liabilities” include ALL assets and liabilities, located within the United States or elsewhere, whether held individually or jointly. 5. Attach continuation pages as needed. On the financial statement, state next to the Item number that the Item is being continued. On the continuation page(s), identify the Item number(s) being continued. 6. Type or print legibly. 7. Initial each page in the space provided in the lower right corner. 8. Sign and date the completed financial statement on the last page. Penalty for False Information: Federal law provides that any person may be imprisoned for not more than five years, fined, or both, if such person: (1) “in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry” (18 U.S.C. § 1001); (2) “in any . . . statement under penalty of perjury as permitted under section 1746 of title 28, United States Code, willfully subscribes as true any material matter which he does not believe to be true” (18 U.S.C. § 1621); or (3) “in any (. . . statement under penalty of perjury as permitted under section 1746 of title 28, United States Code) in any proceeding before or ancillary to any court or grand jury of the United States knowingly makes any false material declaration or makes or uses any other information . . . knowing the same to contain any false material declaration” (18 U.S.C. § 1623). For a felony conviction under the provisions cited above, federal law provides that the fine may be not more than the greater of (i) $250,000 for an individual or $500,000 for a corporation, or (ii) if the felony results in pecuniary gain to any person or pecuniary loss to any person other than the defendant, the greater of twice the gross gain or twice the gross loss. 18 U.S.C. § 3571. ATTACHMENT A BACKGROUND INFORMATION Item 1. Information About You Your Full Name ______________________________________________ Social Security No. ___________________ Place of Birth _________________________ Date of Birth _______________ Drivers License No. _______________ Current Address ______________________________________________________ From (Date) _________________ Rent or Own? _________ Telephone No. _________________________ Facsimile No. _________________________ E-Mail Address _____________________________________ Internet Home Page ____________________________ Previous Addresses for past five years: Address___________________________________________ Rent or Own?________ From/Until_________________ Address___________________________________________ Rent or Own?________ From/Until_________________ Identify any other name(s) and/or social security number(s) you have used, and the time period(s) during which they were used________________________________________________________________________________________ Item 2. Information About Your Spouse or Live-In Companion Spouse/Companion's Name _____________________________________ Social Security No. ___________________ Place of Birth _________________________________________ Date of Birth _______________________________ Identify any other name(s) and/or social security number(s) your spouse/companion has used, and the time period(s) during which they were used ________________________________________________________________________ Address (if different from yours) _____________________________________________________________________ From (Date) _________________________ Rent or Own?___________ Telephone No._________________________ Employer’s Name and Address ______________________________________________________________________ Job Title _______________________ Years in Present Job _________ Annual Gross Salary/Wages $______________ Item 3. Information About Your Previous Spouse Previous Spouse’s Name & Address __________________________________________________________________ ___________________________________ Social Security No. _________________ Date of Birth _______________ Page 2 Initials __________ Item 4. Contact Information Name & Address of Nearest Living Relative or Friend ___________________________________________________ ____________________________________________________________ Telephone No. ______________________ Item 5. Information About Dependents Who Live With You <Name ______________________________________________ Date of Birth ________________________________ Relationship _________________________________________ Social Security No. ____________________________ <Name ______________________________________________ Date of Birth ________________________________ Relationship _________________________________________ Social Security No. ____________________________ <Name ______________________________________________ Date of Birth ________________________________ Relationship _________________________________________ Social Security No. ____________________________ Item 6. Information About Dependents Who Do Not Live With You <Name & Address ________________________________________________________________________________ Date of Birth __________________ Relationship ____________________ Social Security No.___________________ <Name Address __________________________________________________________________________________ Date of Birth __________________ Relationship ____________________ Social Security No.__________________ <Name & Address ________________________________________________________________________________ Date of Birth __________________ Relationship ____________________ Social Security No.__________________ Item 7. Employment Information Provide the following information for this year-to-date and for each of the previous five full years, for each company of which you were a director, officer, employee, agent, contractor, participant or consultant at any time during that period. “Income” includes, but is not limited to, any salary, commissions, draws, consulting fees, loans, loan payments, dividends, royalties or other benefits for which you did not pay (e.g., health insurance premiums, automobile lease or loan payments) received by you or anyone else on your behalf. <Company Name & Address ________________________________________________________________________ Dates Employed: From (Month/Year) ________________________ To (Month/Year) _________________________ Positions Held with Beginning and Ending Dates ________________________________________________________ ________________________________________________________________________________________________ Page 3 Initials __________ Item 7. continued Income Received: This year-to-date: $______________________ _______: $______________________ 20_____: $______________________ _______: $______________________ _______: $______________________ _______: $______________________ <Company Name & Address ________________________________________________________________________ Dates Employed: From (Month/Year) ________________________ To (Month/Year) _________________________ Positions Held with Beginning and Ending Dates ________________________________________________________ ________________________________________________________________________________________________ Income Received: This year-to-date: $______________________ _______: $______________________ 20_____: $______________________ _______: $______________________ _______: $______________________ _______: $______________________ <Company Name & Address ________________________________________________________________________ Dates Employed: From (Month/Year) ________________________ To (Month/Year) _________________________ Positions Held with Beginning and Ending Dates ________________________________________________________ ________________________________________________________________________________________________ Income Received: This year-to-date: $______________________ _______: $______________________ 20_____: $______________________ _______: $______________________ _______: $______________________ _______: $______________________ Item 8. Pending Lawsuits Filed by You or Your Spouse List all pending lawsuits that have been filed by you or your spouse in court or before an administrative agency. (List lawsuits that resulted in final judgments or settlements in Items 16 and 25). Opposing Party’s Name & Address ___________________________________________________________________ Court’s Name & Address ___________________________________________________________________________ Docket No. _________________ Relief Requested ____________________ Nature of Lawsuit ___________________ ____________________________________ Status ______________________________________________________ Page 4 Initials __________ Item 9. Pending Lawsuits Filed Against You or Your Spouse List all pending lawsuits that have been filed against you or your spouse in court or before an administrative agency. (List lawsuits that resulted in final judgments or settlements in Items 16 and 25). Opposing Party’s Name & Address ___________________________________________________________________ Court’s Name & Address ___________________________________________________________________________ Docket No. _________________ Relief Requested ____________________ Nature of Lawsuit ___________________ ____________________________________ Status ______________________________________________________ Item 10. Safe Deposit Boxes List all safe deposit boxes, located within the United States or elsewhere, held by you, your spouse, or any of your dependents, or held by others for the benefit of you, your spouse, or any of your dependents. On a separate page, describe the contents of each box. Owner’s Name Name & Address of Depository Institution Box No. __________________ ___________________________________________________________________ _________ __________________ ___________________________________________________________________ _________ __________________ ___________________________________________________________________ _________ Item 11. Business Interests List all businesses for which you, your spouse, or your dependents are an officer or director. <Business’ Name & Address ________________________________________________________________________ Business Format (e.g., corporation) __________________________ Description of Business _____________________ ______________________________ Position(s) Held, and By Whom _______________________________________ <Business’ Name & Address ________________________________________________________________________ Business Format (e.g., corporation) __________________________ Description of Business _____________________ ______________________________ Position(s) Held, and By Whom _______________________________________ <Business’ Name & Address ________________________________________________________________________ Business Format (e.g., corporation) __________________________ Description of Business _____________________ ______________________________ Position(s) Held, and By Whom _______________________________________ Page 5 Initials __________ FINANCIAL INFORMATION: ASSETS AND LIABILITIES REMINDER: “Assets” and “Liabilities” include ALL assets and liabilities, located within the United States or elsewhere, whether held individually or jointly. Item 12. Cash, Bank, and Money Market Accounts List cash and all bank and money market accounts, including but not limited to, checking accounts, savings accounts, and certificates of deposit, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. The term “cash” includes currency and uncashed checks. Cash on Hand $____________________________ Cash Held For Your Benefit $____________________________ Name on Account Name & Address of Financial Institution Account No. Current Balance _________________ __________________________________________________ _______________ $__________ _________________ __________________________________________________ _______________ $__________ _________________ __________________________________________________ _______________ $__________ _________________ __________________________________________________ _______________ $__________ _________________ __________________________________________________ _______________ $__________ _________________ __________________________________________________ _______________ $__________ Item 13. U.S. Government Securities List all U.S. Government securities, including but not limited to, savings bonds, treasury bills, and treasury notes, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. Name on Account Type of Obligation Security Amount Maturity Date ____________________ _____________________________________________ $________________ _____________ ____________________ _____________________________________________ $________________ _____________ ____________________ _____________________________________________ $________________ _____________ Page 6 Initials __________ Item 14. Publicly Traded Securities and Loans Secured by Them List all publicly traded securities, including but not limited to, stocks, stock options, registered and bearer bonds, state and municipal bonds, and mutual funds, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. <Issuer _______________________________ Type of Security ___________________ No. of Units Owned ________ Name on Security _________________ Current Fair Market Value $_________ Loan(s) Against Security $_________ Broker House, Address _______________________________________________ Broker Account No. ____________ <Issuer _______________________________ Type of Security ___________________ No. of Units Owned ________ Name on Security _________________ Current Fair Market Value $_________ Loan(s) Against Security $_________ Broker House, Address _______________________________________________ Broker Account No. ____________ Item 15. Other Business Interests List all other business interests, including but not limited to, non-public corporations, subchapter-S corporations, limited liability corporations (“LLCs”), general or limited partnership interests, joint ventures, sole proprietorships, and oil and mineral leases, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. <Business Format _____________________________ Business’ Name & Address ______________________________ _________________________________________________________________________ Ownership % ___________ Owner (e.g., self, spouse) ________________________________ Current Fair Market Value $____________________ <Business Format _____________________________ Business’ Name & Address ______________________________ _________________________________________________________________________ Ownership % ___________ Owner (e.g., self, spouse) ________________________________ Current Fair Market Value $____________________ Item 16. Monetary Judgments or Settlements Owed to You, Your Spouse, or Your Dependents List all monetary judgments or settlements owed to you, your spouse, or your dependents. <Opposing Party’s Name & Address __________________________________________________________________ Court’s Name & Address __________________________________________________ Docket No. _______________ Nature of Lawsuit ______________________________ Date of Judgment _______________ Amount $____________ <Opposing Party’s Name & Address __________________________________________________________________ Court’s Name & Address __________________________________________________ Docket No. _______________ Nature of Lawsuit ______________________________ Date of Judgment _______________ Amount $____________ Page 7 Initials __________ Item 17. Other Amounts Owed to You, Your Spouse, or Your Dependents List all other amounts owed to you, your spouse, or your dependents. Debtor’s Name, Address, & Telephone No. ____________________________________________________________ Original Amount Owed $_____________ Current Amount Owed $____________ Monthly Payment $_____________ Item 18. Life Insurance Policies List all life insurance policies held by you, your spouse, or your dependents. <Insurance Company’s Name, Address, & Telephone No. _________________________________________________ ________________________________________________________________________________________________ Insured ________________________ Beneficiary _______________________ Face Value $_____________________ Policy No. _________________ Loans Against Policy $________________ Surrender Value $___________________ <Insurance Company’s Name, Address, & Telephone No. _________________________________________________ ________________________________________________________________________________________________ Insured ________________________ Beneficiary _______________________ Face Value $_____________________ Policy No. _________________ Loans Against Policy $________________ Surrender Value $___________________ Item 19. Deferred Income Arrangements List all deferred income arrangements, including but not limited to, deferred annuities, pensions plans, profit-sharing plans, 401(k) plans, IRAs, Keoghs, and other retirement accounts, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. <Name on Account _________________________ Type of Plan ___________________ Date Established __________ Trustee or Administrator’s Name, Address & Telephone No. _______________________________________________ ________________________________________________________________________________________________ Account No. ______________________ Surrender Value $___________________ <Name on Account _________________________ Type of Plan ___________________ Date Established __________ Trustee or Administrator’s Name, Address & Telephone No. _______________________________________________ ________________________________________________________________________________________________ Account No. ______________________ Surrender Value $___________________ Page 8 Initials __________ Item 20. Personal Property List all personal property, by category, whether held for personal use or for investment, including but not limited to, furniture and household goods of value, computer equipment, electronics, coins, stamps, artwork, gemstones, jewelry, bullion, other collectibles, copyrights, patents, and other intellectual property, held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. Property Category (e.g., artwork, jewelry) Name of Owner Property Location Acquisition Cost Current Value ____________________________ __________________ ___________________________ $_________ $__________ ____________________________ __________________ ___________________________ $_________ $__________ ____________________________ __________________ ___________________________ $_________ $__________ ____________________________ __________________ ___________________________ $_________ $__________ ____________________________ __________________ ___________________________ $_________ $__________ ____________________________ __________________ ___________________________ $_________ $__________ Item 21. Cars, Trucks, Motorcycles, Boats, Airplanes, and Other Vehicles List all cars, trucks, motorcycles, boats, airplanes, and other vehicles owned or operated by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. <Vehicle Type __________________ Make ____________________ Model ______________________ Year _______ Registered Owner’s Name __________________________ Registration State & No. ___________________________ Address of Vehicle’s Location _______________________________________________________________________ Purchase Price $_______________Current Value $_______________ Account/Loan No. ________________________ Lender’s Name and Address _________________________________________________________________________ Original Loan Amount $______________ Current Loan Balance $______________ Monthly Payment $____________ <Vehicle Type __________________ Make ____________________ Model ______________________ Year _______ Registered Owner’s Name __________________________ Registration State & No. ___________________________ Address of Vehicle’s Location _______________________________________________________________________ Purchase Price $_______________Current Value $_______________ Account/Loan No. ________________________ Lender’s Name and Address _________________________________________________________________________ Original Loan Amount $______________ Current Loan Balance $______________ Monthly Payment $____________ Page 9 Initials __________ Item 21. Continued <Vehicle Type __________________ Make ____________________ Model ______________________ Year _______ Registered Owner’s Name __________________________ Registration State & No. ___________________________ Address of Vehicle’s Location _______________________________________________________________________ Purchase Price $_______________Current Value $_______________ Account/Loan No. ________________________ Lender’s Name and Address _________________________________________________________________________ Original Loan Amount $______________ Current Loan Balance $______________ Monthly Payment $____________ Item 22. Real Property List all real estate held by you, your spouse, or your dependents, or held by others for the benefit of you, your spouse, or your dependents. <Type of Property________________________________ Property’s Location_________________________________ Name(s) on Title and Ownership Percentages___________________________________________________________ Acquisition Date________________ Purchase Price $____________________ Current Value $___________________ Basis of Valuation_______________________________________ Loan or Account No._________________________ Lender’s Name and Address_________________________________________________________________________ Current Balance On First Mortgage $__________________ Monthly Payment $_________________ Other Loan(s) (describe)____________________________________________ Current Balance $_________________ Monthly Payment $__________________ Rental Unit?_________________ Monthly Rent Received $_____________ <Type of Property________________________________ Property’s Location_________________________________ Name(s) on Title and Ownership Percentages___________________________________________________________ Acquisition Date________________ Purchase Price $____________________ Current Value $___________________ Basis of Valuation_______________________________________ Loan or Account No._________________________ Lender’s Name and Address__________________________________________________________________________ Current Balance On First Mortgage $__________________ Monthly Payment $_________________ Other Loan(s) (describe)____________________________________________ Current Balance $_________________ Monthly Payment $__________________ Rental Unit?_________________ Monthly Rent Received $_____________ Page 10 Initials __________ Item 23. Credit Cards List each credit card held by you, your spouse, or your dependents. Also list any other credit cards that you, your spouse, or your dependents use. Name of Credit Card (e.g., Visa, MasterCard, Department Store) Account No. Name(s) on Account Current Balance Minimum Monthly Payment ____________________________ __________________ _________________ $____________ $________________ ____________________________ __________________ _________________ $____________ $________________ ____________________________ __________________ _________________ $____________ $________________ ____________________________ __________________ _________________ $____________ $________________ ____________________________ __________________ _________________ $____________ $________________ ____________________________ __________________ _________________ $____________ $________________ Item 24. Taxes Payable List all taxes, such as income taxes or real estate taxes, owed by you, your spouse, or your dependants. Type of Tax Amount Owed Year Incurred _______________________________ $__________________________ ___________________ _______________________________ $__________________________ ___________________ _______________________________ $__________________________ ___________________ _______________________________ $__________________________ ___________________ Item 25. Judgments or Settlements Owed List all judgments or settlements owed by you, your spouse, or your dependents. Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit_______________________________________ Date______________ Amount $______________ Page 11 Initials __________ Item 26. Other Loans and Liabilities List all other loans or liabilities in your, your spouse's, or your dependents’ names. <Name & Address of Lender/Creditor _________________________________________________________________ Nature of Liability_____________________________________ Name(s) on Liability__________________________ Date of Liability___________________ Amount Borrowed $________________ Current Balance $_______________ Payment Amount $_____________________ Frequency of Payment_____________________ <Name & Address of Lender/Creditor _________________________________________________________________ Nature of Liability_____________________________________ Name(s) on Liability__________________________ Date of Liability___________________ Amount Borrowed $________________ Current Balance $_______________ Payment Amount $_____________________ Frequency of Payment_____________________ OTHER FINANCIAL INFORMATION Item 27. Tax Returns List all federal tax returns that were filed during the last three years by or on behalf of you, your spouse, or your dependents. Provide a copy of each signed tax return that was filed during the last three years. Tax Year Name(s) on Return Refund Expected ___________ ___________________________________________________________________ $_______________ ___________ ___________________________________________________________________ $_______________ ___________ ___________________________________________________________________ $_______________ Item 28. Applications for Credit List all applications for bank loans or other extensions of credit that you, your spouse, or your dependents have submitted within the last two years. Provide a copy of each application, including all attachments. Name(s) on Application Name & Address of Lender _________________________________ ______________________________________________________________ _________________________________ ______________________________________________________________ _________________________________ ______________________________________________________________ Page 12 Initials __________ Item 29. Trusts and Escrows List all funds or other assets that are being held in trust or escrow by any person or entity for you, your spouse, or your dependents. Also list all funds or other assets that are being held in trust or escrow by you, your spouse, or your dependents, for any person or entity. Provide copies of all executed trust documents. Trustee or Escrow Agent’s Name & Address Date Established Grantor Beneficiaries Present Market Value of Assets ________________________________ ______________ _________________ ______________ $______________ ________________________________ ______________ _________________ ______________ $______________ ________________________________ ______________ _________________ ______________ $______________ ________________________________ ______________ _________________ ______________ $______________ ________________________________ ______________ _________________ ______________ $______________ Item 30. Transfers of Assets List each person to whom you have transferred, in the aggregate, more than $2,500 in funds or other assets during the previous three years by loan, gift, sale, or other transfer. For each such person, state the total amount transferred during that period. Transferee’s Name, Address, & Relationship Property Transferred Aggregate Value Transfer Date Type of Transfer (e.g., Loan, Gift) ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ Page 13 Initials __________ SUMMARY FINANCIAL SCHEDULES Item 31. Combined Balance Sheet for You, Your Spouse, and Your Dependents ASSETS Cash on Hand (Item 12) LIABILITIES $___________ Credit Cards (Item 23) $____________ Cash in Financial Institutions (Item 12) $___________ Motor Vehicles - Liens (Item 21) $____________ U.S. Government Securities (Item 13) $___________ Real Property - Encumbrances (Item 22) $____________ Publicly Traded Securities (Item 14) $___________ Loans Against Publicly Traded Securities (Item 14) $____________ Other Business Interests (Item 15) $___________ Taxes Payable (Item 24) $____________ Judgments or Settlements Owed to You (Item 16) $___________ Judgments or Settlements Owed (Item 25) $____________ Other Amounts Owed to You (Item 17) $___________ Other Loans and Liabilities (Item 26) $____________ Surrender Value of Life Insurance (Item 18) $___________ Other Liabilities (Itemize) Deferred Income Arrangements (Item 19) $___________ _________________________________ $____________ Personal Property (Item 20) $___________ _________________________________ $____________ Motor Vehicles (Item 21) $___________ _________________________________ $____________ Real Property (Item 22) $___________ _________________________________ $____________ _________________________________ $____________ Other Assets (Itemize) ___________________________ $___________ _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ Total Assets $ Total Liabilities $ Page 14 Initials __________ Item 32. Combined Average Monthly Income and Expenses for You, Your Spouse, and Your Dependents for the Last 6 Months Provide the average monthly income and expenses for you, your spouse, and your dependents for the last 6 months. Do not include credit card payments separately; rather, include credit card expenditures in the appropriate categories. INCOME Salary - After Taxes EXPENSES $___________ Mortgage Payments for Residence(s) $____________ Fees, Commissions, and Royalties $___________ Property Taxes for Residence(s) $____________ Interest $___________ Rental Property Expenses, Including Mortgage Payments, Taxes, and Insurance $____________ Dividends and Capital Gains $___________ Car or Other Vehicle Lease or Loan Payments $____________ Gross Rental Income $___________ Food Expenses $____________ Profits from Sole Proprietorships $___________ Clothing Expenses $____________ Distributions from Partnerships, S-Corporations, and LLCs $___________ Utilities $____________ Distributions from Trusts and Estates $___________ Medical Expenses, Including Insurance $____________ Distributions from Deferred Income Arrangements $___________ Other Insurance Premiums $____________ Social Security Payments $___________ Other Transportation Expenses $____________ Alimony/Child Support Received $___________ Other Household Expenses $____________ Gambling Income $___________ Other Income (Itemize) Other Expenses (Itemize) _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ ___________________________ $___________ _________________________________ $____________ Total Income $ Total Expenses $ Page 15 Initials __________ ATTACHMENTS Item 33. Documents Attached to this Financial Statement List all documents that are being submitted with this financial statement. Item No. Document Relates To Description of Document ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ ___________________ ______________________________________________________________________________ I am submitting this financial statement with the understanding that it may affect action by the Federal Trade Commission or a federal court. I have used my best efforts to obtain the information requested in this statement. The responses I have provided to the items above are true and contain all the requested facts and information of which I have notice or knowledge. I have provided all requested documents in my custody, possession, or control. I know of the penalties for false statements under 18 U.S.C. § 1001, 18 U.S.C. § 1621, and 18 U.S.C. § 1623 (five years imprisonment and/or fines). I certify under penalty of perjury under the laws of the United States that the foregoing is true and correct. Executed on: ______________________________ (Date) Page 16 _____________________________________________________ Signature Initials __________ FEDERAL TRADE COMMISSION FINANCIAL STATEMENT OF CORPORATE DEFENDANT Instructions: 1. Complete all items. Enter “None” or "N/A" (“Not Applicable”) where appropriate. If you cannot fully answer a question, explain why. 2. The font size within each field will adjust automatically as you type to accommodate longer responses. 3. In completing this financial statement, “the corporation” refers not only to this corporation but also to each of its predecessors that are not named defendants in this action. 4. When an Item asks for information about assets or liabilities “held by the corporation,” include ALL such assets and liabilities, located within the United States or elsewhere, held by the corporation or held by others for the benefit of the corporation. 5. Attach continuation pages as needed. On the financial statement, state next to the Item number that the Item is being continued. On the continuation page(s), identify the Item number being continued. 6. Type or print legibly. 7. An officer of the corporation must sign and date the completed financial statement on the last page and initial each page in the space provided in the lower right corner. Penalty for False Information: Federal law provides that any person may be imprisoned for not more than five years, fined, or both, if such person: (1) “in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry” (18 U.S.C. § 1001); (2) “in any . . . statement under penalty of perjury as permitted under section 1746 of title 28, United States Code, willfully subscribes as true any material matter which he does not believe to be true” (18 U.S.C. § 1621); or (3) “in any (. . . statement under penalty of perjury as permitted under section 1746 of title 28, United States Code) in any proceeding before or ancillary to any court or grand jury of the United States knowingly makes any false material declaration or makes or uses any other information . . . knowing the same to contain any false material declaration.” (18 U.S.C. § 1623) For a felony conviction under the provisions cited above, federal law provides that the fine may be not more than the greater of (i) $250,000 for an individual or $500,000 for a corporation, or (ii) if the felony results in pecuniary gain to any person or pecuniary loss to any person other than the defendant, the greater of twice the gross gain or twice the gross loss. 18 U.S.C. § 3571. ATTACHMENT B BACKGROUND INFORMATION Item 1. General Information Corporation’s Full Name ___________________________________________________________________________ Primary Business Address ______________________________________________________ From (Date) _________ Telephone No. _____________________________ Fax No. _____________________________ E-Mail Address________________________ Internet Home Page________________________ All other current addresses & previous addresses for past five years, including post office boxes and mail drops: Address____________________________________________________________ From/Until____________________ Address____________________________________________________________ From/Until____________________ Address____________________________________________________________ From/Until____________________ All predecessor companies for past five years: Name & Address _________________________________________________________ From/Until ______________ Name & Address _________________________________________________________ From/Until ______________ Name & Address _________________________________________________________ From/Until ______________ Item 2. Legal Information Federal Taxpayer ID No. _________________________ State & Date of Incorporation _________________________ State Tax ID No. ____________________ State ________________ Profit or Not For Profit _____________________ Corporation’s Present Status: Active ________________ Inactive _______________ Dissolved __________________ If Dissolved: Date dissolved _________________________ By Whom ______________________________________ Reasons _________________________________________________________________________________________ Fiscal Year-End (Mo./Day) ________________ Corporation’s Business Activities _____________________________ Item 3. Registered Agent Name of Registered Agent __________________________________________________________________________ Address __________________________________________________________ Telephone No. __________________ Page 2 Initials __________ Item 4. Principal Stockholders List all persons and entities that own at least 5% of the corporation’s stock. % Owned Name & Address _________________________________________________________________________________ ______________ _________________________________________________________________________________ ______________ _________________________________________________________________________________ ______________ _________________________________________________________________________________ ______________ Item 5. Board Members List all members of the corporation’s Board of Directors. Name & Address % Owned Term (From/Until) ____________________________________________________________________ __________ _________________ ____________________________________________________________________ __________ _________________ ____________________________________________________________________ __________ _________________ ____________________________________________________________________ __________ _________________ ____________________________________________________________________ __________ _________________ Item 6. Officers List all of the corporation’s officers, including de facto officers (individuals with significant management responsibility whose titles do not reflect the nature of their positions). Name & Address % Owned _______________________________________________________________________________ ________________ _______________________________________________________________________________ ________________ _______________________________________________________________________________ ________________ _______________________________________________________________________________ ________________ _______________________________________________________________________________ ________________ Page 3 Initials __________ Item 7. Businesses Related to the Corporation List all corporations, partnerships, and other business entities in which this corporation has an ownership interest. Name & Address Business Activities % Owned ___________________________________________________________________ ___________________ _________ ___________________________________________________________________ ___________________ _________ ___________________________________________________________________ ___________________ _________ State which of these businesses, if any, has ever transacted business with the corporation _______________________ ________________________________________________________________________________________________ Item 8. Businesses Related to Individuals List all corporations, partnerships, and other business entities in which the corporation’s principal stockholders, board members, or officers (i.e., the individuals listed in Items 4 - 6 above) have an ownership interest. Business Name & Address Individual’s Name Business Activities % Owned __________________ __________________________________________________ __________________ ________ __________________ __________________________________________________ __________________ ________ __________________ __________________________________________________ __________________ ________ State which of these businesses, if any, have ever transacted business with the corporation _______________________ ________________________________________________________________________________________________ Item 9. Related Individuals List all related individuals with whom the corporation has had any business transactions during the three previous fiscal years and current fiscal year-to-date. A “related individual” is a spouse, sibling, parent, or child of the principal stockholders, board members, and officers (i.e., the individuals listed in Items 4 - 6 above). Name and Address Relationship Business Activities _________________________________________________________ _________________ ______________________ _________________________________________________________ _________________ ______________________ _________________________________________________________ _________________ ______________________ Page 4 Initials __________ Item 10. Outside Accountants List all outside accountants retained by the corporation during the last three years. Firm Name Name Address CPA/PA? ____________________ ______________________ ________________________________________ ____________ ____________________ ______________________ ________________________________________ ____________ ____________________ ______________________ ________________________________________ ____________ ____________________ ______________________ ________________________________________ ____________ ____________________ ______________________ ________________________________________ ____________ Item 11. Corporation’s Recordkeeping List all individuals within the corporation with responsibility for keeping the corporation’s financial books and records for the last three years. Position(s) Held Name, Address, & Telephone Number ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ Item 12. Attorneys List all attorneys retained by the corporation during the last three years. Name Firm Name Address ____________________ ___________________________ ________________________________________________ ____________________ ___________________________ ________________________________________________ ____________________ ___________________________ ________________________________________________ ____________________ ___________________________ ________________________________________________ ____________________ ___________________________ ________________________________________________ Page 5 Initials __________ Item 13. Pending Lawsuits Filed by the Corporation List all pending lawsuits that have been filed by the corporation in court or before an administrative agency. (List lawsuits that resulted in final judgments or settlements in favor of the corporation in Item 25). Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Page 6 Initials __________ Item 14. Current Lawsuits Filed Against the Corporation List all pending lawsuits that have been filed against the corporation in court or before an administrative agency. (List lawsuits that resulted in final judgments, settlements, or orders in Items 26 - 27). Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address___________________________________________________________________________ Docket No._________________ Relief Requested____________________ Nature of Lawsuit____________________ ____________________________________ Status______________________________________________________ Page 7 Initials __________ Item 15. Bankruptcy Information List all state insolvency and federal bankruptcy proceedings involving the corporation. Commencement Date _________________ Termination Date _________________ Docket No. __________________ If State Court: Court & County _______________________ If Federal Court: District __________________________ Disposition ______________________________________________________________________________________ Item 16. Safe Deposit Boxes List all safe deposit boxes, located within the United States or elsewhere, held by the corporation, or held by others for the benefit of the corporation. On a separate page, describe the contents of each box. Owner’s Name Name & Address of Depository Institution Box No. __________________ ___________________________________________________________________ __________ __________________ ___________________________________________________________________ __________ __________________ ___________________________________________________________________ __________ __________________ ___________________________________________________________________ __________ __________________ ___________________________________________________________________ __________ FINANCIAL INFORMATION REMINDER: When an Item asks for information about assets or liabilities “held by the corporation,” include ALL such assets and liabilities, located within the United States or elsewhere, held by the corporation or held by others for the benefit of the corporation. Item 17. Tax Returns List all federal and state corporate tax returns filed for the last three complete fiscal years. Attach copies of all returns. Federal/ State/Both Tax Year Tax Due Federal Tax Paid Federal Tax Due State Tax Paid State Preparer’s Name ___________ __________ $_________ $_________ $__________ $__________ ______________________________ ___________ __________ $_________ $_________ $__________ $__________ ______________________________ ___________ __________ $_________ $_________ $__________ $__________ ______________________________ Page 8 Initials __________ Item 18. Financial Statements List all financial statements that were prepared for the corporation’s last three complete fiscal years and for the current fiscal year-to-date. Attach copies of all statements, providing audited statements if available. Year Balance Sheet Profit & Loss Statement Cash Flow Statement Changes in Owner’s Equity Audited? _________ _____________ ______________________ __________________ _______________________ ________ _________ _____________ ______________________ __________________ _______________________ ________ _________ _____________ ______________________ __________________ _______________________ ________ _________ _____________ ______________________ __________________ _______________________ ________ Item 19. Financial Summary For each of the last three complete fiscal years and for the current fiscal year-to-date for which the corporation has not provided a profit and loss statement in accordance with Item 18 above, provide the following summary financial information. Current Year-to-Date 1 Year Ago 2 Years Ago 3 Years Ago Gross Revenue $_________________ $_______________ $_______________ $_______________ Expenses $_________________ $_______________ $_______________ $_______________ Net Profit After Taxes $_________________ $_______________ $_______________ $_______________ Payables $_________________ Receivables $_________________ Item 20. Cash, Bank, and Money Market Accounts List cash and all bank and money market accounts, including but not limited to, checking accounts, savings accounts, and certificates of deposit, held by the corporation. The term “cash” includes currency and uncashed checks. Cash on Hand $_________________________ Cash Held for the Corporation’s Benefit $_______________________ Current Balance _____________________________________ _______________________________ ______________ $___________ Name & Address of Financial Institution Signator(s) on Account Account No. _____________________________________ _______________________________ ______________ $___________ _____________________________________ _______________________________ ______________ $___________ _____________________________________ _______________________________ ______________ $___________ Page 9 Initials __________ Item 21. Government Obligations and Publicly Traded Securities List all U.S. Government obligations, including but not limited to, savings bonds, treasury bills, or treasury notes, held by the corporation. Also list all publicly traded securities, including but not limited to, stocks, stock options, registered and bearer bonds, state and municipal bonds, and mutual funds, held by the corporation. Issuer _________________________________ Type of Security/Obligation __________________________________ No. of Units Owned __________ Current Fair Market Value $__________________ Maturity Date _______________ Issuer _________________________________ Type of Security/Obligation __________________________________ No. of Units Owned __________ Current Fair Market Value $__________________ Maturity Date _______________ Item 22. Real Estate List all real estate, including leaseholds in excess of five years, held by the corporation. Type of Property________________________________ Property’s Location__________________________________ Name(s) on Title and Ownership Percentages___________________________________________________________ Current Value $____________________ Loan or Account No. __________________________ Lender’s Name and Address_________________________________________________________________________ Current Balance On First Mortgage $_______________ Monthly Payment $______________ Other Loan(s) (describe)____________________________________________ Current Balance $_________________ Monthly Payment $__________________ Rental Unit?_________________ Monthly Rent Received $_____________ Type of Property________________________________ Property’s Location__________________________________ Name(s) on Title and Ownership Percentages___________________________________________________________ Current Value $____________________ Loan or Account No. __________________________ Lender’s Name and Address_________________________________________________________________________ Current Balance On First Mortgage $_______________ Monthly Payment $______________ Other Loan(s) (describe)____________________________________________ Current Balance $_________________ Monthly Payment $__________________ Rental Unit?_________________ Monthly Rent Received $_____________ Page 10 Initials __________ Item 23. Other Assets List all other property, by category, with an estimated value of $2,500 or more, held by the corporation, including but not limited to, inventory, machinery, equipment, furniture, vehicles, customer lists, computer software, patents, and other intellectual property. Property Category Property Location Acquisition Cost Current Value ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ ____________________________ _____________________________________________ $__________ $_________ Item 24. Trusts and Escrows List all persons and other entities holding funds or other assets that are in escrow or in trust for the corporation. Trustee or Escrow Agent’s Name & Address Description and Location of Assets Present Market Value of Assets ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ ______________________________________ _______________________________________ $_________________ Page 11 Initials __________ Item 25. Monetary Judgments and Settlements Owed To the Corporation List all monetary judgments and settlements, recorded and unrecorded, owed to the corporation. Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Item 26. Monetary Judgments and Settlements Owed By the Corporation List all monetary judgments and settlements, recorded and unrecorded, owed by the corporation. Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit_______________________________________ Date______________ Amount $______________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Opposing Party’s Name & Address___________________________________________________________________ Court’s Name & Address____________________________________________________ Docket No._____________ Nature of Lawsuit______________________________ Date of Judgment________________ Amount $____________ Page 12 Initials __________ Item 27. Government Orders and Settlements List all existing orders and settlements between the corporation and any federal or state government entities. Name of Agency ___________________________________________ Contact Person __________________________ Address _____________________________________________________________ Telephone No. _______________ Agreement Date ______________ Nature of Agreement __________________________________________________ Item 28. Credit Cards List all of the corporation’s credit cards and store charge accounts and the individuals authorized to use them. Name of Credit Card or Store Names of Authorized Users and Positions Held __________________________________________ _____________________________________________________ __________________________________________ _____________________________________________________ __________________________________________ _____________________________________________________ __________________________________________ _____________________________________________________ __________________________________________ _____________________________________________________ Item 29. Compensation of Employees List all compensation and other benefits received from the corporation by the five most highly compensated employees, independent contractors, and consultants (other than those individuals listed in Items 5 and 6 above), for the two previous fiscal years and current fiscal year-to-date. “Compensation” includes, but is not limited to, salaries, commissions, consulting fees, bonuses, dividends, distributions, royalties, pensions, and profit sharing plans. “Other benefits” include, but are not limited to, loans, loan payments, rent, car payments, and insurance premiums, whether paid directly to the individuals, or paid to others on their behalf. Name/Position Current Fiscal Year-to-Date 1 Year Ago 2 Years Ago Compensation or Type of Benefits _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ Page 13 Initials __________ Item 30. Compensation of Board Members and Officers List all compensation and other benefits received from the corporation by each person listed in Items 5 and 6, for the current fiscal year-to-date and the two previous fiscal years. “Compensation” includes, but is not limited to, salaries, commissions, consulting fees, dividends, distributions, royalties, pensions, and profit sharing plans. “Other benefits” include, but are not limited to, loans, loan payments, rent, car payments, and insurance premiums, whether paid directly to the individuals, or paid to others on their behalf. Name/Position Current Fiscal Year-to-Date 1 Year Ago 2 Years Ago Compensation or Type of Benefits _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ _____________________________ $____________ $___________ $____________ ___________________________ Item 31. Transfers of Assets Including Cash and Property List all transfers of assets over $2,500 made by the corporation, other than in the ordinary course of business, during the previous three years, by loan, gift, sale, or other transfer. Transferee’s Name, Address, & Relationship Property Transferred Aggregate Value Transfer Date Type of Transfer (e.g., Loan, Gift) ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ ______________________________________ ________________ $____________ __________ _________________ Page 14 Initials __________ Item 32. Documents Attached to the Financial Statement List all documents that are being submitted with the financial statement. Item No. Document Relates To Description of Document ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ ___________________ ____________________________________________________________________________ I am submitting this financial statement with the understanding that it may affect action by the Federal Trade Commission or a federal court. I have used my best efforts to obtain the information requested in this statement. The responses I have provided to the items above are true and contain all the requested facts and information of which I have notice or knowledge. I have provided all requested documents in my custody, possession, or control. I know of the penalties for false statements under 18 U.S.C. § 1001, 18 U.S.C. § 1621, and 18 U.S.C. § 1623 (five years imprisonment and/or fines). I certify under penalty of perjury under the laws of the United States that the foregoing is true and correct. Executed on: ______________________________ (Date) _____________________________________________________ Signature _____________________________________________________ Corporate Position Page 15 Initials __________

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