Free Form 5 - Federal

FORM 5
Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). Form 3 Holdings Reported Form 4 Transactions Reported

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person*

2. Issuer Name and Ticker or Trading Symbol

(Last)

(First)

(Middle)

3. Statement for Issuer's Fiscal Year Ended (Month//Day/Year)

4. If Amendment, Date Original Filed (Month/Day/Year)

5. Relationship of Reporting Person(s) to Issuer (Check all applicable) _____ Director _____ 10% Owner _____ Officer (give _____ Other (specify title below) below)

____________________________
6. Individual or Joint/Group Reporting
(check applicable line)

(Street)

_____ Form Filed by One Reporting Person _____ Form Filed by More than One Reporting Person

(City) 1. Title of Security
(Instr. 3)

(State)

(Zip) 2. Transaction Date
(Month/ Day/ Year)

Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

2A.Deemed 3. Trans- 4. Securities Acquired (A) or action Disposed of (D) ExecuCode (Instr. 3, 4 and 5) tion (Instr. 8) Date, if any (Month/ (A) or Day/ Amount (D) Year)

6. Owner- 7. Nature of 5. Amount of ship Indirect Securities BenForm: DiBeneficial eficially Owned rect (D) Ownership at end of (Instr. 4) or IndiIssuer's Fiscal rect (I) Year Price
(Instr. 3 and 4) (Instr. 4)

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see instruction 4(b)(v). Potential persons who are to respond to the collection of informa-

tion contained in this form are not required to respond unless the form displays a currently valid OMB control number.

(Over) SEC 2270 (1-05)

FORM 5 (continued)

Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
Number 10. Owner- 11. Nature of of Deship Indirect rivative Form BenefiSecuriof Decial ties Benrivative Ownereficially Securiship (Instr. 4) Owned ties: at End of Direct Issuer's (D) or Fiscal Indirect Year (I)
(Instr. 4) (Instr. 4)

1. Title of Derivative 2. Conver- 3. Trans- 3A.Deemed 4. Transac- 5. Number of Deriva- 6. Date Exercis- 7. Title and Amount of Underly- 8. Price 9. Security sion or tion tive Securities Acable and Expiing Securities of action Execetion (Instr. 3) (Instr. 3 and 4) ExerDate, if Code quired (A) or Disration Date DeDate (Month/ (Instr. 8) (Month/Day/ cise any posed of (D) rivaYear) (Instr. 3, 4, and 5) Price of Day/ (Month/ tive Year) Day/ DerivaSecutive SeYear) rity (Instr. 5) curity Date Exercisable (A) (D) Expiration Date Amount or Number of Shares

Title

Explanation of Responses:

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.

** Signature of Reporting Person

Date

Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.

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