7373                          VOID              CORRECTED
CORPORATION'S name, street address, city or town, state or province,     1   Date of sale or exchange OMB No. 1545-1814            Changes in 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                   Corporate 
                                                                         2   Aggregate amount rec'd*  2019                         Control and 
                                                                         $                            Form 1099-CAP            Capital Structure
                                                                         3   No. of shares exchanged  4  Classes of stock exchanged
                                                                                                                                   Copy A
CORPORATION'S TIN                   SHAREHOLDER'S TIN                                                                              For 
                                                                                                                                   Internal Revenue 
SHAREHOLDER'S name                                                                                                                 Service Center
                                                                                                                                   File with Form 1096. 
                                                                                                                                   For Paperwork 
Street address (including apt. no.)                                                                                                Reduction Act 
                                                                                                                                   Notice, see the 
                                                                         5                                                         2019 General 
City or town, state or province, country, and ZIP or foreign postal code                                                           Instructions for 
                                                                                                                                   Certain Information 
Account number (see instructions)                                          * The shareholder cannot claim a loss based on the      Returns.
                                                                           amount in box 2.
Form  1099-CAP                      Cat. No. 35115M                      www.irs.gov/Form1099CAP       Department of the Treasury - Internal Revenue Service
Do  Not  Cut  or  Separate  Forms  on  This  Page  —  Do  Not  Cut or  Separate  Forms  on  This  Page

                                                      CORRECTED (if checked)
CORPORATION'S name, street address, city or town, state or province,     1   Date of sale or exchange OMB No. 1545-1814            Changes in 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                   Corporate 
                                                                         2   Aggregate amount rec'd*  2019                         Control and 
                                                                         $                            Form 1099-CAP     Capital Structure
                                                                         3   No. of shares exchanged  4  Classes of stock exchanged
                                                                                                                                   Copy B
CORPORATION'S TIN                   SHAREHOLDER'S TIN                                                                              For Shareholder
                                                                                                                                   This is important tax 
SHAREHOLDER'S name                                                                                                                 information and is being 
                                                                                                                                   furnished to the IRS. If 
                                                                                                                                   you are required to file a 
                                                                                                                                   return, a negligence 
Street address (including apt. no.)                                                                                                penalty or other 
                                                                                                                                   sanction may be 
                                                                         5                                                         imposed on you if 
City or town, state or province, country, and ZIP or foreign postal code                                                           taxable income results 
                                                                                                                                   from this transaction 
                                                                                                                                   and the IRS determines 
Account number (see instructions)                                                                                                  that it has not been 
                                                                           * You cannot claim a loss based on the amount in box 2. reported.

Form  1099-CAP     (keep for your records)                               www.irs.gov/Form1099CAP       Department of the Treasury - Internal Revenue Service

Instructions for Shareholder
A corporation in which you own stock that has had a        Account number. May show an account or other 
change in control or a substantial change in capital       unique number the payer corporation assigned to 
structure must send you this statement by January 31 of    distinguish your account.
the year following the calendar year of the change. You    Box 1. Shows the date the stock was exchanged for 
have received this statement because the corporation       cash, stock, or other property.
has reasonably determined that you may be required to      Box 2. Shows the aggregate amount of any cash and 
recognize gain from the receipt of cash, stock, or other   the fair market value of any stock or other property 
property that was exchanged for the corporation’s          received by you in the exchange for the stock you held.
stock. Report any gain from the exchange on Form 
8949. However, you cannot claim a (loss) on Form 8949      Box 3. Shows the number of shares of the corporation’s 
as a result of this exchange. See Pub. 550, chapter 4,     stock that you held which were exchanged in the 
for additional information.                                transaction.
Shareholder's taxpayer identification number (TIN).        Box 4. Shows the class or classes of stock that were 
For your protection, this form may show only the last      exchanged.
four digits of your TIN (social security number (SSN),     Future developments. For the latest information about 
individual taxpayer identification number (ITIN), adoption developments related to Form 1099-CAP and its 
taxpayer identification number (ATIN), or employer         instructions, such as legislation enacted after they were 
identification number (EIN)). However, the issuer has      published, go to www.irs.gov/Form1099CAP.
reported your complete TIN to the IRS.

                                    VOID              CORRECTED
CORPORATION'S name, street address, city or town, state or province,    1   Date of sale or exchange OMB No. 1545-1814            Changes in 
country, ZIP or foreign postal code, and telephone no.
                                                                                                                                  Corporate 
                                                                        2   Aggregate amount rec'd*  2019                         Control and 
                                                                        $                            Form 1099-CAP            Capital Structure
                                                                        3   No. of shares exchanged  4  Classes of stock exchanged
                                                                                                                                  Copy C
CORPORATION'S TIN                   SHAREHOLDER'S TIN                                                                             For Corporation

SHAREHOLDER'S name                                                                                                                For Paperwork 
                                                                                                                                  Reduction Act 
                                                                                                                                  Notice, see the 
                                                                                                                                  2019 General 
Street address (including apt. no.)                                                                                               Instructions for 
                                                                        5                                                         Certain Information 
                                                                                                                                  Returns.
City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)                                         * The shareholder cannot claim a loss based on the  
                                                                          amount in box 2.
Form  1099-CAP                      www.irs.gov/Form1099CAP                                           Department of the Treasury - Internal Revenue Service

Instructions for Corporation
To complete Form 1099-CAP, use:                          File Copy A of this form with the IRS by          
• The 2019 General Instructions for Certain Information  February 28, 2020. If you file electronically, the due date 
Returns, and                                             is March 31, 2020. To file electronically, you must have 
• The 2019 Instructions for Form 1099-CAP.               software that generates a file according to the 
                                                         specifications in Pub. 1220.
To get or to order these instructions, go to 
www.irs.gov/Form1099CAP.                                 Need help? If you have questions about reporting on 
                                                         Form 1099-CAP, call the information reporting customer 
Due dates. Generally, furnish Copy B of this form to the 
                                                         service site toll free at 866-455-7438 or 304-263-8700 
shareholder by January 31, 2020. However, if the 
                                                         (not toll free). Persons with a hearing or speech 
recipient is a clearing organization, furnish Copy B by 
                                                         disability with access to TTY/TDD equipment can call 
January 6, 2020.
                                                         304-579-4827 (not toll free).