Enlarge image | Secretary of State Business Programs Division Business Entities 1500 11th Street, Sacramento, CA 95814 P.O. Box 944260, Sacramento, CA 94244-2600 Submission Cover Sheet For faster service, file online at bizfileOnline.sos.ca.gov . Instructions: • Complete and include this form with your paper submission. This information only will be used to communicate in writing about the submission, if needed. This form will be treated as correspondence and will not be made part of the filed document. • Make all checks or money orders payable to the Secretary of State. • In person submissions (excluding Statements of Information): $15 handling fee; do not include a $15 handling fee when submitting documents by mail. • Standard processing time for submissions to this office is approximately 5 business days from receipt. All submissions are reviewed in the date order of receipt with online submissions given priority. For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates. Optional Copy and Certification Fees: • If applicable, include optional certification fees with your submission. • For applicable certification fee information, refer to the instructions of the specific form you are submitting. Contact Person: (Please type or print legibly) First Name: Last Name: Phone (optional): Entity Information: (Please type or print legibly) Name: Entity Number (if applicable): Address: Comments Submission Cover Sheet (REV 03/2022) Clear Form Print Form |
Enlarge image | SI-PT Secretary of State Corporate Disclosure Statement (Domestic Stock and Foreign Corporations) Filing Fee – There is no fee for filing the Corporate Disclosure Statement. Certification Fee (Optional) – $5.00 This Space For Office Use Only 1. Corporate Name (Enter the exact name of the corporation as it is recorded with the California Secretary of State.) 2. Secretary of State Entity Number 3. Jurisdiction (Enter the state, foreign country or other place where the corporation is formed.) 4. Independent Auditor 4a. Name of the Independent Auditor that prepared the most recent auditor’s report. 4b. Description of other services, if any, performed by the Independent Auditor named in Item 4a. 4c. Name of the Independent Auditor employed by the corporation on the date of this statement, if different from Item 4a. 5. Board Diversity 5a. Check the applicable statement for the current calendar year (select only one box): The corporation has not moved its principal executive office either into California from another state or out of California into another state. The corporation has moved its principal executive office into California from another state. The corporation has moved its principal executive office out of California into another state. 5d. Number of directors from 5b. Total number of directors on the 5c. Number of female directors on the corporation’s current Board corporation’s current Board of underrepresented communities on the corporation's of Directors (select only one box): Directors (select only one box): current Board of Directors (select only one box): 9 or more 3 or more 3 or more 8 2 2 7 1 1 6 0 0 5 4 or fewer 6. Required Statutory Disclosures 6a. Has an order for relief been entered in a bankruptcy case with respect to the corporation during the Yes No preceding 10 years? 6b. Has the corporation or any of its subsidiaries been a party to, or any of their property been subject to, any material pending legal proceedings, as specified by Item 103, Part 229 of SEC Regulation S-K? If yes, Yes No attach a description. 6c. Has the corporation been found legally liable in any material legal proceeding during the preceding five Yes No years? If yes, attach a description. - CONTINUE ON NEXT PAGE - (Page 1 of 2) SI-PT (REV03/2022) 202 2California Secretary of State Clear Form Print Form bizfileOnline.sos.ca.gov |
Enlarge image | Corporate Disclosure Statement (Domestic Stock and Foreign Corporations) (Page 2 of 2) 7. Directors Names of Directors Compensation Shares Option Bankruptcy Fraud 1) Yes No Yes No 2) Yes No Yes No 3) Yes No Yes No 4) Yes No Yes No 5) Yes No Yes No 6) Yes No Yes No 7) Yes No Yes No 8) Yes No Yes No 9) Yes No Yes No 10) Yes No Yes No 11) Yes No Yes No 12) Yes No Yes No 13) Yes No Yes No 14) Yes No Yes No 15) Yes No Yes No 16) Yes No Yes No 8. Executive Officers 8a. Names of Executive Officers Compensation Shares Options Bankruptcy Fraud 1) Yes No Yes No 2) Yes No Yes No 3) Yes No Yes No 4) Yes No Yes No 5) Yes No Yes No 8b. Chief Executive Officer (if not named in 8a) Compensation Shares Options Bankruptcy Fraud Yes No Yes No 8c. Additional Executive Officers (if not named in 8a or 8b) 1) Bankruptcy Fraud 2) Bankruptcy Fraud 3) Bankruptcy Fraud 9. Loans to Members of the Board of Directors Names of Directors Description of Loan including Amount and Terms 1) 2) If additional space is needed, place the additional information on only one side of a standard letter-sized piece of paper (8 ½ x 11) clearly marked as an attachment to the Corporate Disclosure Statement and attach the extra page(s) to the completed Corporate Disclosure Statement. By submitting this Corporate Disclosure Statement to the Secretary of State, the corporation certifies the information contained herein, including any attachments, is true and correct. __________________________________________ _____________________________ ______________________ _________________ Type or Print Name of Person Completing the Form Signature Title Date SI-PT (REV 03/202 2) 202 2California Secretary of State Clear Form Print Form bizfileOnline.sos.ca.gov |