Filing Fee: $125.00
                                                                                                                                     Late Fee: $25.00
PC               The Commonwealth of Massachusetts
                                                           William Francis Galvin
                                                           Secretary of the Commonwealth
FPC              One Ashburton Place - Room 1717, Boston, Massachusetts 02108-1512

   FORM MUST BE TYPED                        Annual Report for Professional and  
                                             Foreign Professional Corporations
                 (General Laws Chapter 156A, Section 18 and Chapter 156D, Section 16.22)

(1)  Exact name of the corporation:  _______________________________________________________________________________________
(2)  Jurisdiction of incorporation: _________________________________________________________________________________________
(3)  Street address of the corporation’s registered office in the commonwealth: 
    _______________________________________________________________________________________________________________
	                                                          (number,	street,	city	or	town,	state,	zip	code)
(4)  Name of the registered agent at the registered office: _______________________________________________________________________
(5)  Street address of the corporation’s principal office: 
   _______________________________________________________________________________________________________________
	                                                          (number,	street,	city	or	town,	state,	zip	code)
(6)  Provide the names and addresses of the corporation’s board of directors, shareholders, and its president, treasurer, secretary, and if different, its 
  chief executive officer and chief financial officer.

                                             NAME                                       ADDRESS
  President: ________________________________________________________________________________________________________
  Treasurer: ________________________________________________________________________________________________________
  Secretary: ________________________________________________________________________________________________________
  Chief Executive Officer: _____________________________________________________________________________________________
  Chief Financial Officer: _____________________________________________________________________________________________
  Directors:  _______________________________________________________________________________________________________
    _______________________________________________________________________________________________________________
  Shareholders (with residential address):  _________________________________________________________________________________

(7)  Briefly describe the business of the corporation:
    _______________________________________________________________________________________________________________
(8-9) Capital stock of each class and series:

  CLASS OF STOCK TOTAL AUTHORIZED BY ARTICLES OF                                                          TOTAL ISSUED AND OUTSTANDING
                 ORGANIZATION OR AMENDMENTS                                                               Number of Shares
                                             Number of Shares

   COMMON

   PREFERRED

(10) Check if the stock of the corporation is publicly traded. 
(11) Report is filed for fiscal year ending:  ________________________ / ________________________ /_______________________________
	                                                     (month)	                  (day)	                    (year)
It is hereby certified, pursuant to G.L. Chapter 156A, Section 18, that the shareholders, and all the partners of a general partnership which is a share-
holder of the corporation are duly licensed to render one or more professional services for which the corporation was organized, or are professional 
corporations authorized to render such professional services, and that a copy of this report is being sent to the appropriate regulatory board.
 
Signed by:  __________________________________________________________________________________________________________
   Chairman of the board of directors          President         Other officer                              Court appointed fiduciary
on this ____________________________________ day of  _______________________________________________ ,  _________________ .

                                                                                                                                     c156as18c156ds1622 10/26/09