A- D&O Application

    Organization Information

    List and describe all entities in which the Applicant’s ownership interest is 50% or greater or which the Applicant has management control:

    Entity 1

    Entity 2

    Entity 3

    Please provide a schedule of all entities in which the Applicant's ownership is 50% or greater or which the applicant has management control. Include the entity name, % owned, year started, description of operations, and entity type.

    †Entity Type: FP=For-Profit; GP=General Partnership; LP=Limited Partnership; LLC=Limited Liability Company

    In the next 12 months (or during the past 24 months) is the Applicant contemplating (or has the Applicant completed or been in the process of completing) the following:

    Any actual or proposed merger, acquisition, or divestiture?
    Any creation of a new business, subsidiary, or division?
    Any registration for a public offering or a private placement of securities?
    Any reorganization or arrangement with creditors under federal or state law?
    Any branch, location, facility, office, or subsidiary closings, consolidations, or layoffs?