SEC 13H Form 13H

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United States Securities and Exchange Commission
FORM 13H
Large Trader Registration
Information Required of Large Traders Pursuant To Section 13(h) of the
Securities Exchange Act of 1934 and Rules Thereunder
[ ] INITIAL FILING: Date identifying transactions first effected (mm/dd/yyyy)________________________
Voluntary filing? [ ] no

[ ] yes

Date of voluntary filing _________________

[ ] ANNUAL FILING:
Calendar year ending _________
[ ] AMENDED FILING
[ ] INACTIVE STATUS: Date commencing Inactive Status (mm/dd/yyyy)____________________________
[ ] TERMINATION FILING: Effective date (mm/dd/yyyy)________________________________________
[ ] REACTIVATED STATUS: Date identifying transactions first effected, post-Inactive Status
(mm/dd/yyyy)_______________________________________________________

_________________________________________________________________________________________
Name of Large Trader Filing This Form
_____________________________________
LTID
____________________________________
Taxpayer Identification Number
________________________________________________________________________________________
Business Address of the Large Trader (Street, City, State, Zip, Country)
________________________________________________________________________________________
Mailing Address of the Large Trader (Street, City, State, Zip, Country)
Telephone No. (___) ___ - ____ Facsimile No. (___) ___ - ____ Email _____________________________
The Form and the schedules thereto must be submitted by a natural person who is authorized to make this submission
on behalf of the large trader.

SEC 2858 (11-11)

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 control number.

________________________________________________________________________________________
Name of Authorized Person (First, Middle Initial, Last)
________________________________________________________________________________________
Title of Authorized Person
________________________________________________________________________________________
Relationship to Large Trader
________________________________________________________________________________________
Business Address of Authorized Person (Street, City, State, Zip, Country)
Authorized Person’s Telephone No. (___) ___ - ____ Facsimile No. (___) ___ - ____
Authorized Person’s Email _____________________________
ATTENTION
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15
U.S.C. 78ff(a). Intentional misstatements or omissions of facts may result in civil fines and other sanctions pursuant
to the Securities Exchange Act of 1934.

The authorized person signing this form represents that all information contained in the form, schedules, and
continuation sheets is true, correct, and complete. It is understood that all information whether contained in the form,
schedules, or continuation sheets, is considered an integral part of this form and that any amendment represents that
all unamended information remains true, correct, and complete.

___________________________________________
Signature of Person Authorized to Submit this Form

SEC 2858 (11-11)

FORM 13H
INFORMATION REQUIRED OF ALL LARGE TRADERS
ITEM 1. BUSINESSES OF THE LARGE TRADER (check as many as applicable)
(a)
Businesses engaged in by the large trader and any of the large trader’s affiliates (check as many as
applicable)
[
[
[
[

] Broker or Dealer
] Government Securities Broker or Dealer
] Municipal Securities Broker or Dealer
] Investment Adviser
[ ] to Registered Investment Companies
[ ] to Hedge Funds or other Funds not registered
under the Investment Company Act
[ ] Futures Commission Merchant
[ ] Commodity Pool Operator

[
[
[
[
[
[

] Bank Holding Company
] Non-Bank Holding Company
] Bank
] Pension Trustee
] Non-Pension Trustee
] Insurance Company

[ ] Other (specify) __________________________

(b) Describe the nature of the business of the large trader including a description for each Securities Affiliate:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

ITEM 2. SECURITIES AND EXCHANGE COMMISSION FILINGS
Does the large trader or any of its Securities Affiliates file any other forms with the Commission?
[ ] Yes

[ ] No

If yes, specify the entity and the forms filed:
Entity

Form(s) Filed

CIK Number

_________________________________
_________________________________
_________________________________
_________________________________

______________
______________
______________
______________

____________
____________
____________
____________

ITEM 3. CFTC REGISTRATION AND FOREIGN REGULATORS

SEC 2858 (11-11)

(a)

Is the large trader or any of its affiliates registered with the Commodity Futures Trading Commission in any
capacity, including as a “registered trader” pursuant to sections 4i and 9 of the Commodity Exchange Act?
[ ] Yes

[ ] No

If yes, identify each entity and specify the registration number:

(b)

Entity

Registration Number

_________________________________
_________________________________
_________________________________
_________________________________

______________
______________
______________
______________

Is the large trader or any of its Securities Affiliates regulated by a foreign regulator?
[ ] Yes

[ ] No

If yes, identify each entity and its primary foreign regulator(s):
Entity
_________________________________
_________________________________
_________________________________
_________________________________

ITEM 4.

Primary Foreign Regulator
______________
______________
______________
______________

ORGANIZATION INFORMATION

(a) Attach an Organizational Chart that identifies the large trader, its parent company (if applicable), all Securities
Affiliates, and all entities identified in Item 3(a).
(b) Provide the following information on all Securities Affiliates and all entities identified in Item 3(a):
Entity

MPID(s)

_______________
_______________
_______________
_______________

________
________
________
________

Description of
Business
________________
________________
________________
________________

(c) If any affiliates file separately, identify each entity:

SEC 2858 (11-11)

Relationship to the
Large Trader
____________________
____________________
____________________
____________________

Entity
LTID
Suffix (if any)
________________________ ________________ ________________
________________________ ________________ ________________
________________________ ________________ ________________
(d) If any affiliates have been assigned an LTID suffix, identify such entities and their corresponding suffixes:
Entity
________________________
________________________
________________________

ITEM 5.

Suffix
________________
________________
________________

GOVERNANCE OF THE LARGE TRADER

(a) STATUS OF THE LARGE TRADER (check as many as apply)
[ ] Individual

[
[
[
[

[ ] Trustee
[ ] Limited Liability Company

] Partnership
] Limited Partnership
] Corporation
] Other (specify)________________________

(b) Complete the following for each general partner, and in the case of limited partnerships, each limited
partner that is the owner of more than a 10 percent financial interest in the accounts of the large trader:

Name

Status (check one for each)

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

[
[
[
[
[
[
[

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] General Partner
] General Partner
] General Partner
] General Partner
] General Partner
] General Partner
] General Partner

[
[
[
[
[
[
[

] Limited Partner
] Limited Partner
] Limited Partner
] Limited Partner
] Limited Partner
] Limited Partner
] Limited Partner

(c) Complete the following for each executive officer, director, or trustee of a large trader corporation or
trustee:
Name

Status (check one for each)

___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

[
[
[
[
[
[
[

] Executive Officer
] Executive Officer
] Executive Officer
] Executive Officer
] Executive Officer
] Executive Officer
] Executive Officer

[
[
[
[
[
[
[

] Director
] Director
] Director
] Director
] Director
] Director
] Director

[
[
[
[
[
[
[

] Trustee
] Trustee
] Trustee
] Trustee
] Trustee
] Trustee
] Trustee

(d) Jurisdiction in which the large trader entity is incorporated or organized:
________________________________________________________________________________
(state and country)

ITEM 6.

LIST OF BROKER-DEALERS AT WHICH THE LARGE TRADER OR ITS SECURITIES
AFFILIATES HAS AN ACCOUNT

Identify each broker-dealer at which the large trader or any of its Securities Affiliates has an account and the types of
services provided.
Name of Broker-Dealer
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

SEC 2858 (11-11)

[
[
[
[
[
[
[
[
[
[

] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker
] Prime Broker

[
[
[
[
[
[
[
[
[
[

] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker
] Executing Broker

[
[
[
[
[
[
[
[
[
[

] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker
] Clearing Broker

INSTRUCTIONS FOR FORM 13H

Submission of the Form. All submissions on Form 13H must be filed electronically through the
Commission’s Electronic Data Gathering, Analysis, and Retrieval (“EDGAR”) system. For
more information on filing through EDGAR, including instructions on how to obtain access to
and file electronically through EDGAR, see the EDGAR Filer Manual (available on the
Commission’s website at: http://www.sec.gov/info/edgar.shtml).

Definitions. The term “Securities Affiliate” means an affiliate of the large trader that exercises
investment discretion over NMS securities.

The term “affiliate” means any person that directly or indirectly controls, is under common
control with, or is controlled by the large trader.

The term “bank” means a national bank, state member bank of the Federal Reserve System, state
non-member bank, savings bank or association, credit union, or foreign bank.

The term “executive officer” means “policy-making officer” and otherwise is interpreted in
accordance with Rule 16a-1(f) under the Exchange Act.

Type of Filing. Indicate the type of Form 13H filing by checking the appropriate box at the top
of the cover page to Form 13H. All filings must include a valid digital signature.

SEC 2858 (11-11)

If the filing is an “Initial Filing,” indicate whether it is a voluntary filing. Voluntary filings are
submitted regardless of whether the aggregate number of transactions effected reached the
identifying activity level. For voluntary filings, the large trader must input the date on which it
submits its voluntary filing. For non-voluntary filings, the large trader must input the first date
on which the aggregate number of transactions effected reached the identifying activity level. A
non-voluntary “Initial Filing” must be submitted promptly after first effecting an aggregate
number of transactions equal to or greater than the identifying activity level.

If the filing is an “Annual Filing,” input the applicable calendar year.

An “Amended Filing” must be filed promptly following the end of the calendar quarter in which
any of the information contained in a Form 13H filing becomes inaccurate for any reason. A
large trader must file an “Amended Filing” when, for example, it changes its name, business
address, organization type (e.g., the large trader partnership reincorporates as a limited liability
company), or regulatory status (e.g., a hedge fund registers under the Investment Company Act),
or when its organizational chart changes in a manner relevant under Item 4(a) (e.g., it adds or
removes a Securities Affiliate).

If the filing is for “Inactive Status,” input the date that the large trader qualified for Inactive
Status. A large trader that has not effected aggregate transactions at any time during the previous
full calendar year in an aggregate amount equal to or greater than the identifying activity level
may file for Inactive Status. A large trader shall become inactive, and exempt from the filing

SEC 2858 (11-11)

and self-identification requirements upon filing for Inactive Status until the identifying activity
level is reached again.

If the filing is for “Reactivated Status,” indicate the date that the aggregate number of
transactions again reached or exceeded the identifying activity level. A filing for “Reactivated
Status” must be submitted promptly after effecting an aggregate number of transactions -subsequent to filing for “Inactive Status” -- equal to or greater than the identifying activity level.
In addition, a person may voluntarily elect to file for Reactivated Status prior to effecting
aggregate transactions that are equal to or greater than the identifying activity threshold. For
such voluntarily filings for “Reactivated Status,” the date of the voluntarily filing should be
entered rather than the date that the aggregate number of transactions again reached or exceeded
the identifying activity level.

If the filing is a “Termination Filing,” indicate the date on which the large trader ceased
operation. For example, when one large trader merges into another large trader, resulting in only
one surviving entity, the non-surviving large trader should specify the effective date of the
merger in its Termination Filing.

The Form also requires that a large trader input its Taxpayer Identification Number. The Form
further requires a large trader to input its business and mailing addresses. If those addresses are
the same, for the mailing address field, the large trader may either input its address again or input
“same.”

SEC 2858 (11-11)

The Form must be filed by a natural person who is authorized to submit it on behalf of the large
trader. The Commission may require the large trader to provide descriptive or clarifying
information about the information disclosed in the Form 13H, and will contact the Authorized
Person to provide such information.

To amend the name, phone number, and email address of the large trader, the large trader must
modify its EDGAR profile. Thereafter, changes will automatically be reflected in the Form 13H.

Item 1. Businesses of the Large Trader. Item 1 of the Form requires the large trader to specify,
from among the enumerated choices, the types of business engaged in by the large trader, by
checking as many as are applicable. Select “Other” to indicate a financial entity not included in
any of the enumerated categories and enter a short description for each such entity. In addition,
select “Other” if the large trader is an individual and input his or her occupation.

A large trader also is required, for itself and each of its Securities Affiliates, to describe the
nature of its operations, including a general description of its trading strategies. As an example,
the following would be an appropriate description: “Registered market-maker on [SRO],
authorized participant for a number of ETFs based on foreign indices, and proprietary trading
focusing on statistical arbitrage.”

Item 2. Securities and Exchange Commission Filings. The large trader must indicate whether it
or any of its Securities Affiliates files forms with the Commission. If it checks “Yes,” the large
SEC 2858 (11-11)

trader must input the names of the filing entities and, for each of them, input the form(s) they file
and the applicable CIK number.

Item 3. CFTC Registration and Foreign Regulators.
Item 3(a) requires the large trader to indicate whether it or any of its affiliates is registered with
the Commodity Futures Trading Commission in any capacity, including as a “registered trader”
pursuant to Sections 4i and 9 of the Commodity Exchange Act. If it checks “Yes,” the large
trader must input the name of each such entity and the registration number for each such entity.

Item 3(b) requires the large trader to indicate whether it or any of its Securities Affiliates is
regulated by a foreign regulator. Unlike Item 3(a), Item 3(b) applies only to the large trader and
its Securities Affiliates. If it checks “Yes,” the large trader must input the name of each such
regulated entity and its primary foreign regulator.

Item 4. Organization Information.
To comply with Item 4(a), the large trader must attach an organizational chart that depicts the
organization of the large trader. At a minimum, the chart must include the large trader, its parent
company (if applicable), all Securities Affiliates, and all entities identified in Item 3(a) of the
Form (if any) (collectively, “Item 4 Affiliates”).

Item 4(b) requires that a large trader provide information about the Item 4 Affiliates.
Specifically, the large trader must input the names of Item 4 Affiliates and, for each one of them,

SEC 2858 (11-11)

also input the following information: MPID(s); a brief description of its business, and its
relationship to the large trader.

Item 4(c) requires that a large trader identify all affiliates that file a separate Form 13H. Those
affiliates will have a different LTID.

Item 4(d) permits a large trader to assign LTID suffixes to one or more of its Securities
Affiliates. A suffix should have no more than three characters, all of which must be numbers; no
letters or special characters may be used. The same suffix may not be assigned to more than one
affiliate using the same LTID.

Item 5. Governance of the Large Trader.
Item 5 captures basic information about the large trader organization. All terms have the
meanings generally ascribed to them in the United States. If a foreign organization type has no
comparable corporate form, check “Other” and input the organization type. A large trader who
is a natural person must check “Individual.”

Item 6. List of Broker-Dealers at Which the Large Trader or Its Securities Affiliates Has an
Account.
Item 6 requires that a large trader identify each broker-dealer at which the large trader and any
Securities Affiliate has an account. Additionally, for each such broker-dealer, the large trader
must indicate the type(s) of services provided. The large trader must check as many of the
following that apply: Prime Broker; Executing Broker; Clearing Broker.

SEC 2858 (11-11)

Paperwork Reduction Act Disclosures. This collection of information has been reviewed by
OMB in accordance with the clearance requirements of 44 U.S.C. 3507. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid control number.
The Securities Exchange Act of 1934 authorizes the SEC to collect the information on Form
13H from large traders. See 15 U.S.C. 78m(h) and 78w(a). Responses to this collection are
mandatory, pursuant to Section 13(h) of the Exchange Act and Rule 13h-1 thereunder. The
Commission will treat as confidential the information collected pursuant to this Form in a manner consistent with Section 13(h)(7) of the Exchange Act, which sets forth a few limited exceptions. The applicable Privacy Act system of records is SEC-1 and the routine use of the records
are set forth at 40 FR 39255 (August 27, 1975) and 41 FR 5318 (February 5, 1976).
The Form is filed annually by every large trader within 45 days after the end of each full calendar year. Amendments to the Form must be filed promptly following the end of a calendar
quarter in the event that any of the information contained in a Form 13H filing becomes inaccurate for any reason.
The Commission will use the information collected pursuant to this Form 13H to identify significant market participants, i.e., large traders. Form 13H will allow the Commission to collect
background information about large traders, which will contribute to the agency’s ability to
conduct investigations and enforcement matters. The Commission estimates that the average
burden to respond to the Form 13H will be 18 hours. Any member of the public may direct to
the Commission any comments concerning the accuracy of this burden estimate and any suggestions for reducing this burden.

SEC 2858 (11-11)