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FORM BCA 14.30 (rev.  Dec. 2014)
CUMULATIVE REPORT OF CHANGES IN 
ISSUED SHARES AND PAID-IN CAPITAL
Business Corporation Act
Department of Business Services
501 S. Second   St., Rm. 350
Springfield, IL 62756
217-782-1837
www.ilsos.gov
Payment must be made     by check or moneyFile #: _____________________ 
order payable   to Secretary of State.

Franchise Tax: $ ________________ Penalty/Interest:$5 $ _______________  Filing fee:Total $ ________________ Approved: __________
                   ________ Type or Print clearly in black ink ________ Do not write above this line ________

1. Corporate Name: ________________________________________________________________________________
2. State or Country of Incorporation: ___________________________________________________________________
3. Authorized and Issued Shares as last reported (In any document other than an annual report.):
       Class                    Series      Par Value            Number Authorized                                   Number Issued
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
4. Paid-in Capital as last reported (In any document other than an annual report.): $ _____________________________
5. Current Reporting Period Transactions (See Note 1 on back.):
   • List the total issuances and exchanges of shares by class not previously reported to the Secretary of State. Also,
      give the value of the entire consideration received (less expenses paid or incurred in connection with such issuances)
      and added or transferred to paid-in capital for or on account of such shares.
   • List the total amount added or transferred to paid-in capital without the issuance of shares (contributions).
   • List the total of all cancellations of shares by class not previously reported to the Secretary of State and the cost to
      paid-in capital for acquiring such shares.
   • List the total amount subtracted from paid-in capital without a cancellation of shares, but as permitted by Section 9.20
      of the Illinois Business Corporation Act (reductions).
                         Class of                                         Number of                              Consideration
                                              Shares                  Series                  Par Value                        Shares                                     Received/Cost
________________________________________________________________________________________________
Issuance or                                                                                               $
Contributions:                                                                                         $
                                                                                                      $
                                                                                                      $

Cancellations                                                                                          $ (                                                                             )
or Reductions:                                                                                        $ (                                                                              )
(State reason for reduction if no shares were cancelled. See Note 6 on back.)                          $ (                                                                             ) 
                       Cumulative Change (Enter on line 6a below. See Note 2 on back.):    $

6. Franchise Tax and Fees (No additional franchise tax is due when cumulative change is negative amount.):
   a. Cumulative Change ......................................................................    a.
   b. Applicable Allocation Factor (See Note 3 on back.) .....................    b.
   c. Taxable Illinois Capital (Multiply line a by line b.) .........................    c.
   d. Multiply line c by .0015 (Round to nearest cent.) .........................    d.
   e. Additional Franchise Tax (Enter amount from line d.) .........................................................    e.
   f. If Cumulative Report is late, multiply line e by .10 (penalty) ...............................................    f.
   g. If Additional Franchise Tax is late, multiply line e by .02 for each month late
      or part thereof (interest) (minimum $1)................................................................................    g.
   h. FILING FEE ($5)..................................................................................................................    h.                                              5.00
   i. Total Amount Due (Add line e + line f + line g + line h.)......................................................    i.
                                         COMPLETE BOTH SIDES OF THIS REPORT.
                                      Printed by authority of the State of Illinois. January 2015 - 1 - C 284.13

7. Transactions occurring during previous reporting period(s) and not reported to the Secretary of State (See Note 4 below.):
  The Secretary of State will compute fees, taxes and penalties resulting from the following transactions.)
                                               Class of                                                                              Number of                           Consideration
                                 Date                  Shares                    Series                Par Value                   Shares                             Received/Cost
________________________________________________________________________________________________
Issuance or                                                                                                                            $
Contributions:                                                                                                                        $
                                                                                                                                              $
                                                                                                                                              $

Cancellations                                                                                                                         $ (                                        )
or Reductions:                                                                                                                       $ (                                        )
(State reason for reduction if no shares were cancelled. See Note 6 below.)                      $ (                                        )      

                                               ITEMS 8 AND 9 MUST BE COMPLETED.

8. Authorized and Issued Shares after changes: 
          Class                              Series                             Par Value                              Number Authorized                          Number Issued
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

9. Paid-In Capital after changes: $ ______________________________
  (“Paid-In Capital” replaces the terms Stated Capital and Paid-In Surplus and is equal to the total of these accounts.)

                                                             ITEM 10 MUST BE SIGNED.
10. The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under
  penalties of perjury, that the facts stated herein are true and correct.

  Dated _______________________________ ,  _____    ________________________________________________ 
                                   Month  Day                                     Year                                                Exact Name of Corporation

          ______________________________________
                            Any Authorized Officer’s Signature

          ______________________________________
                               Name and Title (type or print)

                                                                NOTES
1. “Current reporting period” for a corporation that has not established an extended filing month means the 12-month period ending with
  the last day of the third month prior to its anniversary month in the current year. In the case of a cor poration that has established an
  extended filing month, the “current reporting period” refers to the 12-month period  ending with the corporation’s most recent fiscal
  year end.
2. “Cumulative  change”  means  the  difference  arrived  at  by  subtracting  all  reductions  as  permitted  by  Section  9.20  of  the  Illinois
  Business Corporation Act in paid-in capital (if any) from all increases in paid-in capital (if any). However, a net reduction in paid-in
  capital reported on Form BCA 14.30 filed after the statutory due date does not reduce the basis for the annual franchise tax until the
  subsequent year.
3. “Applicable allocation factor” means the allocation factor established at the time of filing the Annual Report for the previous year.
  However, if no Annual Report was filed for the previous year, the applicable allocation factor will be that factor established on the
  Articles of Incorporation for a domestic corporation or on the Application for Authority for a foreign corporation.
4. “Previous reporting period” means any time period occurring prior to the current reporting period.
5. If there have been changes reported in item(s) 5 or 7 on Form BCA 14.30, it must be submitted with the Annual Report in the
  same envelope.
6. Pursuant to Section 9.20 of the Illinois Business Corporation Act, paid-in capital may be reduced without cancellation of shares only
  through dividends paid on preferred shares, distributions as liquidating dividends or pursuant to an approved reorganization in bank-
  ruptcy that specifically directs the reduction to be effected.