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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | Persons who 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. | SEC 2270 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Fisher Cynthia A 186 PARK STREET NEWTON, MA 02458 |
 X |  |  |  |
Kathleen H. Wade under POA for the benefit of Cynthia A. Fisher | 01/24/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | This transaction involved the gift of securities from the Reporting Person's spouse to an LLC managed by the Reporting Person and owned by Trusts established for the benefit of the Reporting Person's children and the Reporting Person's spouse's children. The Reporting Person is the Trustee or Co-Trustee for each Trust. |
(2) | The Reporting Person's May 23, 2012 Form 3 filing over-reported the amount of beneficially-owned securities held by the Reporting Person as Trustee in Trust for children as 5,064 shares. The correct amount at that time and as of the filing date is 2,532 shares. |
(3) | The shares are held by West Summit Grand LLC, a limited liability company managed by the Reporting Person. The Reporting Person expressly disclaims beneficial ownership of the securities except to the extent of her pecuniary interest therein. |