Form 5: Annual Statement ofBeneficial Ownership of Securities

• Legal Form Number: FDIC 6800/05
• Section: Federal Deposit Insurance Corporation

FORM 5

Federal Deposit Insurance Corporation Washington, D.C. 20429 ; ANNUAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 ; (PLEASE PRINT OR TYPE ALL RESPONSES)

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Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instruction 1(b). Form 3 holdings reported. Form 4 transactions reported.

1. Name of Reporting Person (Last, First, Middle) *

2. Issuer Name and Ticker or Trading Symbol

5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

Director

10% Owner

Officer (Give title below)

Other (Specify below)

Street Address

3. Statement for Issuer’s Fiscal Year Ended (Month/Day/Year)

4. If Amendment, Date Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check applicable box)

City

State

ZIP Code

Form filed by One Reporting Person

Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security (Instr. 3)

2. Transaction Date Month/Day/Year)

2A. Deemed Execution Date, if any (Month/ Day/ Year)

3. Transaction Code (Instr. 8)

4. Securities Acquired (A) or Disposed of (D) (Instrs. 3, 4, and 5)

5. Amount of Securities Beneficially Owned at End of Bank's Fiscal Year (Instrs. 3. and 4.)

6. Ownership Form Direct (D) Indirect(I) or (Instr. 4)

7. Nature of Indirect Beneficial Ownership (Instr. 4)

Amount

(A) or (D)

Price

FDIC 6800/05 (6-20) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Continue on Page 2)

*If the form is filed by more than one reporting person, see Instruction 4(b)(v) Page       of      .

FORM 5 (continued)

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security (Instr. 3)

2. Con- version or Ex- ercise Price of De- rivative Secu- rity

3. Trans- action Date (Month/ Day/ Year)

3A. Deem- ed Execu- tion Date, if any (Month/ Day/ Year)

4. Trans- action Code (Instr. 8)

5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instrs. 3, 4, and 5)

6. Date Exercisable and Expiration Date (Month/Day/Year)

7. Title and Amount of Underlying Securities (Instrs. 3 and 4)

8. Price of De- rivative Security (Instr. 5)

9. Number of Derivative Securities Beneficially Owned at End of Issuer’s Fiscal Year (Instr. 4)

10. Owner- ship Form of Deriva- tive Secur- ities: Direct (D) or Indirect (I) (Instr.4)

11. Nature of Indirect Beneficial Owner- ship (Instr. 4)

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

...