United States OMBAPPROVAL

Securities and Exchange Commission OMB Number: 3235-0410

Washington, D.C. 20549 Expires: November 30, 2025

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FORM 17-H

RISK ASSESSMENT REPORT FOR BROKERS AND DEALERS

PART I

Risk Assessment Reporting Requirements for Brokers and Dealers

NAME OF REPORTING BROKER-DEALER SEC FILE NO. 12

14 CRD NO. 16

ADDRESS OF PRINCIPAL PLACE OF BUSINESS

18

FIRM I.D. NO.

20 FILING TYPE: (Check Appropriate Boxes)

FOR PERIOD BEGINNING (MM/DD/YY) QUARTERLY ANNUAL AMENDED

22

AND ENDING (MM/DD/YY) 26 28 30

24

NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT

32

NAME(S) OF MATERIAL ASSOCIATED PERSONS CONTAINED IN THIS REPORT:

34 36

38 40

42

NAME OF ASSOCIATED BROKER-DEALER(S) NOT FILING (If applicable)

4_4 46

48 50

52

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 also result in civil fines and other sanctions pursuant to Section 

20 of the Securities Exchange Act of 1934.

The person signing this report represents hereby that all information contained in this Form is true, correct and 

complete. It is understood that all information in this Form is considered an integral part of this Form and that the 

submission of any amendment represents that all unamended information remains true, correct and complete as 

previously filed.

Pursuant to the Securities Exchange Act of 1934, the undersigned has caused this report to be signed on its behalf in 

the City of and State of on the day of , 20 .

(Name of Broker-Dealer)

(Signature and Title of Person Duly Authorized to Submit This Report)

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 2332 (1-10)
PAGE2

GENERAL INSTRUCTIONS

1. This Form consists of two parts. Part I consists of the organizational, policy and legal information required 

by paragraphs (a)(1)(i) through (iii) of section 240.17h-1T, together with the financial statements required by 

paragraphs (a)(1)(iv) and (v) of section 240.17h-1T. Part II contains line items for reporting the numerical and 

other data required by paragraphs (a)(1)(vi) through (x) of section 240.17h-1T.

2. Report as of the last day of the fiscal quarter. This Form is to be filed within 60 calendar days of the end of 

each fiscal quarter by brokers and dealers concerning each Material Associated Person (as defined in Temporary 

Rules 17h-1T and 17h-2T). The Form for the fourth fiscal quarter shall be filed within 60 calendar days of the 

end of the fiscal year. The cumulative year-end financial statements required by paragraphs (a)(1)(iv) and (v) 

of section 240.17h-1T may be filed separately within 105 calendar days of the end of the fiscal year.

3. In the event a broker or dealer is associated with one or more other registered brokers or dealers, each broker

or dealer is required to file a separate Form 17-H. The Commission may exempt from the filing requirements 

all brokers or dealers associated with a broker or dealer that has been designated a “Reporting Broker or Dealer.” 

The term “Reporting Broker or Dealer” shall have the meaning set forth in Rules 17h-1T and 17h-2T. A broker 

or dealer seeking designation as a Reporting Broker or Dealer must apply to the Commission for an exemption 

pursuant to Rule 17h-2T. Pending such designation, each broker or dealer associated with the broker or dealer 

requesting such designation as a Reporting Broker or Dealer is required to file a separate Form 17-H.

4. The information requested in Part II of this Form shall be completed separately for each Material Associated 

Person, even if the financial data contained in the broker or dealer’s Form X-17A-5 contains information 

concerning a Material Associated Person. The broker-dealer should not include information concerning its 

activities in the information required by Part II of this Form if such information is filed with the Commission as 

part of the broker-dealer’s Form X-17A-5 or Form G-405.

ITEM 1

ORGANIZATIONAL CHART REFLECTING ASSOCIATED PERSONS AND THE BROKER-DEALER

1. Provide a copy of the organizational chart maintained by the broker or dealer pursuant to paragraph (a)(1)(i) 

of section 240.17h-1T.

2. The information provided pursuant to this Item should be included in the first Form 17-H filed by the broker 

or dealer and in the year-end filing. Quarterly updates should be provided only where a material change in the 

information provided to the Commission has occurred.

ITEM 2

RISK MANAGEMENT AND OTHER POLICIES

1. Provide copies of the financing, capital adequacy, and risk management and other policies, procedures or 

systems maintained by the broker-dealer pursuant to paragraph (a)(1)(ii) of section 240.17h-1T.

2. The information provided pursuant to this Item should be included in the first Form 17-H filed by the broker 

or dealer. Quarterly updates should be provided only where a material change in the information provided to the 

Commission has occurred.

ITEM 3

LEGALPROCEEDINGS

1. Provide the description of any material pending legal or arbitration proceedings maintained by the broker or 

dealer pursuant to paragraph (a)(1)(iii) of section 240.17h-1T.

2. The information provided pursuant to this Item should be included in the first Form 17-H filed with the 

Commission. Quarterly updates should be provided only where a material change in the information provided 

to the Commission has occurred.

ITEM 4

FINANCIAL STATEMENTS

1. Provide the information required to be maintained by the broker or dealer pursuant to paragraphs (a)(1)(iv) 

and (a)(1)(v) of section 240.17h-1T. The financial statements may be presented on an unaudited basis. The 

statement of cash flows and the notes to financial statements may be omitted for the consolidating financial 

statements. Entities using accounting principles other than U.S. GAAP should indicate in a note the accounting 

principles used.

2. The consolidating financial statements must be presented on a subsidiary basis and shall indicate which 

subsidiaries are Material Associated Persons.
PAGE3

2000

2010

2005

2015

1055

PART II

GENERAL INSTRUCTIONS FOR PART II OF THIS FORM

1. Provide the following information for each Material Associated Person as of the end of the quarter. Indicate the name of each 

Material Associated Person in a separate column or complete a separate Part II for each Material Associated Person. In the event a 

separate listing of a position, financial instrument or otherwise is required pursuant to any of the provisions of section 240.17h-1T, the 

broker or dealer should indicate as such in the appropriate section of this Part II. Where appropriate, indicate long and short positions 

separately. (Report amounts in thousands) Material Associated Person:

I. AGGREGATE SECURITIES AND COMMODITIES POSITIONS LONG (000's omitted) SHORT

1. U.S. Treasury securities ..........................................................

2. U.S. Government agency ........................................................

3. Securities issued by states and political subdivisions in the U.S.

4. Foreign securities:

(a) Debt securities ..................................................................

(b) Equity securities ...............................................................

5. Banker’s acceptances .............................................................

6. Certificates of deposit .............................................................

7. Commercial paper ...................................................................

8. Corporate obligations .............................................................

9. Stocks and warrants (other than arbitrage positions) ..............

10. Arbitrage:

(a) Index arbitrage and program trading ................................

(b) Risk arbitrage ...................................................................

(c) Other arbitrage .................................................................

11. Options:

(a) Market value of put options:

(i) Listed .........................................................................

(ii) Unlisted ......................................................................

(b) Market value of call options:

(i) Listed ...........................................................................

(ii) Unlisted ......................................................................

12. Spot commodities ...................................................................

13. Investments with no ready market:

(a) Equity ..............................................................................

(b) Debt .................................................................................

(c) Other (include limited partnership interests) ....................

14. Other securities or commodities .............................................

1020

1030

1040

1050

1080

1090

1120

1130

1140

1150

1200

1210

1015

1025

1035

1045

1085

1095

1105

1115

1125

1135

1145

1155

1165

1175

1185

1195

1205

1215

15. Summary of delta or similar analysis(if available)(attach analysis)

II. FINANCIAL INSTRUMENTS WITH OFF-BALANCE SHEET RISK AND WITH CONCENTRATION OF CREDIT RISK

(Provide notional or contractual amounts where appropriate, or in the case of options, the values of the underlying instrument. In the 

event a separate listing of a position or instrument is required pursuant to the provisions of section 17h-1T, separately state such position.)

A. Securities

1. When-issued securities:

(a) Gross commitments to purchase .......................................

(b) Gross commitments to sell ................................................

2. Written stock option contracts:

(a) Market value, and the value of the underlying securities, 

of call contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying securities ............................

(ii) Unlisted

(A) Market value ......................................................

(B) Value of underlying securities ............................

LONG (000's omitted) SHORT

2020 2025

2030 2035

2040 2045

2050 2055

1075

1065

1070

1060

1000 1005

1010

1100

1110

1160

1170

1180

1190
PAGE4

Material Associated Person:

LONG (000's omitted) SHORT

(b) Market value, and the value of the underlying securities, 

of put contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying securities ............................

(ii) Unlisted

(A) Market value .......................................................

(B) Value of underlying securities ............................

(c) Market value, and the value of the underlying securities, 

of naked call contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying securities ............................

(ii) Unlisted

(A) Market value ..........................................................

(B) Value of underlying securities ............................

(d) Market value, and the value of the underlying securities, 

of naked put contracts:

(i) Listed

(A) Market value ..........................................................

(B) Value of underlying securities.................................

(ii) Unlisted

(A) Market value ..........................................................

(B) Value of underlying securities ............................

2065

2075

2080 2085

2090 2095

2105

2115

2125

2130 2135

2145

2155

2165

2170 2175

3. Futures:

(a) U.S. Treasury and mortgage-backed securities futures......

(b) Other futures (specify)...........................................................

4. Forwards:

(a) U.S. Treasury and mortgage-backed securities.....................

(i) Aggregate current cost of replacing contracts by counter2180 2185

2195

2205

party in which the Material Associated Person has a gain

(ii) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

(b) Other forwards (specify) ...................................................

(i) Aggregate current cost of replacing contracts by counterparty in which the Material Associated Person has a gain

(ii) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

B. Interest Rate Swaps

1. U.S. dollar denominated swaps:

(a) Total notional or contractual amount ................................

(b) Aggregate current cost of replacing contracts by counterparty in which the Material Associated Person has a gain

(c) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

2. Cross currency swaps:

(a) Total notional or contractual amount ....................................

(b) Aggregate current cost of replacing contracts by counterparty in which the Material Associated Person has a gain

(c) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

C. Foreign exchange

1. Swaps:

(a) Total notional or contractual amount ....................................

(b) Aggregate cost of replacing contracts by counterparty in

which the Material Associated Person has a gain...................

(c) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

2210

2220

2230

2240

2250

2280

2290

2215

2225

2235

2245

2255

2265

2275

2285

2295

2270

2260

2200

2190

2160

2150

2140

2120

2060

2070

2100

2110
PAGE5

Material Associated Person:

LONG (000's omitted) SHORT

2. Notional or contractual amounts of commitments to purchase

foreign currencies and U.S. dollar exchange:

(a) Futures...................................................................................

(b) Forwards................................................................................

(i) Aggregate current cost of replacing contracts by counterparty in which the Material Associated Person has a gain.

(ii) Per counterparty breakdown where credit risk exceeds 

the Materiality Threshold (attach schedule).

3. Naked written option contracts:

(a) Contractual value ..................................................................

(b) Value of the underlying instruments......................................

D. All other swap agreements (specify type)(attach schedule if necessary)

1. Total notional or contractual amount...........................................

2. Aggregate current cost of replacing contracts by counterparty in

which the Material Associated Person has a gain ............................

3. Per counterparty breakdown where credit risk exceeds the 

Materiality Threshold (attach schedule).

E. Commodities

1. Futures.........................................................................................

2. Forwards......................................................................................

(a) Aggregate current cost of replacing contracts by counterparty in which the Material Associated Person has a gain ........

(b) Per counterparty breakdown where credit risk exceeds the 

Materiality Threshold (attach schedule).

3. Sold option contracts (e.g., options on individual commodities 

and commodities indexes)

(a) Market value, and the value of the underlying instruments, 

of call contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying instruments..........................

(ii) Unlisted

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(b) Market value, and the value of the underlying instruments, 

of put contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(ii) Unlisted

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(c) Market value, and the value of the underlying instruments, 

of naked call contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(ii) Unlisted

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(d) Market value, and the value of the underlying instruments, 

of naked put contracts:

(i) Listed

(A) Market value .......................................................

(B) Value of underlying instruments .........................

(ii) Unlisted

(A) Market value .......................................................

(B) Value of underlying instruments .........................

F. Loan committments

1. Total amount .............................................................................................................................

2. Unused portion ..........................................................................................................................

2325

2395

2380

2370

2390

2320

2300 2305

2310 2315

2375

2385

2400

2410

2405

2415

2420

2430

2425

2435

2440

2450

2445

2455

2460

2470

2465

2475

2480

2490

2485

2495

2500

2510

2505

2515

2530

2520

2525

2535

2540

2550

2545

2555

2560

2565

2330 2335

2340 2345

2350 2355

2360 2365
PAGE6

5050

Material Associated Person:

(000's omitted)

G. Total standby, commercial and similar letters of credit or guarantees ............................................

H. Assets sold with recourse ...............................................................................................................

I. Other off-balance sheet items (specify) .......................................................................................... 2580

J. Summary of delta or similar analysis (if available)(attach analysis).

K. Provide a separate listing, by amount, of significant concentrations of credit risk as defined in

Statement of Financial Accounting Standards No. 105 (attach schedule).

(000's omitted)

III. BRIDGE LOANS AND OTHER EXTENSIONS OF CREDIT

1. Bridge loans ....................................................................................................................................

3000

2. Other material credit extensions (specify) ......................................................................................

3. Allowance for losses for credit extensions .....................................................................................

IV. FUNDING SOURCES (000's omitted)

1. Short-term borrowings:

(a) Commercial paper ....................................................................................................................

(b) Bank loans-secured ..................................................................................................................

(c) Bank loans-unsecured ..............................................................................................................

(d) Other ........................................................................................................................................

(e) Total .........................................................................................................................................

2. Long and medium-term debt ..........................................................................................................

3. Committed lines of credit ................................................................................................................

4. Amounts borrowed under credit lines .............................................................................................

5. Credit ratings for commercial paper

(a) Standard & Poor’s Corporation ................................................................................................

(b) Moody’s Investor Service ........................................................................................................

(c) Other Nationally Recognized Statistical Rating Organizations ................................................

V. REAL ESTATE (000's omitted)

1. Real estate loans:

(a) Construction and land development .........................................................................................

(b) Secured by farmland ................................................................................................................

(c) Secured by residential properties .............................................................................................

(d) Commercial and industrial .......................................................................................................

(e) Other ........................................................................................................................................

2. Real estate investments:

(a) Construction and land development .........................................................................................

(b) Farmland ...................................................................................................................................

(c) Residential properties ...............................................................................................................

(d) Commercial and industrial .......................................................................................................

(e) Other............................................................................................................................................

4000

4005

4015

4030

4045

5000

5025

5040

5045

3. Provide a separate listing of the above information by geographic region where the amount exceeds the Materiality Threshold (attach 

schedule).

4. Provide information about risk concentration to a single borrower, location or property in the investment or loan portfolio where the 

amount exceeds the Materiality Threshold (attach schedule).

ADDITIONAL SPACE FOR ANSWERS

The Material Associated Person may use the space below, and additional sheets if necessary, to provide further information or 

explanation regarding any item of information required by the Form. Include the name of the Material Associated Person on each 

page and specify the paragraph of the Form to which the additional information relates.

2570

2575

3005

3015

4020

4025

4035

4040

4050

4055

5005

5015

5020

5030

5035