###### Editorial Note on [Part 240](/current/title-17/part-240?toc=1)

#### Editorial Note:

Nomenclature changes to part 240 appear at [57 FR 36501](https://www.federalregister.gov/citation/57-FR-36501), Aug. 13, 1992, and [57 FR 47409](https://www.federalregister.gov/citation/57-FR-47409), Oct. 16, 1992.

#### § 240.13e-100 Schedule 13E-3, Transaction statement under section 13(e) of the Securities Exchange Act of 1934 and Rule 13e-3 ([§ 240.13e-3](/on/2024-09-16/title-17/section-240.13e-3)) thereunder.

*Securities and Exchange Commission*,

Washington, D.C. 20549

Rule 13e-3 Transaction Statement under Section 13(e) of the Securities Exchange Act of 1934 (Amendment No. \_\_)

(Name of the Issuer)

(Names of Persons Filing Statement)

(Title of Class of Securities)

(CUSIP Number of Class of Securities)

(Name, Address, and Telephone Numbers of Person Authorized to Receive Notices and Communications on Behalf of the Persons Filing Statement)

This statement is filed in connection with (check the appropriate box):

a. [ ] The filing of solicitation materials or an information statement subject to Regulation 14A ([§§ 240.14a-1](/on/2024-09-16/title-17/section-240.14a-1) through [240.14b-2](/on/2024-09-16/title-17/section-240.14b-2)), Regulation 14C ([§§ 240.14c-1](/on/2024-09-16/title-17/section-240.14c-1) through [240.14c-101](/on/2024-09-16/title-17/section-240.14c-101)) or Rule 13e-3(c) ([§ 240.13e-3(c)](/on/2024-09-16/title-17/section-240.13e-3#p-240.13e-3(c))) under the Securities Exchange Act of 1934 (“the Act”).

b. [ ] The filing of a registration statement under the Securities Act of 1933.

c. [ ] A tender offer.

d. [ ] None of the above.

Check the following box if the soliciting materials or information statement referred to in checking box (a) are preliminary copies: [ ]

Check the following box if the filing is a final amendment reporting the results of the transaction [ ]

*General Instructions:*

A. File eight copies of the statement, including all exhibits, with the Commission if paper filing is permitted.

B. This filing must be accompanied by a fee payable to the Commission as required by [§ 240.0-11(b)](/on/2024-09-16/title-17/section-240.0-11#p-240.0-11(b)). The filing fee exhibit required by Item 16(b) of this schedule must be submitted as required by Rule 408 of Regulation S-T ([§ 232.408 of this chapter](/on/2024-09-16/title-17/section-232.408)).

C. If the statement is filed by a general or limited partnership, syndicate or other group, the information called for by Items 3, 5, 6, 10 and 11 must be given with respect to: (i) Each partner of the general partnership; (ii) each partner who is, or functions as, a general partner of the limited partnership; (iii) each member of the syndicate or group; and (iv) each person controlling the partner or member. If the statement is filed by a corporation or if a person referred to in (i), (ii), (iii) or (iv) of this Instruction is a corporation, the information called for by the items specified above must be given with respect to: (a) Each executive officer and director of the corporation; (b) each person controlling the corporation; and (c) each executive officer and director of any corporation or other person ultimately in control of the corporation.

D. Depending on the type of Rule 13e-3 transaction ([§ 240.13e-3(a)(3)](/on/2024-09-16/title-17/section-240.13e-3#p-240.13e-3(a)(3))), this statement must be filed with the Commission:

1. At the same time as filing preliminary or definitive soliciting materials or an information statement under Regulations 14A or 14C of the Act;

2. At the same time as filing a registration statement under the Securities Act of 1933;

3. As soon as practicable on the date a tender offer is first published, sent or given to security holders; or

4. At least 30 days before any purchase of securities of the class of securities subject to the Rule 13e-3 transaction, if the transaction does not involve a solicitation, an information statement, the registration of securities or a tender offer, as described in paragraphs 1, 2 or 3 of this Instruction; and

5. If the Rule 13e-3 transaction involves a series of transactions, the issuer or affiliate must file this statement at the time indicated in paragraphs 1 through 4 of this Instruction for the first transaction and must amend the schedule promptly with respect to each subsequent transaction.

E. If an item is inapplicable or the answer is in the negative, so state. The statement published, sent or given to security holders may omit negative and not applicable responses, except that responses to Items 7, 8 and 9 of this schedule must be provided in full. If the schedule includes any information that is not published, sent or given to security holders, provide that information or specifically incorporate it by reference under the appropriate item number and heading in the schedule. Do not recite the text of disclosure requirements in the schedule or any document published, sent or given to security holders. Indicate clearly the coverage of the requirements without referring to the text of the items.

F. Information contained in exhibits to the statement may be incorporated by reference in answer or partial answer to any item unless it would render the answer misleading, incomplete, unclear or confusing. A copy of any information that is incorporated by reference or a copy of the pertinent pages of a document containing the information must be submitted with this statement as an exhibit, unless it was previously filed with the Commission electronically on EDGAR. If an exhibit contains information responding to more than one item in the schedule, all information in that exhibit may be incorporated by reference once in response to the several items in the schedule for which it provides an answer. Information incorporated by reference is deemed filed with the Commission for all purposes of the Act.

G. If the Rule 13e-3 transaction also involves a transaction subject to Regulation 14A ([§§ 240.14a-1](/on/2024-09-16/title-17/section-240.14a-1) through [240.14b-2](/on/2024-09-16/title-17/section-240.14b-2)) or 14C ([§§ 240.14c-1](/on/2024-09-16/title-17/section-240.14c-1) through [240.14c-101](/on/2024-09-16/title-17/section-240.14c-101)) of the Act, the registration of securities under the Securities Act of 1933 and the General Rules and Regulations of that Act, or a tender offer subject to Regulation 14D ([§§ 240.14d-1](/on/2024-09-16/title-17/section-240.14d-1) through [240.14d-101](/on/2024-09-16/title-17/section-240.14d-101)) or [§ 240.13e-4](/on/2024-09-16/title-17/section-240.13e-4), this statement must incorporate by reference the information contained in the proxy, information, registration or tender offer statement in answer to the items of this statement.

H. The information required by the items of this statement is intended to be in addition to any disclosure requirements of any other form or schedule that may be filed with the Commission in connection with the Rule 13e-3 transaction. If those forms or schedules require less information on any topic than this statement, the requirements of this statement control.

I. If the Rule 13e-3 transaction involves a tender offer, then a combined statement on Schedules 13E-3 and TO may be filed with the Commission under cover of Schedule TO ([§ 240.14d-100](/on/2024-09-16/title-17/section-240.14d-100)). See Instruction J of Schedule TO ([§ 240.14d-100](/on/2024-09-16/title-17/section-240.14d-100)).

J. Amendments disclosing a material change in the information set forth in this statement may omit any information previously disclosed in this statement.

## Item 1. Summary Term Sheet

Furnish the information required by Item 1001 of Regulation M-A ([§ 229.1001 of this chapter](/on/2024-09-16/title-17/section-229.1001)) unless information is disclosed to security holders in a prospectus that meets the requirements of [§ 230.421(d) of this chapter](/on/2024-09-16/title-17/section-230.421#p-230.421(d)).

## Item 2. Subject Company Information

Furnish the information required by Item 1002 of Regulation M-A ([§ 229.1002 of this chapter](/on/2024-09-16/title-17/section-229.1002)).

## Item 3. Identity and Background of Filing Person

Furnish the information required by Item 1003(a) through (c) of Regulation M-A ([§ 229.1003 of this chapter](/on/2024-09-16/title-17/section-229.1003)).

## Item 4. Terms of the Transaction

Furnish the information required by Item 1004(a) and (c) through (f) of Regulation M-A ([§ 229.1004 of this chapter](/on/2024-09-16/title-17/section-229.1004)).

## Item 5. Past Contacts, Transactions, Negotiations and Agreements

Furnish the information required by Item 1005(a) through (c) and (e) of Regulation M-A ([§ 229.1005 of this chapter](/on/2024-09-16/title-17/section-229.1005)).

## Item 6. Purposes of the Transaction and Plans or Proposals

Furnish the information required by Item 1006(b) and (c)(1) through (8) of Regulation M-A ([§ 229.1006 of this chapter](/on/2024-09-16/title-17/section-229.1006)).

*Instruction to Item 6:* In providing the information specified in Item 1006(c) for this item, discuss any activities or transactions that would occur after the Rule 13e-3 transaction.

## Item 7. Purposes, Alternatives, Reasons and Effects

Furnish the information required by Item 1013 of Regulation M-A ([§ 229.1013 of this chapter](/on/2024-09-16/title-17/section-229.1013)).

## Item 8. Fairness of the Transaction

Furnish the information required by Item 1014 of Regulation M-A ([§ 229.1014 of this chapter](/on/2024-09-16/title-17/section-229.1014)).

## Item 9. Reports, Opinions, Appraisals and Negotiations

Furnish the information required by Item 1015 of Regulation M-A ([§ 229.1015 of this chapter](/on/2024-09-16/title-17/section-229.1015)).

## Item 10. Source and Amounts of Funds or Other Consideration

Furnish the information required by Item 1007 of Regulation M-A ([§ 229.1007 of this chapter](/on/2024-09-16/title-17/section-229.1007)).

## Item 11. Interest in Securities of the Subject Company

Furnish the information required by Item 1008 of Regulation M-A ([§ 229.1008 of this chapter](/on/2024-09-16/title-17/section-229.1008)).

## Item 12. The Solicitation or Recommendation

Furnish the information required by Item 1012(d) and (e) of Regulation M-A ([§ 229.1012 of this chapter](/on/2024-09-16/title-17/section-229.1012)).

## Item 13. Financial Statements

Furnish the information required by Item 1010(a) through (b) of Regulation M-A ([§ 229.1010 of this chapter](/on/2024-09-16/title-17/section-229.1010)) for the issuer of the subject class of securities.

*Instructions to Item 13:* 1. The disclosure materials disseminated to security holders may contain the summarized financial information required by Item 1010(c) of Regulation M-A ([§ 229.1010 of this chapter](/on/2024-09-16/title-17/section-229.1010)) instead of the financial information required by Item 1010(a) and (b). In that case, the financial information required by Item 1010(a) and (b) of Regulation M-A must be disclosed directly or incorporated by reference in the statement. If summarized financial information is disseminated to security holders, include appropriate instructions on how more complete financial information can be obtained. If the summarized financial information is prepared on the basis of a comprehensive body of accounting principles other than U.S. GAAP, the summarized financial information must be accompanied by a reconciliation as described in Instruction 2.

2. If the financial statements required by this Item are prepared on the basis of a comprehensive body of accounting principles other than U.S. GAAP, provide a reconciliation to U.S. GAAP in accordance with Item 17 of Form 20-F ([§ 249.220f of this chapter](/on/2024-09-16/title-17/section-249.220f)).

3. The filing person may incorporate by reference financial statements contained in any document filed with the Commission, solely for the purposes of this schedule, if: (a) The financial statements substantially meet the requirements of this Item; (b) an express statement is made that the financial statements are incorporated by reference; (c) the matter incorporated by reference is clearly identified by page, paragraph, caption or otherwise; and (d) if the matter incorporated by reference is not filed with this Schedule, an indication is made where the information may be inspected and copies obtained. Financial statements that are required to be presented in comparative form for two or more fiscal years or periods may not be incorporated by reference unless the material incorporated by reference includes the entire period for which the comparative data is required to be given. *See* General Instruction F to this Schedule.

## Item 14. Persons/Assets, Retained, Employed, Compensated or Used

Furnish the information required by Item 1009 of Regulation M-A ([§ 229.1009 of this chapter](/on/2024-09-16/title-17/section-229.1009)).

## Item 15. Additional Information

Furnish the information required by Item 1011(b) and (c) of Regulation M-A ([§ 229.1011(b)](/on/2024-09-16/title-17/section-229.1011#p-229.1011(b)) and [(c) of this chapter](/on/2024-09-16/title-17/section-229.1011#p-229.1011(c))).

## Item 16. Exhibits

File each of the following as an exhibit to the Schedule:

(a) All documents specified in Item 1016(a) through (d), (f) and (g) of Regulation M-A ([§ 229.1016 of this chapter](/on/2024-09-16/title-17/section-229.1016)); and

(b) The transaction valuation, fee rate, amount of filing fee and, as applicable, information relating to reliance on [§ 240.0-11(a)(2)](/on/2024-09-16/title-17/section-240.0-11#p-240.0-11(a)(2)) in the tabular form indicated.

# Calculation of Filing Fee Tables

Table 1—Transaction Valuation

| | Transaction valuation | Fee rate | Amount of filing fee |
| --- | --- | --- | --- |
| Fees to Be Paid | X | X | X |
| Fees Previously Paid | X | | X |
| Total Transaction Valuation | X | | |
| Total Fees Due for Filing | | | X |
| Total Fees Previously Paid | | | X |
| Total Fee Offsets | | | X |
| Net Fee Due | | | X |

Table 2—Fee Offset Claims and Sources

| | Registrant or filer name | Form or filing type | File number | Initial filing date | Filing date | Fee offset claimed | Fee paid with fee offset source |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Fee Offset Claims | | X | X | X | | X | |
| Fee Offset Sources | X | X | X | | X | | X |

*Instructions to the Calculation of Filing Fee Tables and Related Disclosure (“Instructions”):*

1. General Requirements.

A. Applicable Table Requirements.

The “X” designation indicates the information required to be disclosed, as applicable, in tabular format. Add as many rows of each table as necessary.

B. Fee Rate.

For the current fee rate, *see <https://www.sec.gov/ofm/Article/feeamt.html>.*

C. Explanations.

If not otherwise explained in response to these instructions, disclose specific details relating to the fee calculation as necessary to clarify the information presented in each table, including references to the applicable provisions of Rule 0-11 ([§ 240.0-11 of this chapter](/on/2024-09-16/title-17/section-240.0-11)). All disclosure these Instructions require that is not specifically required to be presented in tabular format must appear in narrative format immediately after the table(s) to which it corresponds.

2. Table 1: Transaction Valuation Table and Related Disclosure.

A. Fees to Be Paid and Fees Previously Paid.

i. Fees to Be Paid.

Provide the information Table 1 requires for the line item “Fees to Be Paid” as follows:

a. Initial Filings.

For an initial filing on this schedule, provide the required information for the total transaction valuation.

b. Amendments with Then-Current Total Transaction Valuation Higher than Highest Total Transaction Valuation Previously Reported.

For amendments to this schedule that reflect a then-current total transaction valuation higher than the highest total transaction valuation previously reported, provide the required information for the incremental increase.

ii. Fees Previously Paid.

Provide the information Table 1 requires for the line item “Fees Previously Paid” for the prior initial filing or amendment to this transaction statement that reflected a then-current total transaction valuation that was the highest total transaction valuation previously reported.

B. Other Tabular Information.

Provide the following information in the table for the line items “Fees to be Paid” and “Fees Previously Paid”, as applicable:

i. The transaction valuation computed pursuant to Exchange Act Rule 0-11;

ii. The fee rate; and

iii. The filing fee due, without regard to any previous payments or offsets.

C. Totals.

i. Total Transaction Valuation.

Provide the sum of the transaction valuations for the line items “Fees to be Paid” and “Fees Previously Paid.”

ii. Total Fees Due for Filing.

Provide the sum of the fees due without regard to any previous payments or offsets for the line items “Fees to be Paid” and “Fees Previously Paid.”

iii. Total Fees Previously Paid.

Provide the aggregate of filing fees previously paid with this filing.

iv. Total Fee Offsets.

Provide the aggregate of the fee offsets that are claimed in Table 2 pursuant to Instruction 3.

v. Net Fee Due.

Provide the difference between (a) the total fees due for this transaction statement from the Total Fees Due for Filing row; and (b) the sum of (i) the aggregate of filing fees previously paid from the Total Fees Previously Paid row; and (ii) the aggregate fee offsets claimed from the Total Fee Offsets row.

D. Narrative Disclosure

Explain how the transaction valuation was determined.

3. Table 2: Fee Offset Claims and Sources.

A. Terminology.

For purposes of this Instruction 3 and Table 2, the term “submission” means any (i) initial filing of, or amendment (pre-effective or post-effective), to a fee-bearing document; or (ii) fee-bearing form of prospectus filed under Rule 424 under the Securities Act ([§ 230.424 of this chapter](/on/2024-09-16/title-17/section-230.424)), in all cases that was accompanied by a contemporaneous fee payment. For purposes of these instructions to Table 2, a contemporaneous fee payment is the payment of a required fee that is satisfied through the actual transfer of funds, and does not include any amount of a required fee satisfied through a claimed fee offset. Instruction 3.B.ii requires a filer that claims a fee offset under Rule 0-11(a)(2) to identify previous submissions with contemporaneous fee payments that are the original source to which the fee offsets claimed on this filing can be traced. *See* Instruction 3.C for an example.

B. Rule 0-11(a)(2).

If relying on Rule 0-11(a)(2) to offset some or all of the filing fee due on this transaction statement by amounts paid in connection with earlier filings (other than this Schedule 13E-3) relating to the same transaction, provide the following information:

i. Fee Offset Claims.

For each earlier filed Securities Act registration statement or Exchange Act document relating to the same transaction from which a fee offset is being claimed, provide the information that Table 2 requires for the line item “Fee Offset Claims”. The “Fee Offset Claimed” column requires the dollar amount of the previously paid filing fee to be offset against the currently due fee.

Note to Instruction 3.B.i.

If claiming an offset from a Securities Act registration statement, provide a detailed explanation of the basis for the claimed offset.

ii. Fee Offset Sources.

With respect to amounts claimed as an offset under Rule 0-11(a)(2), identify those submissions with contemporaneous fee payments that are the original source to which those amounts can be traced. For each submission identified, provide the information that Table 2 requires for the line item “Fee Offset Sources”. The “Fee Paid with Fee Offset Source” column requires the dollar amount of the contemporaneous fee payment made with respect to each identified submission that is the source of the fee offset claimed pursuant to Rule 0-11(a)(2).

C. Fee Offset Source Submission Identification Example.

A filer:

• Initially files a registration statement on Form S-1 on 1/15/20X1 (assigned file number 333-123456) with a fee payment of $10,000;

• Files pre-effective amendment number 1 to the Form S-1 (333-123456) on 2/15/20X1 with a fee payment of $15,000 and the registration statement goes effective on 2/20/20X1;

• Initially files a registration statement on Form S-1 on 1/15/20X4 (assigned file number 333-123467) with a fee payment of $25,000 and relies on Rule 457(p) to claim an offset of $10,000 related to the unsold securities registered on the previously filed Form S-1 (333-123456) and apply it to the $35,000 filing fee due and the registration statement goes effective on 2/15/20X4.

• Initially files a registration statement related to a tender offer on Form S-4 (assigned file number 333-123478) on 1/15/20X7 with a fee payment of $15,000 and relies on Rule 457(p) to claim an offset of $30,000 related to the unsold securities registered on the most recently effective Form S-1 (333-123467) filed on 1/15/20X4 and apply it to the $45,000 filing fee due.

• Initially files a Schedule TO related to the same tender offer on 1/22/20X7 and relies on Rule 0-11(a)(2) to claim an offset of $45,000 from the fee paid directly and by offset claimed on the Form S-4 (333-123478) filed 1/15/20X7 and apply it to the $45,000 filing fee due.

For the Schedule TO filed on 1/22/20X7, the filer can satisfy the submission identification requirement when it claims the $45,000 fee offset from the Form S-4 (333-123478) filed on 1/15/20X7 by referencing any combination of the Form S-4 (333-123478) filed on 1/15/20X7, the Form S-1 (333-123467) filed on 1/15/20X4, the pre-effective amendment to the Form S-1 (333-123456) filed on 2/15/20X1 or the initial filing of the Form S-1 (333-123456) on 1/15/20X1 in relation to which contemporaneous fee payments were made equal to $45,000.

One example could be:

• The Form S-4 (333-123478) filed on 1/15/20X7 in relation to the payment of $15,000 made with that submission;

• the Form S-1 (333-123467) filed on 1/15/20X4 in relation to the payment of $25,000 made with that submission; and

• the pre-effective amendment to the Form S-1 (333-123456) filed on 2/15/20X1 in relation to the payment of $5,000 out of the payment of $15,000 made with that submission (it would not matter if the filer cited to this pre-effective amendment and/or the initial submission of this Form S-1 (333-123456) on 1/15/20X1 as long as singly or together they were cited as relating to a total of $5,000 in this example).

In this example, the filer could not satisfy the submission identification requirement solely by citing to the Form S-4 (333-123478) filed on 1/15/20X7 because even though the offset claimed and available from that filing was $45,000, the contemporaneous fee payment made with that filing ($15,000) was less than the offset being claimed. As a result, the filer must also identify a prior submission or submissions with an aggregate of contemporaneous fee payment(s) of $30,000 as the original source(s) to which the rest of the claimed offset can be traced.

*Signature.* After due inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

(Signature)

(Name and title)

(Date)

*Instruction to Signature:* The statement must be signed by the filing person or that person's authorized representative. If the statement is signed on behalf of a person by an authorized representative (other than an executive officer of a corporation or general partner of a partnership), evidence of the representative's authority to sign on behalf of the person must be filed with the statement. The name and any title of each person who signs the statement must be typed or printed beneath the signature. See [§ 240.12b-11](/on/2024-09-16/title-17/section-240.12b-11) with respect to signature requirements.

[[64 FR 61454](https://www.federalregister.gov/citation/64-FR-61454), Nov. 10, 1999, as amended at [76 FR 6045](https://www.federalregister.gov/citation/76-FR-6045), Feb. 2, 2011; [86 FR 70253](https://www.federalregister.gov/citation/86-FR-70253), Dec. 9, 2021]