# EDGAR Filing Document

**Accession Number:** 0001845982
**File Stem:** 0000950170-25-110949
**Filing Date:** 2025-8
**Character Count:** 20505
**Document Hash:** c6355fb7054053c49a3a6ab2aca5c9db
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0000950170-25-110949.hdr.sgml**: 20250822

**ACCESSION NUMBER**: 0000950170-25-110949

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250821

**FILED AS OF DATE**: 20250822

**DATE AS OF CHANGE**: 20250822

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** RPII Order LLC
- **CENTRAL INDEX KEY:** 0001845982

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246268

**BUSINESS ADDRESS:**
- **STREET 1:** C/O THE RAINE GROUP
- **STREET 2:** 55 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-603-5500

**MAIL ADDRESS:**
- **STREET 1:** C/O THE RAINE GROUP
- **STREET 2:** 55 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Partners II LP
- **CENTRAL INDEX KEY:** 0001594261

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246267

**BUSINESS ADDRESS:**
- **STREET 1:** 810 SEVENTH AVENUE
- **STREET 2:** 39TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10019
- **BUSINESS PHONE:** (212) 603-5500

**MAIL ADDRESS:**
- **STREET 1:** 810 SEVENTH AVENUE
- **STREET 2:** 39TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10019
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Capital LLC
- **CENTRAL INDEX KEY:** 0001631543

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246262

**BUSINESS ADDRESS:**
- **STREET 1:** C/O THE RAINE GROUP LLC
- **STREET 2:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-603-5521

**MAIL ADDRESS:**
- **STREET 1:** C/O THE RAINE GROUP LLC
- **STREET 2:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Management LLC
- **CENTRAL INDEX KEY:** 0001956806

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246265

**BUSINESS ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** 212-603-5500

**MAIL ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Holdings LLC
- **CENTRAL INDEX KEY:** 0001887500

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246263

**BUSINESS ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** (646) 874-0782

**MAIL ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Group LLC
- **CENTRAL INDEX KEY:** 0001887502

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246264

**BUSINESS ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** (646) 874-0782

**MAIL ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Raine Associates II LP
- **CENTRAL INDEX KEY:** 0001887509

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40213
- **FILM NUMBER:** 251246266

**BUSINESS ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
- **BUSINESS PHONE:** (646) 874-0782

**MAIL ADDRESS:**
- **STREET 1:** 65 EAST 55TH STREET, 24TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Olo Inc.
- **CENTRAL INDEX KEY:** 0001431695
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-BUSINESS SERVICES, NEC [7389]
- **ORGANIZATION NAME:** 07 Trade & Services
- **EIN:** 202971562
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 285 FULTON STREET
- **STREET 2:** ONE WORLD TRADE CENTER, 82ND FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10007
- **BUSINESS PHONE:** 212-260-0895

**MAIL ADDRESS:**
- **STREET 1:** 285 FULTON STREET
- **STREET 2:** ONE WORLD TRADE CENTER, 82ND FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10007

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** MOBO SYSTEMS, INC
- **DATE OF NAME CHANGE:** 20141017

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** MOBO SYSTEMS INC
- **DATE OF NAME CHANGE:** 20080407

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>RPII Order LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Partners II LP<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Associates II LP<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Management LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Group LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Holdings LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Raine Capital LLC<br><sub>(Last) (First) (Middle)</sub><br>C/O THE RAINE GROUP LLC<br>65 EAST 55TH STREET, 24TH FLOOR<br><sub>(Street)</sub><br>NEW YORK, NY 10022<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-08-21 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Olo Inc. [ OLO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| CLASS A COMMON STOCK | 2025-08-21 |  | C |  | 265000<sup>(1)</sup> | A | $0 | 3065000 | I | See footnotes<sup>(2)(3)</sup> |
| CLASS A COMMON STOCK |  |  |  |  |  |  |  | 25928 | I | See footnote<sup>(4)</sup> |
| CLASS A COMMON STOCK |  |  |  |  |  |  |  | 25928 | I | See footnote<sup>(5)</sup> |
| CLASS A COMMON STOCK |  |  |  |  |  |  |  | 409426 | I | See footnote<sup>(6)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| CLASS B COMMON STOCK | <sup>(7)</sup> | 2025-08-21 |  | C |  |  | 265000<sup>(1)</sup> | <sup>(7)</sup> | <sup>(7)</sup> | CLASS A COMMON STOCK | 265000 | $0 | 29155439 | I | See footnotes<sup>(2)(3)</sup> |

---

### Footnotes:

(1) The conversion of these shares of Class B Common Stock into Class A Common Stock was effected to ensure that the Reporting Persons' ownership of the issuer's outstanding voting stock does not exceed 49.9%, in connection with the settlement of the class action and derivative complaint filed against the issuer in the Court of the Chancery of the State of Delaware captioned Scarantino v. Glass, et al. (C.A. No. 2024-0517-KSJM), as described in the issuer's prior SEC filings.

(2) These shares are held of record by RPII Order LLC ("RPII"). The sole member of RPII is Raine Partners II LP ("Raine Partners"), whose general partner is Raine Associates II LP ("Raine Associates"), whose general partner is Raine Management LLC ("Raine Management"), whose sole member is The Raine Group LLC ("Raine Group"), whose majority member is Raine Holdings LLC ("Raine Holdings"). Raine Capital LLC ("Raine Capital") is an SEC-registered Investment Advisor to Raine Partners and subsidiary of Raine Group. By virtue of these relationships, the Reporting Persons may be deemed to beneficially own the shares held of record by RPII.

(3) (Continued from footnote 2) The Reporting Persons disclaim beneficial ownership over shares held by RPII except to the extent of their pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Persons are the beneficial owner of these securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purposes.

(4) These shares are held of record by Brandon Gardner, a member of the board of directors (the "Board") of the issuer. Mr. Gardner is a partner of Raine Holdings, which is the majority member of Raine Group, which is the sole member of Raine Management, which is the general partner of Raine Associates, which is the general partner of Raine Partners, which is the sole member of RPII. Raine Capital is an SEC-registered Investment Advisor to Raine Partners. By virtue of these relationships, the Reporting Persons may be deemed to beneficially own the shares held of record by Mr. Gardner. The Reporting Persons disclaim beneficial ownership over shares held by Mr. Gardner except to the extent of their pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Persons are the beneficial owner of these securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purposes.

(5) These shares are held of record by Colin Neville, a member of the Board. Mr. Neville is a partner of Raine Holdings, which is the majority member of Raine Group, which is the sole member of Raine Management, which is the general partner of Raine Associates, which is the general partner of Raine Partners, which is the sole member of RPII. Raine Capital is an SEC-registered Investment Advisor to Raine Partners. By virtue of these relationships, the Reporting Persons may be deemed to beneficially own the shares held of record by Mr. Neville. The Reporting Persons disclaim beneficial ownership over shares held by Mr. Neville except to the extent of their pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Persons are the beneficial owner of these securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purposes.

(6) These shares are held of record by Raine Associates.  The general partner of Raine Associates is Raine Management, whose sole member is Raine Group, whose majority member is Raine Holdings. Raine Capital is an SEC-registered Investment Advisor to Raine Partners and subsidiary of Raine Group. By virtue of these relationships, the Reporting Persons may be deemed to beneficially own the shares held of record by Raine Associates. The Reporting Persons disclaim beneficial ownership over shares held by Raine Associates except to the extent of their pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Persons are the beneficial owner of these securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purposes.

(7) Each share of Class B Common Stock is convertible into one share of Class A Common Stock of the issuer at any time, at the holder's election, and has no expiration date.

**Signature:** RPII Order LLC, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** Raine Partners II LP, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** Raine Associates II LP, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** Raine Management LLC, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** The Raine Group LLC, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** Raine Holdings LLC, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

**Signature:** Raine Capital LLC, by /s/ Alfred J. Chianese, attorney-in-fact  
**Date:** 2025-08-22

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* 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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**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 Number.**