📄 Extracted Text (437 words)
SOF III - 1081 Southern Financial LLC
2. Please indicate whether or not the Investor is, or is acting on behalf of, (i) an "employee benefit
plan" within the meaning of Section 3(3) of ERISA, and subject to Title I of ERISA, (ii) a plan to
which Section 4975 of the Internal Revenue Code of 1986, as amended, applies (including
without limitation, an individual retirement account) (iii) an entity whose underlying assets
include plan assets by reason of a plan's investment in such entity or (iv) an entity that otherwise
constitutes a "benefit plan investor" within the meaning of Section 3(42) of ERISA and the
Department of Labor Regulation 2510.3-101, 29 C.F.R. Section 2510.3-101, or any successor
regulation (together. the "Plan Asset Provisions"), including but not limited to certain insurance
company general accounts (each of (i), (ii), (iii) or (iv), a "Benefit Plan Investor").
Yes No
3(a). If the Investor checked "Yes" to question 2, please check all boxes that describe the Investor or the
entity that the Investor is acting on behalf of:
L an "employee benefit plan" within the meaning of Section 3(3) of ERISA
or a "plan" as described in Section 4975(e) of the Code that is subject to
Title I of ERISA or Section 4975 of the Code (e.g., a 401(k) plan).
O an individual retirement account ("IRA") or an individual retirement
annuity.
O an entity or fund whose underlying assets include - plan assets" by reason
of a plan's investment in such entity (e.g., an insurance company separate
account or an entity in which 25% or more of a class of equity interest is
held by Benefit Plan Investors (calculated in accordance with the Plan
Asset Provisions)). Please indicate the maximum expected percentage of
the entity or fund that will constitute "plan assets" for purposes of Title I
of ERISA: %. An Investor that cannot provide the foregoing
percentage hereby acknowledges that for purposes of determining
whether Benefit Plan Investors own less than 25% of the outstanding
Interests, 100% of the assets of the Investor shall be treated as "plan
assets."
I an insurance company general account. Please indicate the maximum
expected percentage of the general account that will constitute "plan
assets" for purposes of Title I of ERISA: %. An Investor that
cannot provide the foregoing percentage hereby acknowledges that for
purposes of determining whether Benefit Plan Investors own less than
25% of the outstanding Interests, 100% of the assets of its general account
shall be treated as "plan assets."
O Other.
Investor Questionnaire - 9
Confidential
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0108592
CONFIDENTIAL SONY GM_00254776
EFTA01451783
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EFTA01451783
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document
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