The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete. The reader should not assume that the information is accurate and complete. |
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Intentional misstatements or omissions of fact constitute federal criminal violations. See 18 U.S.C. 1001.
FORM D
Notice of Exempt Offering of Securities
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| OMB APPROVAL |
| OMB Number: |
3235-0076 |
| Estimated average burden |
| hours per response: |
4.00 |
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1. Issuer's Identity
| CIK (Filer ID Number) |
Previous Names |
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Entity Type |
| 0001550184 |
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| |
Corporation |
| |
Limited Partnership |
| |
Limited Liability Company |
| |
General Partnership |
| |
Business Trust |
| X |
Other (Specify) |
Delaware Statutory Trust |
| Name of Issuer |
| CW Pharmacy I DST |
| Jurisdiction of Incorporation/Organization |
| DELAWARE |
| Year of Incorporation/Organization |
| |
Over Five Years Ago |
| X |
Within Last Five Years (Specify Year) |
2012 |
| |
Yet to Be Formed |
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2. Principal Place of Business and Contact Information
| Name of Issuer |
| CW Pharmacy I DST |
| Street Address 1 |
Street Address 2 |
| 2901 BUTTERFIELD ROAD |
| City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
| OAK BROOK |
ILLINOIS |
60523 |
630-218-4916 |
3. Related Persons
| Last Name |
First Name |
Middle Name |
| Inland Private |
Capital Corporation |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/PostalCode |
| Oak Brook |
ILLINOIS |
60523 |
| Relationship: |
|
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| CW Pharmacy |
I, L.L.C. |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/PostalCode |
| Oak Brook |
ILLINOIS |
60523 |
| Relationship: |
|
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| CW Pharmacy I |
Exchange, L.L.C. |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/PostalCode |
| Oak Brook |
ILLINOIS |
60523 |
| Relationship: |
|
Executive Officer |
|
Director |
X |
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Lampi |
Keith |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/PostalCode |
| Oak Brook |
ILLINOIS |
60523 |
| Relationship: |
X |
Executive Officer |
|
Director |
|
Promoter |
Clarification of Response (if Necessary):
Mr. Lampi is the Senior Vice President of Inland Private Capital Corporation, the Member of CW Pharmacy I Exchange, L.L.C., the Signatory Trustee of CW Pharmacy I DST.
4. Industry Group
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Agriculture |
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Banking & Financial Services |
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Commercial Banking |
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Insurance |
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Investing |
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Investment Banking |
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Pooled Investment Fund |
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Is the issuer registered as an investment company under the Investment Company Act of 1940? |
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Other Banking & Financial Services |
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Business Services |
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Energy |
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Health Care |
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Manufacturing |
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Real Estate |
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Retailing |
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Restaurants |
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Technology |
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Travel |
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Tourism & Travel Services |
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Other |
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5. Issuer Size
| Revenue Range |
OR |
Aggregate Net Asset Value Range |
| |
No Revenues |
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No Aggregate Net Asset Value |
| |
$1 - $1,000,000 |
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$1 - $5,000,000 |
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$1,000,001 - $5,000,000 |
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$5,000,001 - $25,000,000 |
| |
$5,000,001 - $25,000,000 |
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$25,000,001 - $50,000,000 |
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$25,000,001 - $100,000,000 |
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$50,000,001 - $100,000,000 |
| |
Over $100,000,000 |
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Over $100,000,000 |
| X |
Decline to Disclose |
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Decline to Disclose |
| |
Not Applicable |
|
Not Applicable |
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
| |
Rule 504(b)(1) (not (i), (ii) or (iii)) |
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Rule 505 |
| |
Rule 504 (b)(1)(i) |
X |
Rule 506 |
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Rule 504 (b)(1)(ii) |
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Securities Act Section 4(5) |
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Rule 504 (b)(1)(iii) |
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Investment Company Act Section 3(c) |
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Section 3(c)(1) |
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Section 3(c)(9) |
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Section 3(c)(2) |
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Section 3(c)(10) |
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Section 3(c)(3) |
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Section 3(c)(11) |
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Section 3(c)(4) |
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Section 3(c)(12) |
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Section 3(c)(5) |
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Section 3(c)(13) |
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Section 3(c)(6) |
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Section 3(c)(14) |
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7. Type of Filing
| |
New Notice |
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Date of First Sale |
2012-05-14 |
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First Sale Yet to Occur |
| X |
Amendment |
8. Duration of Offering
| Does the Issuer intend this offering to last more than one year? |
|
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9. Type(s) of Securities Offered (select all that apply)
| |
Equity |
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Pooled Investment Fund Interests |
| |
Debt |
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Tenant-in-Common Securities |
| |
Option, Warrant or Other Right to Acquire Another Security |
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Mineral Property Securities |
| |
Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security |
X |
Other (describe) |
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Beneficial interests in Delaware Statutory Trust reflecting beneficial interests in real estate. |
10. Business Combination Transaction
| Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? |
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Clarification of Response (if Necessary):
11. Minimum Investment
| Minimum investment accepted from any outside investor |
$25,000
|
USD |
12. Sales Compensation
| Recipient |
| Recipient CRD Number |
|
None |
|
| Inland Securities Corporation |
15807 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Inland Securities Corporation |
15807 |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/Postal Code |
| Oak Brook |
ILLINOIS |
60523 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Christopher G. Conness |
4778193 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
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| G.F. Investment Services, LLC |
132939 |
| Street Address 1 |
Street Address 2 |
| 2740 East Oakland Park Boulevard |
Suite 201 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Fort Lauderdale |
FLORIDA |
33306 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Vic V. Mullett |
4656976 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 2822 3rd Avenue North, Suite 204 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Billings |
MONTANA |
59101 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Peter Fisher |
1259923 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Investacorp, Inc. |
7684 |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/Postal Code |
| Oak Brook |
ILLINOIS |
60523 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Kyle H. Imholte |
5448950 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| 1st Global Capital Corp. |
30349 |
| Street Address 1 |
Street Address 2 |
| 1215 Washington Avenue South |
| City |
State/Province/Country |
ZIP/Postal Code |
| Detroit Lakes |
MINNESOTA |
56502 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Robert R. Tweed |
2339324 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
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| Concorde Investment Services, LLC |
151604 |
| Street Address 1 |
Street Address 2 |
| 2060 Huntington Drive, Suite 1 |
| City |
State/Province/Country |
ZIP/Postal Code |
| San Marino |
CALIFORNIA |
91108 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| John P. Harvey, Jr. |
4227692 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| Sandlapper Securities, LLC |
137906 |
| Street Address 1 |
Street Address 2 |
| 101 North Main Street, Suite 207 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Greenville |
SOUTH CAROLINA |
29601 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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| Recipient |
| Recipient CRD Number |
|
None |
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| Douglas L. Hall |
1679998 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| 1st Global Capital Corp. |
30349 |
| Street Address 1 |
Street Address 2 |
| 1801 Market Street |
Ten Penn Center, Suite 1700 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Philadelphia |
PENNSYLVANIA |
19103 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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| Recipient |
| Recipient CRD Number |
|
None |
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| William S. Sheehan |
2328614 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| Investors Capital Corp. |
30613 |
| Street Address 1 |
Street Address 2 |
| 2 Orr Hatch Drive |
| City |
State/Province/Country |
ZIP/Postal Code |
| Cornwall |
NEW YORK |
12518 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
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| Recipient |
| Recipient CRD Number |
|
None |
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| Jeffery W. Graumlich |
4816380 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| Sigma Financial Corporation |
14303 |
| Street Address 1 |
Street Address 2 |
| 1078 Carol Lane, #203 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Lafayette |
CALIFORNIA |
94549 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Peter M. Maris |
2177794 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
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| Securities Service Network, Inc. |
13318 |
| Street Address 1 |
Street Address 2 |
| 1000 Skokie Road, Suite 525 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Wilmette |
ILLINOIS |
60091 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
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| Gary L. Ackerman |
4668422 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
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| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 10900 Nuckols Road, Suite 200 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Glen Allen |
VIRGINIA |
23060 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Patrick R. Conway |
1337831 |
| (Associated) Broker or Dealer |
|
None |
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| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Investacorp, Inc. |
7684 |
| Street Address 1 |
Street Address 2 |
| 2901 Butterfield Road |
| City |
State/Province/Country |
ZIP/Postal Code |
| Oak Brook |
ILLINOIS |
60523 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| William A. Meloy |
1653157 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Proequities, Inc. |
15708 |
| Street Address 1 |
Street Address 2 |
| 1208 Ballybunion Court |
| City |
State/Province/Country |
ZIP/Postal Code |
| Dyer |
INDIANA |
46311 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
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| Recipient |
| Recipient CRD Number |
|
None |
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| Joseph G. Michaletz |
1327534 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Triad Advisors, Inc. |
25803 |
| Street Address 1 |
Street Address 2 |
| 150 St. Andrews Court, Suite 210 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Mankato |
MINNESOTA |
56001 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Alan J. Schryer |
1847282 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Money Concepts Capital Corp |
12963 |
| Street Address 1 |
Street Address 2 |
| #6B Liberty, Suite 130 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Aliso Viejo |
CALIFORNIA |
92656 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Thomas J. Ealy |
863042 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Investment Planners, Inc. |
18557 |
| Street Address 1 |
Street Address 2 |
| 1802 Fox Drive |
| City |
State/Province/Country |
ZIP/Postal Code |
| Champaign |
ILLINOIS |
61821 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| David B. Levinson |
705929 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Newport Coast Securities, Inc. |
16944 |
| Street Address 1 |
Street Address 2 |
| 18872 Macarthur Boulevard, Suite 100 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Irvine |
CALIFORNIA |
92612 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Nathaniel M. Kuhn |
4624143 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Investacorp, Inc. |
7684 |
| Street Address 1 |
Street Address 2 |
| 1100 West Northwest Highway, Suite 203 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Mt. Prospect |
ILLINOIS |
60056 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Bryon E. Martinsen |
1621649 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 220 Fort Salonga Road, Suite 301C |
| City |
State/Province/Country |
ZIP/Postal Code |
| Northport |
NEW YORK |
11768 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Richard W. Brown |
1595628 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Summit Brokerage Services, Inc. |
34643 |
| Street Address 1 |
Street Address 2 |
| 12830 University Drive, Suite 150 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Fort Myers |
FLORIDA |
33907 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Troy Thomas |
4691720 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 625 The City Drive, Suite 380 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Orange |
CALIFORNIA |
92868 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Joral T. Schmalle |
4491484 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Sigma Financial Corporation |
14303 |
| Street Address 1 |
Street Address 2 |
| 1009 Amito Drive |
| City |
State/Province/Country |
ZIP/Postal Code |
| Berkeley |
CALIFORNIA |
94705 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Dwight K. Kay |
5376903 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Independent Financial Group, LLC |
7717 |
| Street Address 1 |
Street Address 2 |
| 1717 Palacious Drive |
| City |
State/Province/Country |
ZIP/Postal Code |
| San Pedro |
CALIFORNIA |
90274 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Eric J. Schindler |
1439999 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Multi-Financial Securities Corporation |
10299 |
| Street Address 1 |
Street Address 2 |
| 7777 Alvarado Road, Suite 621 |
| City |
State/Province/Country |
ZIP/Postal Code |
| La Mesa |
CALIFORNIA |
91941 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| James D. Goodland |
2385266 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Cambridge Investment Research, Inc. |
39543 |
| Street Address 1 |
Street Address 2 |
| 3340 Annapolis Lane N, Suite B |
| City |
State/Province/Country |
ZIP/Postal Code |
| Plymouth |
MINNESOTA |
55447 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Raymond W. Harrison |
2287436 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Proequities, Inc. |
15708 |
| Street Address 1 |
Street Address 2 |
| 2237 Douglas Boulevard, Suite 120 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Roseville |
CALIFORNIA |
95661 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Gary G. Benson |
1182211 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| NPB Financial Group, LLC |
137743 |
| Street Address 1 |
Street Address 2 |
| 5435 Balboa Boulevard, Suite 106 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Encino |
CALIFORNIA |
91316 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Emily M. Lafferty |
2888481 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Lincoln Financial Advisors Corporation |
3978 |
| Street Address 1 |
Street Address 2 |
| 7701 France Avenue South, Suite 100 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Edina |
MINNESOTA |
55435 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Kenneth M. Chong |
2972285 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Sigma Financial Corporation |
14303 |
| Street Address 1 |
Street Address 2 |
| 13328 Valley Heart Drive North |
| City |
State/Province/Country |
ZIP/Postal Code |
| Sherman Oaks |
CALIFORNIA |
91423 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Dana K. Graves |
2811852 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 79 Woodfin Place, Suite 201 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Asheville |
NORTH CAROLINA |
28801 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Louis F. Batmale |
4072017 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 1000 4th Street, Suite 400 |
| City |
State/Province/Country |
ZIP/Postal Code |
| San Rafael |
CALIFORNIA |
94901-3133 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Michael Stieglitz |
4623788 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| 1st Global Capital Corp. |
30349 |
| Street Address 1 |
Street Address 2 |
| 200 Valley Road, Suite 300 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Mount Arlington |
NEW JERSEY |
07856 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| James M. Poindexter |
1867899 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 1965 Commerce Center Circle, Suite D |
| City |
State/Province/Country |
ZIP/Postal Code |
| Prescott |
ARIZONA |
86301 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Jeffrey B. Baker |
2102752 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Vanderbilt Securities, LLC |
5953 |
| Street Address 1 |
Street Address 2 |
| 12 East Water Street |
| City |
State/Province/Country |
ZIP/Postal Code |
| Newburgh |
INDIANA |
47629 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Matthew T. Laverone |
4908896 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Financial Network Investment Corporation |
13572 |
| Street Address 1 |
Street Address 2 |
| 723 North Main Street |
| City |
State/Province/Country |
ZIP/Postal Code |
| Manteca |
CALIFORNIA |
95336 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Jeffrey A. Gore |
2844692 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 9725 East Hampden Avenue, Suite 203 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Denver |
COLORADO |
80231 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Edward R. Lara |
302498 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Lara, Shull & May, LLC |
145589 |
| Street Address 1 |
Street Address 2 |
| 7600 Leesburg Pike, Suite 120 East |
| City |
State/Province/Country |
ZIP/Postal Code |
| Falls Church |
VIRGINIA |
22043 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Shawn W. Dunnigan |
1967001 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 2032 Caribou Drive, Suite 101 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Ft. Collins |
COLORADO |
80525 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| John T. Eschels |
202236 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Proequities, Inc. |
15708 |
| Street Address 1 |
Street Address 2 |
| 180 East Brown |
| City |
State/Province/Country |
ZIP/Postal Code |
| Birmingham |
MICHIGAN |
48009 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Daniel L. Whittenburg |
2181920 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Lincoln Financial Advisors Corporation |
3978 |
| Street Address 1 |
Street Address 2 |
| 3165 East Millrock Drive |
Suites 300 and 325 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Salt Lake City |
UTAH |
84121 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Michael J. Lerner |
2627709 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 1434 South Mission Road, Suite B |
| City |
State/Province/Country |
ZIP/Postal Code |
| Fallbrook |
CALIFORNIA |
92028 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Tyrone H. Wynfield |
1341666 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Hagen Securities, Inc. |
27353 |
| Street Address 1 |
Street Address 2 |
| 2112 Century Park Lane, Suite 415 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Los Angeles |
CALIFORNIA |
90067 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Ryan P. Vaughn |
4727701 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Proequities, Inc. |
15708 |
| Street Address 1 |
Street Address 2 |
| 4 West Main Street |
| City |
State/Province/Country |
ZIP/Postal Code |
| Strasburg |
PENNSYLVANIA |
17579 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Tomas J. Velken |
1600404 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Sigma Financial Corporation |
14303 |
| Street Address 1 |
Street Address 2 |
| 1078 Carol Lane, Suite 203 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Lafayette |
CALIFORNIA |
94549 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Jeffrey S. Anderson |
2896908 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| 1st Global Capital Corp. |
30349 |
| Street Address 1 |
Street Address 2 |
| 5807 Osborne Drive West |
| City |
State/Province/Country |
ZIP/Postal Code |
| Hastings |
NEBRASKA |
68901 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| David N. Chazin |
4506422 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Lincoln Financial Advisors Corporation |
3978 |
| Street Address 1 |
Street Address 2 |
| 3000 Executive Parkway, Suite 400 |
| City |
State/Province/Country |
ZIP/Postal Code |
| San Ramon |
CALIFORNIA |
94583 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Michael A. DiPietro |
2811047 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Centaurus Financial, Inc. |
30833 |
| Street Address 1 |
Street Address 2 |
| 907 South Myrtle Avenue |
| City |
State/Province/Country |
ZIP/Postal Code |
| Monrovia |
CALIFORNIA |
91016 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Magdalena J. Georgopoulos |
4517398 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 3655 Torrance Boulevard, Suite 341 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Torrance |
CALIFORNIA |
90503 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Mark A. Welch |
1272729 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 7673 Olivas Lane |
| City |
State/Province/Country |
ZIP/Postal Code |
| Vacaville |
CALIFORNIA |
95688-9511 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Michael W. Newton |
2185103 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Investment Planners, Inc. |
18557 |
| Street Address 1 |
Street Address 2 |
| 191 West Professional Park Court |
Suite 2-B |
| City |
State/Province/Country |
ZIP/Postal Code |
| Bowling Green |
KENTUCKY |
42104 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Dane C. Streeter |
4613533 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 11620 Wilshire Boulevard, Suite 400 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Los Angeles |
CALIFORNIA |
90025 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Phillip H. Lafler |
2844926 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| Sandlapper Securities, LLC |
137906 |
| Street Address 1 |
Street Address 2 |
| 101 North Main Street, Suite 207 |
| City |
State/Province/Country |
ZIP/Postal Code |
| Greenville |
SOUTH CAROLINA |
29601 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
| Recipient |
| Recipient CRD Number |
|
None |
|
| Gilbert R. Hawkins |
240165 |
| (Associated) Broker or Dealer |
|
None |
|
| (Associated) Broker or Dealer CRD Number |
|
None |
|
| LPL Financial LLC |
6413 |
| Street Address 1 |
Street Address 2 |
| 2625 Piner Road |
| City |
State/Province/Country |
ZIP/Postal Code |
| Santa Rosa |
CALIFORNIA |
95401-4036 |
State(s) of Solicitation (select all that apply) Check “All States” or check individual States |
|
All States |
|
|
|
13. Offering and Sales Amounts
| Total Offering Amount |
$17,977,380
|
USD |
|
| Total Amount Sold |
$17,977,380
|
USD |
| Total Remaining to be Sold |
$0
|
USD |
|
Clarification of Response (if Necessary):
14. Investors
|
Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors, and enter the number of such non-accredited investors who already have invested in the offering. |
|
|
Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: |
|
15. Sales Commissions & Finder's Fees Expenses
Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
| Sales Commissions |
$1,258,417
|
USD |
|
| Finders' Fees |
$0
|
USD |
|
Clarification of Response (if Necessary):
This response is based on the assumption that the full amount of the potential sales commissions will be earned and paid.16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
Clarification of Response (if Necessary):
Signature and Submission
Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.
Terms of Submission
| In submitting this notice, each issuer named above is: |
- Notifying the SEC and/or each State in which this notice is filed of the offering of
securities described and undertaking to furnish them, upon written request, in the accordance with applicable
law, the information furnished to offerees.*
- Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator
or other legally designated officer of the State in which the issuer maintains its principal
place of business and any State in which this notice is filed, as its agents for service of
process, and agreeing that these persons may accept service on its behalf, of any notice,
process or pleading, and further agreeing that such service may be made by registered or
certified mail, in any Federal or state action, administrative proceeding, or arbitration
brought against the issuer in any place subject to the jurisdiction of the United States, if the
action, proceeding or arbitration (a) arises out of any activity in connection with the
offering of securities that is the subject of this notice, and (b) is founded, directly or
indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange
Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the
Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii)
the laws of the State in which the issuer maintains its principal place of business or any State
in which this notice is filed.
- Certifying that, if the issuer is claiming a Rule 505 exemption, the issuer is not disqualified
from relying on Rule 505 for one of the reasons stated in Rule 505(b)(2)(iii).
|
Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.
| Issuer |
Signature |
Name of Signer |
Title |
Date |
| CW Pharmacy I DST |
/s/ Keith Lampi |
Keith Lampi |
Senior Vice President of the Member of the Signatory Trustee |
2012-10-30 |
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.
* This undertaking does not affect any limits Section 102(a) of the National Securities Markets
Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to
require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes
of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot
routinely require offering materials under this undertaking or otherwise and can require offering materials only to the
extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.