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  • 8/6/2019 OTC Email 20

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    State of OklahomaSMALL BUSINESS CAPITAL COMPAN'r"INFORMATION REPORTFQrtheCalaridar Year " l ;OQi 'hg : : ' 12'3112007

    Identification Number D CorporationName of ~~~~r~~~~n~ss_Capltal Company SOONER INVESTMENTS, L.L.C.Address

    ~ : $ : Z 7 1 vu ea : 2 C 1 X io Partnership Due

    City. State Zip ~Complete the aRPli~abf~ S'&cti'~n~.;f~;t~~O$t;n 'o~: t~ ' fu~ ,d~ 'dort t i fJthi~ :,~~,I~Jid~i"Y~M, Attach additionalach Ddu.j~$ ~f.naCO$SEr ry . ~IlCIO~H~,~opy of the, c . fp lWl compailY'fif .anhu~lfina'hc!aLfltatel'nMtst includingdoC!.lmE!l)t~tlon to Indicate t he . m,ethods o f i : lp,er.at lort a nd conduct ' C i f th e b ( A $ ! n e . ' S $ oHM ca pltE iI 'company,

    . . . ,. . . . . .. :: . . - . .:A ENTlTIE;5 INVESTING IN THE SMALL BUSINESS CAPJTAL COMPANY ,, .' '" . . . . . . '. . .' ," - - . . . .J t fe .h t l. fic ,~ t lQ a ' 'Date'Clf TYpB,of: Amount. Numb~r love$~ir.i~l1t,InV6siliuml Invested1) SEE ATTAC! iEO

    .nvostot's' Name, , '

    2)~ ~ - - - - - - - - - - - -3)4)B ENTITIES INVESTING IN OKLAHOMA SMALL BUSINESS VENTURES

    IN CO NJUNCTIO N W ITH THE SMALL BUSINESS C AP ITA L C O MP AN Y

    3)

    iderl tl f lcationNj,nnber, BO ,l '! ln e t; J .s , - -Inve'st~d.l.n'' ~d~ntlfjc;J.tlol'l" ,Date,of', ''liype,of AmountNllmbr.+r investment Investment.: Invested1) ~ - - - - - - - - ' - - - - - - ~ - - - - - - - - 4 - - - - - - - - - - - ~ - - - - - - ~ r - - - - - - + - - - - - - - - + - - - - - ~2)

    tnVO:itQr-: 's Name. - .. .

    2) ~ - - - - - - - - - - - - - - - - - - ~ - - - - - - - ~ - - - - - - - - - - - - - - - - ~ - - - - ~ - - - - - - ~ ~ - - - - -3)1) SEE ATTACHED

    Invested

    This information return, including enclosures, must be filed by April 30th.Under penal ties of perjury. I declare tha~ I have examined thiR mt~rn jn.-,llItiinn A

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    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT

    DPar tner sh ipdentification Number . ~~ 0CorporationN a m e o f Small B u s i n e s s Capital C o m p a n y _ T _ e _ r C _ 9 _ t P _ a _ r t _ t l _ e _ r s . . . : . _ , _ L _ ; _ . l _ , C . ; _ . ; _ _ _ ~ _Addre$$ __ --~ ~---- ~ ___C ily _

    Se e SCa te me nt 12)3)4)

    DLLC

    24,972.00

    1)2)3)

    1) Se e SCa te me nt 1 24,972.002)

    t - " - - - - - - - - - - - - - - - - - - 1 - - - - - - - ~ ~ - - - - - - - - - - - - - - ; - - - - - - - _ r - - - - - - - - + _ - - - - ~3 >Under penalties of perjury, I declare that I have examinededge and belief It is true, correct and complete,

    The Oklahoma Tax CommissiOa te

    ce to taxpayer Of Gflanges in any state tax law,

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    : : ' r~ozrS"iBfI)3 '@:lit-~I " if ~~t~

    ~ 8 ' ~::JO"'.:.:; 0~

    III m 2 t::E 0 : : . f 5 ~II _JLL. Z (/) () I-

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    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINfORMATION REPORT: ( : . # b ~theCp{~darYeaeE~-d. i t jg~ : : ;2 ; 3 1 ;2~07" .

    1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ~ 1 1 1 1 1 1 1 1 1 1 1 1 ~ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 \~ 5 Z : 1 1. ,. - . . ' . i N : R a lli se d 2 0 07ld e n t l f t c a t io n N um b e r ~ ~ _ oCorporat ion oP armers t sp riucN a m e 0 1 Small B u s in e s s C a p lt al C o m p a n y _ . .! .! M .! .: :: c ~ C :. :. :: le :: .: .. :n ~ d o ~ n ~ V . .: .. e: :: ;l ~ lt ;, :. .! U t: ;: ;: e. .. .: :C ~ o : :. :m . ! l: p :: ;: a: :. :. n Y 4 ,. ., :; ;L ; :; ;l C .: ;: __ - - - - - - - _Add re s sCity _::.~g~~pl~tofl1~,~Jlf>Ji.C.~.b,l~I~pti9ri~orJn1lesl1ffet.:.:-.If-~qesea~:.EncI0$e;.a'~py.9f",the~'caj:iiitl~I\~Q'rilIndicate the :methOds o"o~ratlon ,cOlndi l ic t : .of~thEHj lJ$l l les is: ( : fUt lec8pi t tWco. l i t1p:ahY U~~innt~:""n

    f

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    McClendon Venture Company, LLCSchedule to Fonn 521

    Oklahoma Tax CommisSion

    S9Ctlon A for Form 5~ Enuties Investing In the Rural Small Business Capltisl CompanyInvestors Nilme . Addr~ss~l I d N u m lW r I Date of lov I Type of Investment Amount Investad

    Procure Midwest Holdings, LLC ~ .. ... ..- - .. - 4,000,000._ ..... ... - , . . . "h .Section C (or Form 52J - Oklahoma Small Business Ventures in Which Invastmal'lts Wero Made B y Too

    Small Business Capi tal Compa~y~ ~.- -Name of Business Invested In 1 0 N um b e r I T y p e of Bus i ne s s I Date of Investment I Typo of Investment Amount Invested1 O k la h om a P ro cw e M l 1 m ( , LI.C ' I , o o a , O O O2 InnovAlanll ~OI1 35,600: - ; - l!!!1D\'~~?fjJarmlon r z e . o o calo ManufuchJring Holdif1!)~,L l < . ? _ _ _ _ _ i-- r s o , o o oBla Manuf9c lu r in9. Holdi~gs, LLC 750,000'_--,--'--- ...........--r-..... I u . u 5,661,000

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    "

    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT' # p ' ~ ' : ~ h ~, F : ~ ' ! # , ~ : ~ ' ~ t " X ~ , ~ ' i . \ f f i n . : ~ ' , ~ ! r y : ~' , ; ,

    1 1 1 m 1 m 1 1 1 1 1 1 l 1 l 1 1 1 1 1 1 1 1 1 1 1 1 1 ~ 1I ~ I I I ~ 1 1 1 1 1 1 ~ 1 1 ~I I~ ~'27 IIde ntifica tion Numbe r _ oCorpora t fon oPartnership Du.cNam e of Sm all B us ine ss CapIta l C o m p a n Y ! 1 . . ~ : . : : : s ; ; ; : _ a _ ; O : : . : : k = . : 1 = a . h = o . : . : . : m ; ; : : . a _ ; G ; : : : ; r , . : : o : : . : . w : . : : t : . : : : h : _ ; : _ F u n = d ; : : _ : I 4 ' - -=L= -P --- ~AddressClt~ ,.. - Sta te , Z Ip ~ .. ,.~ '~ ~p : l . ~ ~ ~ ) h , ~ : ~ : r : ~ ' V f ;~ ~ J ~. f : ~ ~ ~ Y . p r l ~~,~~ ~ v e ~ ~ 9 . O ~, i~~, i J :~ :~~rh i ' ~~: ! . + : : ~ i ~ ' ~ ~ ~ r . : ~ ~ ~ f . . : ' A ~ ' ~ H A ~ ~ f N ~ h ~ I ~: ~ "f ' , > ' : ' : ; : ' ~ "r i.nca~~~,t:Y,~,;~~9:19:~,RW~~?ry,,~~.~h~

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    E

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    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT:For the calendar Year Ending: 1213112007

    I de n ti fI Ca t io n Numbe r 0CorporationName of Small"Business Capital C o m p a n y_ ;: ; : O .: . . : : A : : _ K . : . . ; H : : . : I L := L : : : . S .. . : : : C ; : . . ; A ; : _ P I : . . . : _ T . : . . : : A : : : ; . L ; : ; . C .; ; : . . O .: . . : : M : . : . . . _ PA : . . ; : N : . ; . . Y :. . ! , . . . : : : L = L C = -- ~ -- -Address .-~-- _... . . - ... ~ ....City State ZipCo I~ the applicable sectI n for ihVestrnents mad e d '1 h ts '~ '~ {~ :O O dil i6r ia t':s ch e dtite s .'.if mp .. Enclose II .0 Se ..' .... !s .. ~ng. :. '~::":''''':'''''''''' .c: .:' \>.:.: '.'. .c.:;..,.. .. . n,ece$S3IY copy of til wpital~ ' ~~ .~:., . q~I:$~~.tq ,.i) 'adlcatethe methods of o P c f a t i a n and ~hC ; fU~C)f tf ie - bU i~$ ': (f f) he : ~ " '.' . , .; ' .. ... .~ t~Stfe:~,Otii~r' .

    o Partnership DtLC

    2 ) G IA N T IN VES TM EN TS U .C 600,000266 ,171) G IAN T I N VE ST ME N TS UC

    InVestor'S Name'1 )2)3)

    1) GWU IMPACTUC600,000

    2.000,0002) GIANT IMPACT LLC3) GIANT IMPACTllC 256,171

    0If1Cei.~ P~MeriJe( DataTh e O kla hom a Ta x Com m iss ion ts not r equI r ed to give actual notice to taxpayer of cha rJges tn a ny state tax l aw.

  • 8/6/2019 OTC Email 20

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    ('State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT

    1 1 " ~ " ' l ll l ll l lI l r l ll l l l ll l ll l ll l ll l ll ~ 1 1 m 1 1 ! l l l l ll ~ I I I ! l lf l l l l~5211ov i sed ~OO7For the Calendar Year Ending; 12/31/2007Identification Number 0 Corporatlon 0 PartnershipNam e of Sm all B Us ine s s C a p ita l Com pa ny O KLAHO MA L IFE SC IENCE FUND , LLCAdd re s s - - ',._~ _City State Zip _Complete the apllHcable'!l'eotlons:forlnvGstmants made during this calendar year. Attach additional schedulesIf necessary. Enclose a copy.oltha capltal companY's annual'financiall stat{)ments; Including documentation toindIcate thE i 'me thodso fQ P~r" , t lbn iand, .conduct6Uf :t ( : t ib i l s l r ies $c: l f ,: th~ oap lXI. ' i: \ ( itn ' I1~ny ~" ( Sef3 . noto .onback)

    CLLC

    AInvestor's Name Address,

    . . , J a e 'r ii Hl h ii fl di i: " "Q ~ ~tlf .... "YP~ofNumber '.hiilltstt'nanf Investment A l T l o i J O tInves ted

    1) 1 - - - - ~ - - - - - - - - - - ~ ~ - - - - - - - - - - - - - - - - - - - - 4 -2) I--'~---"-'-"---." ~.~-----------.J.------J----~------+-----l3}4)8}tiNiijj j i ' ! f i N V E S T , I N G . ,kofilAlki tvlf~ . S r ~ A L L) 3U tNE~ ;SV F . t i i i J R E ~ L : < ~ : (. " > . : : . : \ : ' : . . ~ ' . . . , : , , ' . ' : : : . : : :. , : \ ; : : . ' ~ : > ; : . ~ , ; : : _ : ,! :. ' . c ' .; m t s ~ , . ; , : . ~ ~ : ; ' ~ . : , ~ : , ~ n q i . : : : \ . :. . ,. .)J:t.~I.' .' r . : ., . ..:~.i19~~11.,:....:~..:..::~.~':.:':..." "~'..:, '.:'.:,,:.... . : : " ; : , , 7 ~ : ~ T

    I nv e -s t or 's : N ame . . . Jd l ) t: lUf lont lon: : 'sltslheiis. :ld~n.tlfltJana,l: ; ;o . i f te \ o f . : : :. , ,1:j :miof " A m o u n t (. . . : ' . N . , " '. m . . ' t .. , : . o ' , t : . . . . , . 1 ; : , . ~ , . . ! . , $ . ' _ . t : , j i l l. : . ' . . , i : . J ' ,I1 ,., . N u m b e r , l ' l 1 . Y ' t > s . t l r i. . nt 'Invaiitmerit, tnVM .+~ ., _ , , '" ' . , . ." : . . , , , . . \ , ' , ~ ' : ' I ' , . ,. , . . . ~ ( : ' '~.1' .' , ..... , . ...:,' . V~~':".':",1)2)

    Type.of'Buslness1) INOVEON 20,736.002)3)

    under p'~!lafties.of pe~u fY , I declare that I h~ve examine?this re turn, tnclud~cCompanying statements, a nd to t tW b s Sl 'o t m y kno '~ecig~and bel ief it is true, co r rec t and complete, . . .. .

    Omcer, ucnCll1t'armer or />wmot!r OaleThe Oklahoma Ta x Commission is not required to give actual notice to taxpayer of changes in any state tax law.

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    "

    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT" '~o/tl le 'C~i :~ '~d~t :v~r, 'l i~ 'a in 'g~ 'f C E '" 8 fl ~ 3'. zo IId en tif ic a tio n N um b e r, 0Corpora t fon 0 Pa r tne r sh i p C : : ' LL CName ot Small Bus !nessCap i t a l Company ()XU~UO""R LIFe SC,'NCE FIINQ]I, t.LC:AddressCity ?tate _,_, Zip ,

    ; " " ~ . ' ~ . ~ - ~ ~ ~ , " . ~ ~" . ~ , . _ . / ' : ' : , - " o . i ; ' " . - : ; c;,~~; TJe " , ~ ,.'{ " , _r . _.":"~;": ',, :, '\" "::. 'I~::':" "c ':,: . . : ... ~. _ "" '.,.~ ' ", ",; , '; , 'r,' _ \_.~_ :. _.__, .: _, "". :. _"1,,:,,_ -~"::\ _":,~ "1',;. ',- i'__._-;' , I i-. '_ . :: i ' ~ . ,- ~ -. ~ ; . :, ' . ~ ~ - ': . . . : - . ' . ' .. " , ~ _ .. : :~ ' , ' : ': ;~ ~ . ' . > ,,~Cp.mpte{' ;~ij~ffpJ)JrCii~ltj i$~Q~J.(jt i-1f:qril nV~~!i1e! ' i~ 'm~de,dtJ , r jO~\ ' i i l is .~i~i 'Odaf 'Y-~r.',:4:ttii,ij"~~I.loj1~F$'n~#t$$';',,',:': " i f : ' n ( i e ~ $ ' ~ f ~ : ~ h : C I 9 ' ~ ~ ' i j , 9 . n ' Y ; ~ i 1 h ~;:~P.ft~'ic9(ri'p.~hY:'~:!!:Ii~~~lljnal:lClitl~t~ie:jri~rii$;n t li J i{ b ~ ; d ~ ~ Y m ~ D t ~ r u o b .t Q , :' " ': : , ' : I , ry9. I~~1~i i~e: :~~~,~:~:~~~~t~~1:~~~~~1;~,p:~, ,~ :~~k~~\~~; t~et~,~:6.~,~f~~;~f ,

    1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I r I I I fl l l li l l I 1 1 1 I1 1 II~527 1oviSed 2007

    1)2)3}

    2 )3),,:':",J ,..'. , ' ,This information return, including enclosures, must be filed by Apt'il30th.' " .",'U nde r pe na ltie s of pe ~ury , I de cla re th at I h ave e xa mine d th is re tu rn , inc luding a ccom pa ny ing s ta te m ents , a nd to th e ba st o f m y know le dg ea n d b e lie f it is true . cor re ct a nd com ple te , . ,._ _ _ , . . __.. _ _ _ _ ... _ . . _ _

    .. ~ \ .. Officer,General P;r tr tar D r M(;fub;' ..... DaleTh e O kla hom a Ta x Com m is sion Is not re quire d to g i ve a ct ua l n otic e to ta xp a ye r ot ch ang es in a ny s ta te ta x la w.

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    State of OklahomaSMALL BUSINESS CAP fT AL COMPANYINFORMATION REPORT f , : i i # 4 f . . h ! : j . i J { :ik~ \;V~ t);EWdift~~ t:r.. ." ,'. .':;.:".':~!'f'~~~lifW'\'1~'W:t,x~':!~~fl"~

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    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT, - , i , r 'ar : '~~~,,6*t~~'~:~:r : : :; ',;"':; J t ~ ~ ~ : l l i ~ t : l : : : , .~ ~ , ~~ ? , ~ ~ ~ : , , ' , ' , ' , ~ ; ' , ' , : , , : , ~ ~ ~ , : :Id e n t i f ic a t io n N u m b e r , _ _ ,_ ,_ , , _ ~ , , , _ _ 0Corpora t i onN a m e o f S m a l l B u s in e s s C a o it a l C o m o a n v _ S _ O - ,O c . .: .N . . :. .: ,E . .: .. :, "R - ,- -, -, -IN _ V c . .: .E . .: .. :, S ;_ , ;T . .; .. M .; .; .E ; ;. ., N .. ., T _. S ., :. .. '. . . _ _. ; . _ _ , C . ; . _ _ . _A d d r e s s .C i t y .

    1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1~5271e vis ed 2 00 7

    o Pa r t ne r sh i p ,~LLC

    1) SEE AITACHED

    2 )3 )4)

    1)2 )~:I )

    1) ChIsholm Private CapIta! Partners Fund 160,0002 )3)" . ',; ',',' " ' .' " .', ";This information return, Including enclosures, must be filed by April 30th. ' , - ' " ,U nd e r p e na ltie s o f p e rju ry , I d e cla re th a t I h a ve e xa m in e d th is .l)e tu rn , in clu dln q a c com pa n yin g s ta te m e n ts , a n d to th e b e s t o f m y k nowle d g ea n d b e lie f it is tr ue , c or re ct a n d c om p le te .

    X ; .. _ _ _ O f t l c e r , J e M r a l ! Z i W c r M e m b e r DateT h~ O k la h om a T ax C omm is s ion I, no t re qJ re d to/' a c tu a l n otic e to ta xp ay er 0 1 ch a ng e s In a n y s ta te ta x .la w .

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    SOONER INVESTMENTS, LL.C.

    ruLtlEPULEkPART A) ENTITIES INVESTING IN THE SMALL BUSINESS CAPITAL COMPANY

    ..........- Ii ~V ESTbR.S'~-'-'----~:NAME

    1) HARVEY FAMILY L.L.C,JOt-IN R. HARVEY, MD. , MANAGER

    2) MT 1984 L.L,C.M, TIMOTHY HAUSER, MD., MANAGER

    -3) ROBERT R. KIPPERMAN, MD.

    4) JOHN D, RANDOLPH, MD.

    5} SCOTT FAMILY L.LC.BROOKE O. SCOTT, MD., MANAGER

    ,6) SCHMIDT FAMilY lLC,DWAYNE SCHMIDT, MD., MANAGER

    7) RONALD H, WHITE, MD,

    r DATE iINVESTED,. . . .H __ _ __ : - A M O U N f - ;! . ! . ~ _ Y ~ . S . ' f E 930,000,0010,000.00

    15,000,00

    30,000,00

    15,000,00

    30,000,00

    30,000.00

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    State of OklahomaSMALL BUSINESS CAPITAL COMPANYINFORMATION REPORT

    1 I D I I I I I m l l l m l l ~ I I I ~ ~ ~ l l l l m l l l l l l ~ 1 1~5211~~~~~~~~~~~~_~~".'~~--- __ ~~4~~ Raw~~7

    12/31/2007o Partnership OLLCden t if ica t ion Numbe r 0Oorpo ranon

    N a m e o f S m a l l B u s in e s s C a p it a l C o m p a n y . . . . . . . : , T . : : ; _ e r : . . : : : : c . : : . ;e t ;_ : , P . . ; : a ; ; _ : r t : : . . : . n e : : . ; r . ; ; , s , ! . . , : L : . , ; ; . L ; : : . . C . : : : : . . : . _ . _Address

    1) See Statement 1 1.025,512.002) ~ - - - - - - - - - - - - - - ~ ~ - - - - - - - - - - - - - - - - - - - + - - - - - - - - - ~ - - - - - - r - - - - - - - + - - - - ~3)4)

    2)3)

    1) Sse Slaterneni 1 2,000.000.00

    2)3)

    1) s ee S ta te m e nt 1 1,025,512. .00

    U n d e r panamas o f p e ~ u r y , I d e c la r e t h a t Ia nd be li e f i t is tr ue , c or re ct a n d c omp le te .This information return, includinp enclosures, must be filed by A p r i l 30th.

    -u J I1OOr.G en era l Par tnE ltwWm ber D aleT he O k la h om a T ax C omm is sion is n ot r equ i r ed to g ive a ctua l n otice to ta xpa ye r o f o ha ng os in a ny s ta te ta x l a w .

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    .~

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