ANNUAL AUDITED 'esskt ,7,g*, X-17A-5 1AP WashirigtOn ... · (e) Statement of Changesin...

18
OMBAPPROVAL SECUE " "" " ON OMS Numbet: 3235-0123 15025284 SEC wire: Muchst2ois ANNUAL AUDITED REN 'essk t" ,7,g*",... FORM X-17A-5 1AP 0 9 200 SEOFILENUMBER PART111 ' ' " ,(gg WashirigtOn DC E FACING PAGE 404 Inforrnation Required of Brokers and Dealers Pursuant to Section 17 of the Securities Exchange Act of 1934 andRule 17a-5 Thereunder REPORTFORTHEPERIODBEGINNING O DI i AND ENDING _ _ MM/DDMY MM/DDMY A. REGISTRANT IDENTIFICATION NAMB OF BROKBR-DBALER: 9 M Se.i.noha a G OFFIOIALUSEONLY ADDRESS OF PRINCIPAL PLACE OF BUSINESS: (Do not useP.O. Box No.) FIRM1.D. NO. (No.amiStreet) C.RaeioW.- ¡O C.. z.s1..o'L. (City) (state) (zip code) NAMB AND TBLBPHONE NUMBER OF PERSONTO CONTACT IN RBOARD TO THIS REPORT (Arca Code - Telephone Number) B. ACCOUNTANT IDENTIFICATION INDBPENDBNT PUBLIC ACCOUNTANT whose opinion is containedin this Report* tName-lf individual. state last,jint, middle name) (oT 2..T (Borego.., 'à\uà dok. suo C.MeioMe. Ao(.- 2..%d) (Address) (City) (State) (21pCode) CHECK ONE: Áertified Public Accotatant O Public Accountant 0 Accountant not resident in United States or anyof its possessions. POR OPPICIAI. USE ONLY *Claims for exemption from therequirement that the annualreport becoveredby theopinion ofan independent public accountant must besupported by a statement offects and circumstances relled on as the basisfor the eremption. SeeSection 240.17a.5(e)(2) Potential persons who are to respond to the collection of informationcontainedinthieformaronotreaufradtorespond SEC1410(08-02) unleastheformdisplaysacurrentlyvalldOMBoontroinumber, nea oy L.,ameCanner

Transcript of ANNUAL AUDITED 'esskt ,7,g*, X-17A-5 1AP WashirigtOn ... · (e) Statement of Changesin...

Page 1: ANNUAL AUDITED 'esskt ,7,g*, X-17A-5 1AP WashirigtOn ... · (e) Statement of Changesin Stockholders'Equity or Partners'or SoleProprietors'Capital, f) Statementof Changesin Liabilities

OMBAPPROVALSECUE " " " " ON OMSNumbet: 3235-0123

15025284 SEC wire: Muchst2ois

ANNUAL AUDITEDREN 'esskt" ,7,g*",...FORMX-17A-5 1AP 0 9200 SEOFILENUMBER

PART111 ' ' " ,(ggWashirigtOnDC EFACINGPAGE 404

Inforrnation Required of Brokers andDealersPursuant to Section 17 of theSecurities ExchangeAct of 1934andRule17a-5Thereunder

REPORTFORTHEPERIODBEGINNING O D I i AND ENDING

__ MM/DDMY MM/DDMY

A.REGISTRANT IDENTIFICATION

NAMBOF BROKBR-DBALER: 9 M Se.i.noha a G OFFIOIALUSEONLY

ADDRESS OF PRINCIPAL PLACE OF BUSINESS: (Do not useP.O.Box No.) FIRM1.D.NO.

(No.amiStreet)

C.RaeioW.- ¡O C.. z.s1..o'L.(City) (state) (zip code)

NAMB AND TBLBPHONE NUMBER OF PERSONTO CONTACT IN RBOARD TO THISREPORT

(Arca Code - TelephoneNumber)B.ACCOUNTANT IDENTIFICATION

INDBPENDBNT PUBLIC ACCOUNTANT whoseopinion is containedin this Report*

tName-lf individual.state last,jint, middle name)

(oT 2..T (Borego.., 'à\uà dok. suo C.MeioMe. Ao(.- 2..%d)(Address) (City) (State) (21pCode)

CHECK ONE:

Áertified Public Accotatant

O Public Accountant

0 Accountant not resident in United Statesoranyof its possessions.

POROPPICIAI.USE ONLY

*Claimsforexemptionfrom therequirement that the annualreport becoveredby theopinionofan independentpublic accountant

must besupported by astatement offects and circumstances relledonas the basisfor the eremption.SeeSection 240.17a.5(e)(2)

Potential persons who are to respond to the collection ofinformationcontainedinthieformaronotreaufradtorespond

SEC1410(08-02) unleastheformdisplaysacurrentlyvalldOMBoontroinumber,

nea oy L.,ameCanner

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OATH OR AFFIRMATION

1, ,swear(or affirm) that, to the bestofmyknowledgeand belief the accompanyingfinanclatstatementandsupportingschedulespertaining to the firm of

M ács g,4-ita L.LC.... , asof 2.3 fe.hm.as ,20 i T' ,are true andcorrect.I further swear (or affirm) that

neither the companynorany partner,proprietor,prlacipal officer or directorhas anyproprietary interest in any accountclassified solely as that of a customer,except asfollows:

TA Title

T oport **c ntains (check all applicable bo /RG GStatement of FinancialCondition.Statement of Income (Loss).Statementof Changesin FinancialCondition.

(e) Statement of Changesin Stockholders'Equity or Partners'or SoleProprietors' Capital,f) Statement of Changesin Liabilities Subordinatedto Claimsof Creditors.

Computationof Net Capital,

(h) Computationfor Determinationof ReserveRequirementsPursuant to Rule 15o3-3.(i) InformationRelatingto the Possessionor Control RequirementsUnder Rule 1503-3,

(i) A Reconcillation,including appropriate explanation of the Computationof NotCapitalUnder Rule ISc3-1andtheComputationfor Determinationof the ReserveRequirementsUnderExhibit A of Rulo 1503-3,

D (k) A Reconciliationbetween the auditedandunauditedStatementsof FinancialConditionwith respectto methodsofconsolidation._ ß)-'''An Oathor Affirmation.W(m) A copyof the SIPCSupplementalReport.

O (n) A reportdescribinganymaterial inadequaclesfoundtoexistor foundto haveexistedsincethe dateof thepreviousaudit.

**Forconditionsofconfidentiat treatment of certainportions of t/sisfiling, seesection 240.11a-3(e)(3).

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TMSECURITIES,LLC

TABLEOF CONTENTS

Page No.

REPORTOF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM.............. 1

FINANCIALSTATEMENTS

Statementof Financial Condition................................................................................2

Statementof Operations............................................................................................3

Statementof Member's Equity...................................................................................4

Statementof Cash Flows...........................................................................................5

Notes to Financial Statements ...................................................................................6

SUPPLEMENTALINFORMATION

ScheduleI - Computation of Net Capital Under Rule 15c3-1of the Securities and Exchange Commission.............................................................9

7M Securities Exemption Report................................................................................11

Reportof IndependentRegistered PublicAccounting Firm -

ExemptionReport Review..........................................................................................12

Reportof Independent Registered PublicAccountingFirm'sReport onApplyingAgreed-Upon Procedure Relatedto anEntity'sSIPCAssessmentReconciliation Requiredby SEC Rule 17A-5(e)(4).................................13

FormSIPC-7..............................................................................................................14

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DHGDIXONHUGHESGOODMANe

REPORTOF INDEPENDENTREGISTEREDPUBLICACCOUNTINGFIRM

To the Membersof 7M Securities, LLC

We have audited the accompanying financial statements of 7M Securities,LLC (the"Company"),whichcomprise the statement of financlai condition as of December 31, 2014, and the related statements ofoperations, members' equity and cash flows for the year then ended that are filed pursuant to Rule 17a-5 under the Securities Exchange Act of 1934, and the related notes to the financial statements andsupplementalInformation.The Company'smanagement is responsible for these financial statements.Our responsibliity is to express an opinion on these financial statementsbased on our audit.

We conducted our audit in accordance with the standards of the Public Company Accounting OversightBoard (United States).Those standards require that we plan and perform the audit to obtain reasonableassuranceaboutwhether the financial statements are free of materialmisstatement.The Companyisnot required to have, nor were we engaged to perform,an audit of its internal control over financialreporting.Our audit included consideration of internal control over financlai reporting as a basis fordesigning audit procedures that are appropriate in the circumstances, but not for the purpose ofexpressing an opinion on the effectivenessof the company'sinternal control over financial reporting.Accordingly,we express no such opinlon.An audit also includesexamining,on a test basis,evidencesupporting the amounts and disclosures in the financial statements, assessing the accounting principlesused and significant estimates made by management,as well as evaluating the overall financialstatement presentation.We believe that our audit provides a reasonable basis for ouropinion.

In our opinion, the financial statements referred to above present fairly, in all material respects,thefinancial condition of the Company as of December 31, 2014, and the results of its operations and itscash flows for the year then ended in accordance with accounting principles generally accepted in theUnited States of America.

The Computation of Net Capital pursuant to Rule 15c3-1 of the Securities Exchange Act of 1943 hasbeen subjected to audit procedures performed in conjunction with the audit of the Company's financialstatements. The supplemental information is the responsibility of the Company'smanagement.Ouraudit procedures included determining whether the supplemental Information reconciles to the financialstatements or the underlyingaccounting and other records,as applicable,and performing proceduresto test the completeness and accuracy of the information presented in the supplemental Information.Informing our opinion on the supplemental information, we evaluated whether the supplementalInformation,includingits form and content,is presentedinconformitywith Rule17a-5 of the SecuritiesExchangeAct of 1934. In our opinion, the supplementalInformationis fairly stated, in all materialrespects, in relation to the financial statements as a whole.

Pia llulwGaduan/2Charlotte, North CarolinaFebruary 27, 2015

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TMSECURITIES,LLCSTATEMENT OF FINANCIAL CONDITIONDecember 31,2014

ASSETS

CURRENTASSETS

Cash $ 217,131Note receivable 37,500

TOTAL ASSETS $ 254,631

LIABILITIES AND MEMBER'S EQUITY

CURRENTLIABILITIESAccounts payable $ 23,128Accrued expenses 150,000

TOTAL LIABILITIES 173,128

MEMBER'SEQUITY 81,503

TOTAL LIABILITIESAND MEMBER'SEQUITY $ 254,631

See accompanyingnotes. Page 2

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TM SECURITIES,LLCSTATEMENTOF OPERATIONSYearEnded December 31,2014

FINANCIAL ADVISORY FEES $ 2,208,823

OPERATING EXPENSES:Commissions 1,413,044Wages and benefits - related party 156,000Professionalfees 25,612Rent - relatedparty 1,200Other operatingexpenses 3,229

1,599,085

NET INCOME $ 609,738

Seeaccompanyingnotes. Page 3

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TM SECURITIES,LLCSTATEMENTOF CHANGES IN MEMBER'S EQUITYYearEnded December 31, 2014

BALANCE,December 31, 2013 16,765

Net Income 609,738Lesscash distribution to Parent (545,000)

BALANCE,December 31, 2014 $ 81,503

Seeaccompanyingnotes. Page 4

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TM SECURITIES,LLCSTATEMENTOF CASH FLOWSYear Ended December 31,2014

CASH FLOWS FROM OPERATING ACTIVITiES

Net income $ 609,738Adjustmentsto reconcile net income to net cash

provided by operating activities:Changes in operating assets and liabilities:

Note receivable (37,500)Accounts payable 6,321Accrued expenses 130,000

NET CASH PROVIDED

BYACTIVITIES 708,559

CASH FLOWS FROM FINANCING ACTIVITIES

Cash Distributionto Parent (545,000)

NET INCREASEIN CASH 163,559

CASH,BEGINNING 53,572

CASH,ENDING $ 217,131

Seeaccompanyingnotes. Page 5

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TM SECURITIES,LLCNOTESTO FINANCIAL STATEMENTSDecember 31,2014

NOTEA - NATUREOF BUSINESSAND SIGNIFICANTACCOUNTINGPOLICIES

Natureof Operations

7M Securities, LLC (the "Company")was incorporated in the state of North Carolina on March3, 2010for the purpose of becoming qualified as a licensed broker/dealer. In 2011, the Company becamelicensedas a broker/dealer and began operation providingmerger and acquisition services to middlemarket companies and private equity firms. Effective January 1, 2013, 7M Securities became awholly-ownedsubsidiaryof 7 Mile Advisors, LLC.("7MA").Prior to January 1,2013, the Companywasrelatedto 7 MileAdvisors, LLC by common ownership.

Useof estimates

The preparationof financial statements in conformity with accounting principles generally accepted inthe United States of America ("U.S. GAAP") requires management to make estimates andassumptions that affect the reported amounts of assets and liabilities and disclosure of contingentassets and liabilities at the date of the financial statementsand the reported amounts of revenues andexpensesduring the reporting period. Actual results could differ from those estimates.

Revenue

The Company enters into contracts with customers to provide investment banking services. Thecontractsgenerally contain a success fee that is contingent upon the closing of a transaction. Thecontingent success fee is recognized as revenue upon the achievement of the contingent event,which is generallythe successful closing of the transaction.

Incometaxes

The Company is organized as a limited liability company and has elected to be treated as apartnershipfor income tax purposes. The Companyrecognizes the tax benefits from an uncertaintaxpositiononly if it is more likely than not that the tax position will be sustained on examination by thetaxing authority, based on the technical merits of the position. Tax years that remain subject toexamination by major tax Jurisdictionsdate back to the year ended December 31, 2011. All federaland state income tax positions taken or anticipated to be taken in the income tax returns areattributableto the members and not to the entity.

The income and losses of the Company are included in the member's personal tax retum. As ofDecember 31, 2014, there are no known items which would result in a material accrual related towhere the Company has federal or state attributabletax positions.

Subsequentevents

The Companyevaluated subsequent events through the date that these financial statementswereissued.

Page 6

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7MSECURITIES,LLCNOTES TOFINANCIAL STATEMENTSDecember 31,2014

NOTE B - TRANSACTIONS WiTH RELATED PARTIES

Through December 31, 2012, the Company was related to 7MA by common ownership. TheCompanyand 7MA entered into a managementservice agreement (the "Agreement"), in accordancewith the terms of the Agreement, 7MA charges the Company a portion of the general andadministrative expenses incurred by 7MA based on the amount used by the Company. Theseexpenses include: (a) management and administrative salaries, wages, and benefits; (b) sharedfacilities costs; and (c) other miscellaneous general and administrative expenses. For the yearsended December31, 2014, included in wages and benefits - related party was $6,000. For the yearsendedDecember31, 2014, included in rent - relatedparty was $1,200 of allocated costs.There wereno allocatedcosts in other operating expenses for the year ended December31, 2014.

Employees of the Company and of 7MA are eligible to participate in the profit sharing plan (the"Plan"). After completing one year of service, each participant is eligibie to receive a discretionaryemployer contribution each year. The Company does not have any employees but is allocated aportionof salariesfrom 7MA including a profit sharing contribution. For the year ended December31,2014, 7MA allocated contributions of $150,000 to the Company which was recorded in accruedexpenses at December 31, 2014. There were no outstanding related party amounts due as ofDecember31, 2014.

NOTEC - CONCENTRATIONOF CREDITRISK

The Company maintains its cash in bank deposits,which at times may exceed federally insured limits.The Companyhas not experienced any losses in such accounts.

NOTED - SIGNIFICANT CUSTOMERS

Sevencustomersaccounted for 100% of total revenuefor the year ended December 31, 2014.

Page 7

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TM SECURITIES,LLCNOTES TO FINANCIAL STATEMENTSDecember 31,2014

NOTEE - COMMITMENTS

The Company ieases office space from a related party (see Note B) through November 30, 2019.The Company recorded rent expense of $100 per month for a total of $1,200 for the year endedDecember31, 2014.

At December31, 2014 the expected approximate rent paymentsunder the iease are as follows:

Year EndedDecember 31,

2015 $ 1,2002016 1,2002017 1,2002018 1,2002019 1,200

$ 6,000

NOTEF - NET CAPITAL REQUIREMENTS

The Company is subject to the Securities and Exchange CommissionUniform Net Capital Rule (SECRule 15c3-1), which requires the maintenance of minimum net capital and requires that the ratio ofaggregate indebtedness to net capital, both as defined, shall not exceed 15 to 1. At December 31,2014, the Company had net capital of $44,003which was$32,461 in excess of its required net capitalof $5,000 in 2014. The Company's aggregate indebtedness to net capital ratio was 3.9 to 1 atDecember31, 2014.

NOTEG - POSSESSIONOR CONTROL REQUIREMENTS

The Companydoes not take possession of or control customerfunds or securities.

Page 8

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a

SUPPLEMENTALINFORMATION

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7M SECURITIES,LLCSCHEDULEI - COMPUTATION OF NET CAPITAL UNDERRULE 15c3-1

OF THESECURITIES AND EXCHANGE COMMISSIONDecember 31, 2014

COMPUTATIONOF NET CAPITAL

Total member'sequity qualified for net capital $ 81,503

Add:Subordinatedborrowings allowable in computationof

net capitalOther (deduction) or allowable credits -

Total capitaland allowable subordinated borrowings 81,503

Deductions and/or charges:Total nonallowableassets - Notes receivable (37,500)Other additionsand/or allowable credits

Net capital $ 44,003

Seereport of independent registered public accounting firm. Page9

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TM SECURITIES,LLCSCHEDULEI - COMPUTATION OF NET CAPITAL UNDERRULE 15c3-1

OF THESECURITIES AND EXCHANGE COMMISSION(Continued)December 31, 2014

COMPUTATIONOF AGGREGATE INDEBTEDNESS

Total liabilitiesfrom statement of financial condition

$ 173,128

Total aggregate indebtedness 173,128

COMPUTATIONOF BASIC NET CAPITAL REQUIREMENT

Minimumnet capital required 11,542

Minimumdollar requirement 5,000

Net capital requirement 11,542

Excess net capital at 1500% $ 32,461

Excessnet capital at 1000% $ 26,690

Percentageof aggregate indebtedness to net capital 393.45%

RECONCILIATIONWITH COMPANY'S COMPUTATIONTO AUDIT FINANCIAL STATEMENTS

Net capital,as reported in Company'sPart li (Unaudited)FOCUSreport $ 44,003

Net auditadjustments

Net capitalper previous page $ 44,003

Seereport of independent registered pubiic accountingfirm. Page 10

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DHGDIXONHUGHESGOODMANur

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

To the Memberof 7M Securities,LLC

We have reviewed management's statements, included in the accompanying the exemption report, inwhich (1) 7M Securities, LLC (the "Company") identified the following provisions of 17 C.F.R.§15c3-3(k)under which the Company claimed an exemption from 17 C.F.R.§240.15c3-3: (2)(l) (the "exemptionprovisions")and (2) 7M Securities,LLC stated that the Companymet the identified exemptionprovisionsthroughout the most recent fiscal year without exception.The Company's management is responsible forcompliance with the exemption provisions and its statements.

Our review was conducted in accordance with the standards of the Public Company AccountingOversightBoard (United States) and, accordingly,includedinquiriesand other required procedurestoobtain evidence about the Company'scompliance with the exemption provisions.A reviewis substantiallyless in scope than an examination, the objective of which is the expression of an opinion onmanagement'sstatements.Accordingly,we do not expresssuchan opinion.

Based on our review, we are not aware of any material modificatlons that should be made tomanagement'sstatements referred to above for them to be fairly stated, in all material respects,basedon the provisions set forth in paragraph (k)(2)(i) of Rule 15c3-3 under the Securities Exchange Act of1934.

Charlotte,North CarolinaFebruary 27, 2015

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7M Securities Exemption Report

7M Securities (the "Company") is a registered broker-dealer subject to Rule 17a-5 promulgated by theSecurities and ExchangeCommission (17 C.F.R.§240.17a-5,"Reportsto be made by certain brokers anddealers").This Exemption Report waspreparedas required by 17 C.F.R.§240.17a-5(d)(1)and (4).To thebest of its knowledge and belief, the Company states the following:

The Company may file an Exemption Report becausethe Company had no obligations under 17 C.F.R.§240.15c3-3(k)(2)(l).

Further,the Company met the identified exemption provisions throughout the most recent year fromJanuary1,2014 through December 31,2014 without exception.

7M Securities

1,Leroy Davis,swear (or affirm) that, to my best knowledge andbelief, this Exemption Report is trueand correct.

By:

Title: Leroy Davis,Partner

Date: February 23, 2015

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DHGDIXONHUGHESGOODMANete

INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM'S AGREED-UPON PROCEDURESREPORT ON SCHEDULE OF ASSESSMENT AND PAYMENTS (FORM SIPC-7)

Tothe Membersof 7M Securities,LLC

In accordance with Rule 17a-5(e)(4) under the Securities Exchange Act of 1934,we have perlormedthe procedures enumerated below with respect to the accompanying Schedule of AssessmentandPayments(Form SIPC-7) to the SecuritiesinvestorProtectionCorporation (SIPC) for the year endedDecember 31, 2014, which were agreed to by 7M Securities,LLC (the "Company"),and the Securitiesand Exchange Commission,Financial industry Regulatory Authority, Inc.,SIPC, solely to assist youand the other specified parties in evaluating the Company'scompliance with the applicable instructionsof FormSIPC-7.The Company'smanagement is responsible for the Company'scompliance with thoserequirements.This agreed-upon procedures engagementwasconductedInaccordancewithattestationstandards established by the Public Company Accounting Oversight Board (United States). Thesufficiency of these procedures is solely the responsibility of those parties specifled in this report.Consequently, we make no representation regarding the sufficiency of the procedures described beloweither for the purpose for which this report has been requested or for any other purpose.The procedureswe performed and our findings are as follows:

1) Compared the listed assessmentpayments in Form SIPC-7 with respective cash disbursementrecords entries of the Company,noting no differences;

2) Compared the amounts reported on the audited FormX-17A-5 for the year ended December 31,2014, as applicable,with the amounts reported in FormSIPC-7 for the year ended December 31,2014, noting no differences;

3) Comparedany adjustments reported in FormSIPC-7 with supporting schedules andworkingpapers,noting no differences;

4) Proved the arithmetical accuracy of the calculations reflected in Form SIPC-7 and in the relatedschedulesand working paperssupportingthe adjustmentsnoting no differences; and

5) Comparedthe amountof any overpaymentappliedto the currentassessmentwith the FormSIPC-7 on which it wasoriginally computed,noting no differences.

We were not engaged to, and did not conduct an examination, the objective of which would be theexpression of an opinion on compilance.Accordingly, we do not express such an opinion. Had weperformed additional procedures, other mattersmight have come to our attention that would have beenreported to you.This report is intended solely for the information and useof the specified parties listed above and is notintended to be and should not be used by anyone other than these specified parties.

��\,Charlotte,North Carolina

February 27, 2015

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SECURITIES INVESTOR PROTECTION CORPORATION

SIPC-7 e ° 8°×32,33 wassington. o.o. 20000-2135 SIPC-7202-371-8300

{33-REV 7/10) General ASSeSSment R0000Cilll00 (33-REV 7/10)

For the baal year ended 12/31/20l4

(Read carefuly the insuuebens in your Wortog Copy before complohng IMs Form)

TO BE FILED BY ALL SIPC MEMBERS WITHFISCAL YEAR ENDINGS

1. Nameof Member. address. Designaled Examining Authorly, 1934 Act registralion no. and monih in which liscal year ends forpurposes of the audit tenuirement of SEC Rolo Da 5

Note: 11any of the informalion shownon the16'i6"""""2115"*"""""""""MIXED AADC 220 i mailing label requires correcjlon, please e-mail068587 FINRA DEC any corrections to [email protected] so7MSECURITIES LLC indicate on the form filed.201 S COLLEGE ST STE 2383

CHARLOTTE NC 28244-0002 Name and telephone number of person tocontact respecting this form.

2. A. General Assessment (item 2e trom page 2) S 5 i 37

B. Less paymentmadewith SIPC-6 bled (exclude Interest)

Date Paid

C. Less prior overpayment applied

D. Assessment balance due or (overpayment) 5531

E. Interest computed on late payment (see instruction E) for____daysat 20% per annum "'

F. Total assessment balance and interest due (or overpayment carried forward) $ 5 077G. PAID WITH THIS FORM:

Check enclosed, payable to SIPCTotal (must be same as F above) $ 55 22.

H. Overpayment carried forward $( )

3 Subsidiaries (S) and predecessors (P) included in this form (give nameand 1934 Act registration number):

The SIPC member submitting this form and theperson by whom it is executed represent therebythat all information contained herein is true, correct 72 h(.t.en Uf.f & (and complete. *****¶0 i Panneop or oma orenusuony

(AAndredsignange)

Dated the day of , 20i. dytros)

This term and the assessment payment is due 60 days after the end at the fiscal year. Retain the Working Copy of this tormfor a period of not less than 6 years, the latest 2 years in aneasily accessible place.

Dates:

a Postmarked Received Reviewedi.u9 Calculations Documentation ForwardCopyuacc:e Exceptions:

co" Disposition of exceptions:

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