This is the Primary Document downloaded from EDGAR on 3/12/2021 5:02:47 PM EST for EFDID 307021 and Accession Number 0001766259-21-000001.

SEC FORM D/A

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.

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

Notice of Exempt Offering of Securities

OMB APPROVAL
OMB Number: 3235-0076
Estimated average burden
hours per response: 4.00

1. Issuer's Identity

CIK (Filer ID Number) Previous Names
X None
Entity Type
0001766259
   Corporation
   Limited Partnership
X Limited Liability Company
   General Partnership
   Business Trust
   Other (Specify)

Name of Issuer
Bourne Seniors Housing V, LLC
Jurisdiction of Incorporation/Organization
DELAWARE
Year of Incorporation/Organization
   Over Five Years Ago
X Within Last Five Years (Specify Year) 2018
   Yet to Be Formed

2. Principal Place of Business and Contact Information

Name of Issuer
Bourne Seniors Housing V, LLC
Street Address 1 Street Address 2
228 N. PARK AVENUE, SUITE A
City State/Province/Country ZIP/PostalCode Phone Number of Issuer
WINTER PARK FLORIDA 32789 (407) 636-7226

3. Related Persons

Last Name First Name Middle Name
Bourne Robert A.
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Bourne R. Kyle
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Kelley Michael C.
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Spears Samuel
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship: X Executive Officer    Director    Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Bourne Seniors Housing Manager V, LLC Bourne Seniors Housing Manager V, LLC
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship:    Executive Officer    Director X Promoter

Clarification of Response (if Necessary):


Last Name First Name Middle Name
Bourne Financial Group, LLC Bourne Financial Group, LLC
Street Address 1 Street Address 2
228 N. Park Avenue, Suite A
City State/Province/Country ZIP/PostalCode
Winter Park FLORIDA 32789
Relationship:    Executive Officer    Director X Promoter

Clarification of Response (if Necessary):


4. Industry Group

   Agriculture
Banking & Financial Services
   Commercial Banking
   Insurance
   Investing
   Investment Banking
   Pooled Investment Fund
Is the issuer registered as
an investment company under
the Investment Company
Act of 1940?
   Yes    No
   Other Banking & Financial Services
   Business Services
Energy
   Coal Mining
   Electric Utilities
   Energy Conservation
   Environmental Services
   Oil & Gas
   Other Energy
Health Care
   Biotechnology
   Health Insurance
   Hospitals & Physicians
   Pharmaceuticals
   Other Health Care
   Manufacturing
Real Estate
   Commercial
   Construction
   REITS & Finance
   Residential
X Other Real Estate
  
Retailing
  
Restaurants
Technology
   Computers
   Telecommunications
   Other Technology
Travel
   Airlines & Airports
   Lodging & Conventions
   Tourism & Travel Services
   Other Travel
  
Other

5. Issuer Size

Revenue Range OR Aggregate Net Asset Value Range
   No Revenues    No Aggregate Net Asset Value
   $1 - $1,000,000    $1 - $5,000,000
   $1,000,001 - $5,000,000    $5,000,001 - $25,000,000
   $5,000,001 - $25,000,000    $25,000,001 - $50,000,000
   $25,000,001 - $100,000,000    $50,000,001 - $100,000,000
   Over $100,000,000    Over $100,000,000
X Decline to Disclose    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))
   Rule 504 (b)(1)(i)
   Rule 504 (b)(1)(ii)
   Rule 504 (b)(1)(iii)
X Rule 506(b)
   Rule 506(c)
   Securities Act Section 4(a)(5)
   Investment Company Act Section 3(c)
   Section 3(c)(1)    Section 3(c)(9)  
   Section 3(c)(2)    Section 3(c)(10)
   Section 3(c)(3)    Section 3(c)(11)
   Section 3(c)(4)    Section 3(c)(12)
   Section 3(c)(5)    Section 3(c)(13)
   Section 3(c)(6)    Section 3(c)(14)
   Section 3(c)(7)

7. Type of Filing

   New Notice Date of First Sale 2019-04-22    First Sale Yet to Occur
X Amendment

8. Duration of Offering

Does the Issuer intend this offering to last more than one year?
X Yes    No

9. Type(s) of Securities Offered (select all that apply)

X Equity    Pooled Investment Fund Interests
   Debt    Tenant-in-Common Securities
   Option, Warrant or Other Right to Acquire Another Security    Mineral Property Securities
   Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security    Other (describe)

10. Business Combination Transaction

Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer?
   Yes X No

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
Cobalt Capital, Inc. 136161
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
11650 S. State Street
City State/Province/Country ZIP/Postal Code
Draper UTAH 84020
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
X All States
   Foreign/non-US

Recipient
Recipient CRD Number    None
Alan R. Druckenmiller 5191639
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Advisory Group Equity Services Ltd. 15427
Street Address 1 Street Address 2
1215 Story Hill Road
City State/Province/Country ZIP/Postal Code
Wilbraham MASSACHUSETTS 01095
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
COLORADO
CONNECTICUT
MAINE
MASSACHUSETTS
NEW HAMPSHIRE
NORTH CAROLINA
OHIO
VERMONT
WISCONSIN

Recipient
Recipient CRD Number    None
Rodney Bahy Ibrahim 4358176
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Aegis Capital Corp. 15007
Street Address 1 Street Address 2
40 Wall Street, 46th Floor
City State/Province/Country ZIP/Postal Code
New York NEW YORK 10005
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
CALIFORNIA
COLORADO
CONNECTICUT
FLORIDA
GEORGIA
ILLINOIS
LOUISIANA
MARYLAND
MASSACHUSETTS
MICHIGAN
NEW JERSEY
NEW YORK
NORTH DAKOTA
OKLAHOMA
PENNSYLVANIA
PUERTO RICO
SOUTH CAROLINA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Jason Corey Griggs 4795395
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Arkadios Capital 282710
Street Address 1 Street Address 2
10739 Deerwood Park Blvd, #105
City State/Province/Country ZIP/Postal Code
Jacksonville FLORIDA 32256
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
COLORADO
FLORIDA
MICHIGAN

Recipient
Recipient CRD Number    None
James O'Neal Mitchell Jr. 336937
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Berthel, Fisher & Company Financial Services, Inc. 13609
Street Address 1 Street Address 2
1902 Flint Road SE, Suite A
City State/Province/Country ZIP/Postal Code
Decatur ALABAMA 35601
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA

Recipient
Recipient CRD Number    None
Jamie Mittiga Powell 1596875
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Berthel, Fisher & Company Financial Services, Inc. 13609
Street Address 1 Street Address 2
8240 Beckett Park Drive, Suite B
City State/Province/Country ZIP/Postal Code
West Chester OHIO 45069
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
COLORADO
FLORIDA
GEORGIA
ILLINOIS
INDIANA
KENTUCKY
MARYLAND
MICHIGAN
MINNESOTA
MISSOURI
NEW YORK
OHIO
OREGON
UTAH
VIRGINIA
WISCONSIN

Recipient
Recipient CRD Number    None
Brian Aurey Uphoff 1569323
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Calton & Associates, Inc. 20999
Street Address 1 Street Address 2
7219 US Hwy 41 North
City State/Province/Country ZIP/Postal Code
Palmetto FLORIDA 34221
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
COLORADO
FLORIDA
MICHIGAN
NEW JERSEY
VIRGINIA
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Byron Keith Crosby 2158157
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Calton & Associates, Inc. 20999
Street Address 1 Street Address 2
8780 Seminole Blvd, Suite 100
City State/Province/Country ZIP/Postal Code
Seminole FLORIDA 33772
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA

Recipient
Recipient CRD Number    None
John Treadway Brogdon, Jr. 1450806
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Calton & Associates, Inc. 20999
Street Address 1 Street Address 2
13111 Westheimer Road, Suite 475
City State/Province/Country ZIP/Postal Code
Houston TEXAS 77077
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
CALIFORNIA
IOWA
LOUISIANA
NORTH CAROLINA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Marc Alan Seeherman 1131557
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Calton & Associates, Inc. 20999
Street Address 1 Street Address 2
32 West 40th Street, 7th Floor
City State/Province/Country ZIP/Postal Code
New York NEW YORK 10018
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
ILLINOIS
INDIANA
IOWA
KANSAS
MARYLAND
MICHIGAN
MISSOURI
NEVADA
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
TEXAS
VIRGINIA
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Center Street Securities, Inc. 26898
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
2 International Plaza, Suite 301
City State/Province/Country ZIP/Postal Code
Nashville TENNESSEE 37217
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
X All States
   Foreign/non-US

Recipient
Recipient CRD Number    None
Tyler Don Sullivan 5401187
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Client One Securities LLC 152974
Street Address 1 Street Address 2
104 W 9th Avenue
City State/Province/Country ZIP/Postal Code
Bristow OKLAHOMA 74010
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CALIFORNIA
COLORADO
GEORGIA
ILLINOIS
KANSAS
MISSOURI
NEVADA
OKLAHOMA
TEXAS

Recipient
Recipient CRD Number    None
James Franklin Shenk 2876098
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Coastal Equities, Inc. 23769
Street Address 1 Street Address 2
3032 Seven Valleys Road
City State/Province/Country ZIP/Postal Code
Glen Rock PENNSYLVANIA 17327
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
COLORADO
CONNECTICUT
FLORIDA
MAINE
MARYLAND
MICHIGAN
NEW JERSEY
NORTH CAROLINA
OHIO
OREGON
PENNSYLVANIA
VIRGINIA
WISCONSIN

Recipient
Recipient CRD Number    None
Benjamin Melvin Schick 4897243
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Cobalt Capital, Inc. 136161
Street Address 1 Street Address 2
600 Wilkinson Street, Suite 300
City State/Province/Country ZIP/Postal Code
Orlando FLORIDA 32803
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ARKANSAS
CALIFORNIA
COLORADO
FLORIDA
GEORGIA
ILLINOIS
INDIANA
MASSACHUSETTS
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW MEXICO
NEW YORK
NORTH CAROLINA
OHIO
PUERTO RICO
SOUTH DAKOTA
TEXAS
UTAH

Recipient
Recipient CRD Number    None
Concorde Investment Services, LLC 151604
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
19500 Victor Parkway, Suite 550
City State/Province/Country ZIP/Postal Code
Livonia MICHIGAN 48152
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Dempsey Lord Smith, LLC 141238
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
901 N Broad Street, Suite 400
City State/Province/Country ZIP/Postal Code
Rome GEORGIA 30161
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
DFPG Investments, LLC 155576
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
9017 S Riverside Drive, Suite 210
City State/Province/Country ZIP/Postal Code
Sandy UTAH 84070
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Dan Holzer 5779187
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Emerson Equity LLC 130032
Street Address 1 Street Address 2
155 Bovet Road, Suite 725
City State/Province/Country ZIP/Postal Code
San Mateo CALIFORNIA 94402
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
COLORADO
FLORIDA
ILLINOIS
MARYLAND
MICHIGAN
NEVADA
NEW MEXICO
NEW YORK
OHIO
OKLAHOMA
PENNSYLVANIA
TEXAS
UTAH
VIRGINIA
WASHINGTON

Recipient
Recipient CRD Number    None
Navinbhai Hirabhai Patel 6994505
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Emerson Equity LLC 130032
Street Address 1 Street Address 2
155 Bovet Road, Suite 725
City State/Province/Country ZIP/Postal Code
San Mateo CALIFORNIA 94402
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
CALIFORNIA
FLORIDA
GEORGIA
KENTUCKY
MISSOURI
NEW JERSEY
NORTH CAROLINA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Sudhir G. Pai 5928622
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Emerson Equity LLC 130032
Street Address 1 Street Address 2
4512 Legacy Drive, Suite 100
City State/Province/Country ZIP/Postal Code
Plano TEXAS 75024
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSOURI
NEBRASKA
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
SOUTH CAROLINA
TENNESSEE
TEXAS
UTAH
VIRGINIA
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Dakota A. Lawrence 5255723
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Great Point Capital LLC 114203
Street Address 1 Street Address 2
100 Rialto Place, Suite 700
City State/Province/Country ZIP/Postal Code
Melbourne CALIFORNIA 32901
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA

Recipient
Recipient CRD Number    None
Brad Whalen 2582276
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Green Vista Capital, LLC 293630
Street Address 1 Street Address 2
222 N. Park Avenue
City State/Province/Country ZIP/Postal Code
Winter Park FLORIDA 32789
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ARIZONA
ARKANSAS
CALIFORNIA
FLORIDA
ILLINOIS
INDIANA
KANSAS
MARYLAND
MASSACHUSETTS
MISSOURI
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
PENNSYLVANIA
SOUTH CAROLINA
TEXAS
VIRGINIA
WISCONSIN

Recipient
Recipient CRD Number    None
Samuel Scott Bianchi 3036667
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
IBN Financial Services, Inc. 42360
Street Address 1 Street Address 2
404 Old Liverpool Road
City State/Province/Country ZIP/Postal Code
Liverpool NEW YORK 13088
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ILLINOIS
MASSACHUSETTS
NEW YORK
OHIO
PENNSYLVANIA

Recipient
Recipient CRD Number    None
Timothy Daniel Nihill 4220287
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
IBN Financial Services, Inc. 42360
Street Address 1 Street Address 2
23 Middle Street, Suite 301
City State/Province/Country ZIP/Postal Code
Newburyport MASSACHUSETTS 01950
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA
MAINE
MASSACHUSETTS
NEW HAMPSHIRE
NEW YORK
RHODE ISLAND
TEXAS
VERMONT

Recipient
Recipient CRD Number    None
Todd Robert Rhine 2384366
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
IBN Financial Services, Inc. 42360
Street Address 1 Street Address 2
7 Finch Street
City State/Province/Country ZIP/Postal Code
Hilton Head Island SOUTH CAROLINA 29926
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CALIFORNIA
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
KANSAS
LOUISIANA
MARYLAND
MASSACHUSETTS
NEW MEXICO
NEW YORK
NORTH CAROLINA
OREGON
SOUTH CAROLINA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Barry Eugene Weed 816202
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Intercarolina Financial Services, Inc. 19475
Street Address 1 Street Address 2
1400 Battleground Avenue, Suite 210
City State/Province/Country ZIP/Postal Code
Greensboro NORTH CAROLINA 27408
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
NORTH CAROLINA

Recipient
Recipient CRD Number    None
Williams Keen Butcher 2098675
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
International Assets Advisory, LLC 10645
Street Address 1 Street Address 2
5701 Woodway Drive, Suite 330
City State/Province/Country ZIP/Postal Code
Houston TEXAS 77057
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
COLORADO
MASSACHUSETTS
NEW YORK
NORTH CAROLINA
OHIO
SOUTH CAROLINA
TEXAS
WASHINGTON

Recipient
Recipient CRD Number    None
Alexander Raymond Creede 6392369
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
International Assets Advisory, LLC 10645
Street Address 1 Street Address 2
5701 Woodway Drive, Suite 330
City State/Province/Country ZIP/Postal Code
Houston TEXAS 77057
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA
GEORGIA
ILLINOIS
LOUISIANA
MARYLAND
SOUTH CAROLINA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Kalos Capital, Inc. 44337
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
11525 Park Woods Circle, Suite 280
City State/Province/Country ZIP/Postal Code
Alpharetta GEORGIA 30005
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Guy Anthony Harrigan 1817525
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Lion Street Financial, LLC 165828
Street Address 1 Street Address 2
4770 Baseline Road, Suite 380
City State/Province/Country ZIP/Postal Code
Boulder COLORADO 80303
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
FLORIDA
HAWAII
INDIANA
MINNESOTA
MISSISSIPPI
NEW YORK
NORTH CAROLINA
RHODE ISLAND
SOUTH DAKOTA
TEXAS
VIRGINIA
WYOMING

Recipient
Recipient CRD Number    None
James Bradley Teegarden 2812366
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Lion Street Financial, LLC 165828
Street Address 1 Street Address 2
4770 Baseline Road, Suite 380
City State/Province/Country ZIP/Postal Code
Boulder COLORADO 80303
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
COLORADO

Recipient
Recipient CRD Number    None
Christopher Brian Pelley 1008077
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Moloney Securities Co., Inc. 38535
Street Address 1 Street Address 2
6312 S. Fiddlers Green Circle, Suite 310
City State/Province/Country ZIP/Postal Code
Greenwood Village COLORADO 80111
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
FLORIDA
GEORGIA
IOWA
KANSAS
MICHIGAN
MINNESOTA
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW MEXICO
NORTH CAROLINA
OKLAHOMA
TEXAS
UTAH
VIRGINIA
WISCONSIN

Recipient
Recipient CRD Number    None
David Norval Wood 2306563
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Moloney Securities Co., Inc. 38535
Street Address 1 Street Address 2
13537 Barrett Parkway Drive, #300
City State/Province/Country ZIP/Postal Code
Manchester MISSOURI 63021
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA
ILLINOIS
MISSOURI
OHIO
SOUTH CAROLINA
TEXAS
WASHINGTON

Recipient
Recipient CRD Number    None
John Hubert Chaney 44529
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Moloney Securities Co., Inc. 38535
Street Address 1 Street Address 2
13537 Barrett Parkway Drive, #300
City State/Province/Country ZIP/Postal Code
Manchester MISSOURI 63021
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
MISSOURI
NEBRASKA
TEXAS

Recipient
Recipient CRD Number    None
Robert Morgan Vance 1887560
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Moloney Securities Co., Inc. 38535
Street Address 1 Street Address 2
14570 Mono Way, Suite A
City State/Province/Country ZIP/Postal Code
Sonora CALIFORNIA 95370
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALASKA
ARIZONA
CALIFORNIA
COLORADO
IDAHO
NEVADA
OREGON
SOUTH CAROLINA

Recipient
Recipient CRD Number    None
Newbridge Securities Corporation 104065
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
1200 North Federal Highway, Suite 400
City State/Province/Country ZIP/Postal Code
Boca Raton FLORIDA 33432
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
SCF Securities, Inc. 47275
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
155 E. Shaw Avenue, Suite 102
City State/Province/Country ZIP/Postal Code
Fresno CALIFORNIA 93710
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Sunbelt Securities, Inc. 42180
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
2700 Post Oak Boulevard, Suite 1700
City State/Province/Country ZIP/Postal Code
Houston TEXAS 77056
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
The Strategic Financial Alliance, Inc. 126514
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
2200 Century Parkway, Suite 500
City State/Province/Country ZIP/Postal Code
Atlanta GEORGIA 30345
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
X All States
   Foreign/non-US

Recipient
Recipient CRD Number    None
Titan Securities 131392
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
16775 Addison Road, Suite 525
City State/Province/Country ZIP/Postal Code
Addison TEXAS 75001
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
KANSAS
LOUISIANA
MARYLAND
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
NEBRASKA
NEVADA
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Christopher Michael Dukes 4712873
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Westpark Capital, Inc. 39914
Street Address 1 Street Address 2
650 S. Westlake Boulevard, Suite 205
City State/Province/Country ZIP/Postal Code
Thousand Oaks CALIFORNIA 91362
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
FLORIDA
HAWAII
IDAHO
KANSAS
MONTANA
NEBRASKA
NEVADA
NEW YORK
OREGON
PENNSYLVANIA
SOUTH CAROLINA
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Patrick Morehead 6661646
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Westpark Capital, Inc. 39914
Street Address 1 Street Address 2
8107 Loyola Boulevard
City State/Province/Country ZIP/Postal Code
Los Angeles CALIFORNIA 90045
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
MINNESOTA

Recipient
Recipient CRD Number    None
Sheldon Singleton 2060931
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Westpark Capital, Inc. 39914
Street Address 1 Street Address 2
8107 Loyola Boulevard
City State/Province/Country ZIP/Postal Code
Los Angeles CALIFORNIA 90045
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA

Recipient
Recipient CRD Number    None
John Arthur Doane 4083486
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Advisory Group Equity Services Ltd. 15427
Street Address 1 Street Address 2
33 Hilltop Drive
City State/Province/Country ZIP/Postal Code
Wenham MASSACHUSETTS 01984
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CONNECTICUT
DISTRICT OF COLUMBIA
FLORIDA
ILLINOIS
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
RHODE ISLAND
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Peggy Lynn Romero 6227087
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Advisory Group Equity Services Ltd. 15427
Street Address 1 Street Address 2
71 Hibbert Street
City State/Province/Country ZIP/Postal Code
Arlington MASSACHUSETTS 02476
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
DISTRICT OF COLUMBIA
FLORIDA
MAINE
MARYLAND
MASSACHUSETTS
NEW HAMPSHIRE
NEW YORK
OHIO
SOUTH CAROLINA
TENNESSEE
VERMONT
VIRGINIA

Recipient
Recipient CRD Number    None
Stephen Charles Olsson 857922
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Advisory Group Equity Services Ltd. 15427
Street Address 1 Street Address 2
902 Montgomery St
City State/Province/Country ZIP/Postal Code
Manchester NEW HAMPSHIRE 03102
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
MASSACHUSETTS
NEW HAMPSHIRE

Recipient
Recipient CRD Number    None
Arturo J Rodriguez Diaz 1301783
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Aegis Capital Corp. 15007
Street Address 1 Street Address 2
2000 Ponce De Leon, Suite 516-B
City State/Province/Country ZIP/Postal Code
Coral Gables FLORIDA 33134
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
DELAWARE
FLORIDA
PUERTO RICO

Recipient
Recipient CRD Number    None
Martin Hunter McFarlin 2838151
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Arkadios Capital 282710
Street Address 1 Street Address 2
1119 Virginia Avenue
City State/Province/Country ZIP/Postal Code
Murfreesboro TENNESSEE 37310
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ARIZONA
GEORGIA
MICHIGAN
NORTH CAROLINA
TENNESSEE
TEXAS
WISCONSIN

Recipient
Recipient CRD Number    None
William Louis Herford 2066018
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Arkadios Capital 282710
Street Address 1 Street Address 2
10316 Feldfarm Lane, Suite 300
City State/Province/Country ZIP/Postal Code
Charlotte NORTH CAROLINA 28210
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
CALIFORNIA
FLORIDA
NEVADA
NORTH CAROLINA
SOUTH CAROLINA

Recipient
Recipient CRD Number    None
Jason Christopher Cook 4349388
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Berthel, Fisher & Company Financial Services, Inc. 13609
Street Address 1 Street Address 2
208 S. Marshall Street
City State/Province/Country ZIP/Postal Code
Graham NORTH CAROLINA 27253
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
NORTH CAROLINA
PENNSYLVANIA
SOUTH CAROLINA
VIRGINIA

Recipient
Recipient CRD Number    None
Robert Boris Hardcastle 1101791
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Berthel, Fisher & Company Financial Services, Inc. 13609
Street Address 1 Street Address 2
16100 Chesterfield Parkway West, Ste 150
City State/Province/Country ZIP/Postal Code
Chesterfield MISSOURI 63017
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ARIZONA
CALIFORNIA
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
IOWA
KENTUCKY
MICHIGAN
MINNESOTA
MISSOURI
NEVADA
NEW JERSEY
NEW MEXICO
NORTH CAROLINA
OHIO
OREGON
PENNSYLVANIA
SOUTH CAROLINA
TENNESSEE
TEXAS
UTAH

Recipient
Recipient CRD Number    None
TJ Iwan Setro 1428815
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Berthel, Fisher & Company Financial Services, Inc. 13609
Street Address 1 Street Address 2
2992 Reidiville Road
City State/Province/Country ZIP/Postal Code
Spartanburg SOUTH CAROLINA 29301
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
FLORIDA
GEORGIA
LOUISIANA
NORTH CAROLINA
OHIO
SOUTH CAROLINA
VIRGINIA

Recipient
Recipient CRD Number    None
Douglas Stephen Drelich 2459757
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Client One Securities LLC 152974
Street Address 1 Street Address 2
7077 Bonneval Road, #440
City State/Province/Country ZIP/Postal Code
Jacksonville FLORIDA 32216
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ARKANSAS
FLORIDA
GEORGIA
ILLINOIS
IOWA
KANSAS
MARYLAND
MICHIGAN
MISSOURI
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
PENNSYLVANIA
SOUTH CAROLINA
TENNESSEE
VIRGINIA
WASHINGTON

Recipient
Recipient CRD Number    None
Donald Neal Sullivan 1979017
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Client One Securities LLC 152974
Street Address 1 Street Address 2
7077 Bonneval Road, #440
City State/Province/Country ZIP/Postal Code
Jacksonville FLORIDA 32216
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARKANSAS
CALIFORNIA
COLORADO
FLORIDA
GEORGIA
ILLINOIS
INDIANA
IOWA
LOUISIANA
MARYLAND
MICHIGAN
MISSOURI
NEW YORK
NORTH CAROLINA
OHIO
OKLAHOMA
PENNSYLVANIA
VIRGINIA
WASHINGTON

Recipient
Recipient CRD Number    None
Jay Reid Porter 1123708
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Coastal Equities, Inc. 23769
Street Address 1 Street Address 2
10400 NE. 4th Street, Suite 500
City State/Province/Country ZIP/Postal Code
Bellevue WASHINGTON 98004
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALASKA
ARIZONA
CALIFORNIA
INDIANA
MASSACHUSETTS
WASHINGTON

Recipient
Recipient CRD Number    None
Nathaniel Michael Kuhn 4624143
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
DAI Securities, LLC 36673
Street Address 1 Street Address 2
120 W Eastman Street, #300
City State/Province/Country ZIP/Postal Code
Arlington Heights ILLINOIS 60004
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
COLORADO
FLORIDA
ILLINOIS
INDIANA
MINNESOTA
NEW JERSEY
OHIO
WISCONSIN

Recipient
Recipient CRD Number    None
Roy Vincent Pfleger 5896655
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
DAI Securities, LLC 36673
Street Address 1 Street Address 2
17 Stony Wood Road
City State/Province/Country ZIP/Postal Code
E Setauket NEW YORK 11733
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
COLORADO
FLORIDA
GEORGIA
MARYLAND
MASSACHUSETTS
NEW JERSEY
NEW YORK
NORTH CAROLINA
OREGON
RHODE ISLAND
TEXAS
UTAH
VERMONT

Recipient
Recipient CRD Number    None
Joseph Gerard Michaletz 1327534
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
DAI Securities, LLC 36673
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
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
FLORIDA
GEORGIA
IDAHO
ILLINOIS
IOWA
KANSAS
MICHIGAN
MINNESOTA
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
SOUTH DAKOTA
TEXAS
UTAH
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Michael Edward O'Toole 6336251
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
DAI Securities, LLC 36673
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
   Foreign/non-US
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
FLORIDA
GEORGIA
IDAHO
ILLINOIS
IOWA
KANSAS
MICHIGAN
MINNESOTA
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
SOUTH DAKOTA
TEXAS
UTAH
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
William Christopher Duffy 6726333
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Emerson Equity LLC 130032
Street Address 1 Street Address 2
155 Bovet Road, Suite 725
City State/Province/Country ZIP/Postal Code
San Mateo CALIFORNIA 94402
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
CALIFORNIA
COLORADO
DISTRICT OF COLUMBIA
ILLINOIS
MASSACHUSETTS
MONTANA
NEBRASKA
NEW HAMPSHIRE
PUERTO RICO
TEXAS
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Philippus Theunis Van Staden 4489166
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Green Vista Capital, LLC 293630
Street Address 1 Street Address 2
222 N. Park Avenue
City State/Province/Country ZIP/Postal Code
Winter Park FLORIDA 32789
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSOURI
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
VERMONT
VIRGINIA
WASHINGTON
WISCONSIN

Recipient
Recipient CRD Number    None
Randall George Skrabonja 1858245
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Green Vista Capital, LLC 293630
Street Address 1 Street Address 2
222 N. Park Avenue
City State/Province/Country ZIP/Postal Code
Winter Park FLORIDA 32789
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA
NEVADA

Recipient
Recipient CRD Number    None
Hantz Financial Services, Inc. 46047
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
26200 American Drive, 5th Floor
City State/Province/Country ZIP/Postal Code
Southfield MICHIGAN 48034
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Recipient
Recipient CRD Number    None
Carnell Moore 2715870
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
International Assets Advisory, LLC 10645
Street Address 1 Street Address 2
201 E. Kennedy Blvd, Suite 950
City State/Province/Country ZIP/Postal Code
Tampa FLORIDA 33602
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
MARYLAND
MICHIGAN
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
SOUTH CAROLINA
TEXAS

Recipient
Recipient CRD Number    None
David Peter Reiss 6591492
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
International Assets Advisory, LLC 10645
Street Address 1 Street Address 2
167 Valleyview Road
City State/Province/Country ZIP/Postal Code
Fairfield CONNECTICUT 06824
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CONNECTICUT
FLORIDA
MAINE
MASSACHUSETTS
NEW YORK
RHODE ISLAND
VERMONT
VIRGINIA

Recipient
Recipient CRD Number    None
Reina Loree Schlager 2370434
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
J.W. Cole Financial, Inc. 124583
Street Address 1 Street Address 2
12525 New Brittany Blvd. Bldg. #30
City State/Province/Country ZIP/Postal Code
Ft. Myers FLORIDA 33907
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
ILLINOIS
INDIANA
IOWA
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
NORTH CAROLINA
OHIO
PENNSYLVANIA
SOUTH CAROLINA
TENNESSEE
TEXAS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN

Recipient
Recipient CRD Number    None
Cindy Larue Crossett 5868822
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
J.W. Cole Financial, Inc. 124583
Street Address 1 Street Address 2
203 S Candy Lane, Suite 10B
City State/Province/Country ZIP/Postal Code
Cottonwood ARIZONA 86326
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CALIFORNIA
COLORADO
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
NORTH DAKOTA
OREGON
TEXAS
VIRGINIA

Recipient
Recipient CRD Number    None
Ken Levin 2823854
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
J.W. Cole Financial, Inc. 124583
Street Address 1 Street Address 2
12525 New Brittany Blvd. Bldg. #30
City State/Province/Country ZIP/Postal Code
Ft. Myers FLORIDA 33907
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ARIZONA
CONNECTICUT
FLORIDA
INDIANA
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSOURI
NEW HAMPSHIRE
NEW JERSEY
NEW YORK
OHIO
PENNSYLVANIA
WISCONSIN

Recipient
Recipient CRD Number    None
Michael Robert Rubenstein 5445954
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
J.W. Cole Financial, Inc. 124583
Street Address 1 Street Address 2
12525 New Brittany Blvd. Bldg. #30
City State/Province/Country ZIP/Postal Code
Ft. Myers FLORIDA 33907
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
FLORIDA
NEW YORK

Recipient
Recipient CRD Number    None
Stephen Wayne Wingard 2746603
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Lion Street Financial, LLC 165828
Street Address 1 Street Address 2
13155 Noel Road, Suite 900
City State/Province/Country ZIP/Postal Code
Dallas TEXAS 75240
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
COLORADO
TEXAS
UTAH

Recipient
Recipient CRD Number    None
John Patrick Shortal 2233172
(Associated) Broker or Dealer    None
(Associated) Broker or Dealer CRD Number    None
Moloney Securities Co., Inc. 38535
Street Address 1 Street Address 2
607 S. State Street
City State/Province/Country ZIP/Postal Code
Jerseyville ILLINOIS 62052
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
   All States
   Foreign/non-US
ILLINOIS
MISSOURI
NEVADA

13. Offering and Sales Amounts

Total Offering Amount $75,000,000 USD
or    Indefinite
Total Amount Sold $47,961,994 USD
Total Remaining to be Sold $27,038,006 USD
or    Indefinite

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:
376

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 $7,500,000 USD
X Estimate
Finders' Fees $0 USD
   Estimate

Clarification of Response (if Necessary):

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.

$1,125,000 USD
X Estimate

Clarification of Response (if Necessary):

The Manager will receive acquisition fees equal to 1.5% of the acquisition and development costs of the Company's real estate assets. The total amount paid will depend on the actual amount of such costs.

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 Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).

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
Bourne Seniors Housing V, LLC /s/ Robert A. Bourne Robert A. Bourne CEO of the Sole Member of the Issuer's Manager 2021-03-12

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.