*The remainder of this cover page shall
be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for
any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder
of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of
1934 (“
Act
”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all
other provisions of the Act (however, see the Notes).
1.
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Names of Reporting Persons.
First Capital Real Estate Trust Incorporated
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions):
|
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(a)
x
(b)
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3.
|
SEC Use Only
|
4.
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Source of Funds (See Instructions):
OO
|
5.
|
Check if Disclosure of Legal Proceedings Is Required Pursuant
to Items 2(d) or 2(e):
Not Applicable
|
6.
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Citizenship or Place of Organization: Maryland
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Number of Shares
|
7.
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Sole Voting Power:
0
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Beneficially Owned by
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8.
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Shared Voting Power: (1)
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Each Reporting
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Person With
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9.
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Sole Dispositive Power:
0
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10.
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Shared Dispositive Power: (1)
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person: (1)
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
¨
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13.
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Percent of Class Represented by Amount in Row (11): 16.6%
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14.
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Type of Reporting Person (See Instructions):
CO
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See Item 5(a) for an explanation of the shares of beneficial ownership and percent ownership being reported.
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1.
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Names of Reporting Persons.
First Capital Real Estate Operating Partnership
L.P.
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions):
|
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(a)
x
(b)
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3.
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SEC Use Only
|
4.
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Source of Funds (See Instructions):
OO
|
5.
|
Check if Disclosure of Legal Proceedings Is Required
Pursuant to Items 2(d) or 2(e):
Not Applicable
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6.
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Citizenship or Place of Organization: Delaware
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Number of Shares
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7.
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Sole Voting Power:
0
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Beneficially Owned by
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8.
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Shared Voting Power: (1)
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Each Reporting
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Person With
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9.
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Sole Dispositive Power:
0
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10.
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Shared Dispositive Power: (1)
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person: (1)
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions): [ ]
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13.
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Percent of Class Represented by Amount in Row (11): 16.6
%
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14.
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Type of Reporting Person (See Instructions):
PN
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See Item 5(a) for an explanation of the
shares of beneficial ownership and percent ownership being reported.
1.
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Names of Reporting Persons.
Suneet Singal
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions):
|
|
(a)
x
(b)
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions):
OO
|
5.
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Check if Disclosure of Legal Proceedings Is Required
Pursuant to Items 2(d) or 2(e):
Not Applicable
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6.
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Citizenship or Place of Organization: United States
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Number of Shares
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7.
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Sole Voting Power:
0
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Beneficially Owned by
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8.
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Shared Voting Power: (1)
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Each Reporting
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Person With
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9.
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Sole Dispositive Power:
0
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10.
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Shared Dispositive Power: (1)
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person: (1)
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12.
|
Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
x
|
|
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13.
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Percent of Class Represented by Amount in Row (11): 16.6
%
|
|
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14.
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Type of Reporting Person (See Instructions):
IN
|
See Item 5(a) for an explanation
of the shares of beneficial ownership and percent ownership being reported.
Item 1. Security and Issuer.
This Schedule 13D (“
Schedule
13D
”) relates to the common stock, par value $0.01 per share (the “
Common Stock
”), of PhotoMedex,
Inc., a corporation formed under the laws of Nevada (the “
Issuer
”), whose principal executive offices are located
at 2300 Computer Drive, Building G, Willow Grove, PA 19090.
Item 2. Identity and Background.
This statement is being
filed by the following persons (each a “
Reporting Person
” and, collectively, the “
Reporting Persons
”):
|
(1)
|
First Capital Real Estate Trust Incorporated
|
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(2)
|
First Capital Real Estate Operating Partnership L.P.;
and
|
First Capital Real Estate
Trust Incorporated (the “
Contributor Parent
”) is a Maryland corporation, and First Capital Real Estate Operating
Partnership L.P. (the “
Contributor
”, and together with Contributor Parent, the “
Contributor Parties
”)
is a Delaware limited partnership. The business address of each of the Contributor Parent and the Contributor is 60 Broad Street,
25th Floor, New York, NY 10004. The principal business of the Contributor Parent is a real estate investment trust (REIT) and the
Contributor is the principal operating company subsidiary of the Contributor Parent. Mr. Singal is the
Chief Executive of the Contributor Parent, which is the general partner of the Contributor.
Mr. Singal is a United
States citizen. His address is c/o First Capital Real Estate Trust Incorporated, 60 Broad Street, 25th Floor, New York, NY 10004.
During the last five
years, none of the Reporting Persons: (i) has been convicted in any criminal proceeding (excluding traffic violations or similar
misdemeanors) or (ii) was a party to a civil proceeding of a judicial or administrative body of competent jurisdiction and as a
result of such proceeding was or is subject to a judgment, decree or final order enjoining future violations of, or prohibiting
or mandating activities subject to, federal or state securities laws or finding any violation with respect to such laws.
Item 3. Source and Amount of Funds or
Other Consideration.
Pursuant to an
Interest Contribution Agreement dated March 31, 2017 by and among the Issuer, FC Global Realty Operating Partnership, LLC
(the “
Acquiror
”), a newly formed subsidiary of the Issuer, the Contributor Parent and the Contributor
(the “
Contribution Agreement
”), the Contributor will contribute to the Issuer interests in real
estate properties, and interests in entities holding real estate properties (the “
Transferred Interests
”),
which it currently owns or plans to acquire, in exchange for securities of the Issuer. The Contribution Agreement provided
for a due diligence right of termination by either party, which expired on April 20, 2017, without either party having
elected to terminate. Except as described herein, no cash or other consideration will be paid to the Issuer in connection
with the transaction.
Item 4. Purpose of Transaction.
The purpose of the
transaction is for the Reporting Persons to acquire a substantial voting and equity interest in the Issuer. Following the
Initial Closing (as defined below), the Contributor will hold approximately 16.6% of the Common Stock of the Issuer, and
approximately 47.7% of the combined Common Stock and nonvoting Preferred Stock of the Issuer. If, pursuant to the
rules of NASDAQ, the stockholders of the Issuer approve the issuance of 20% or more of the Common Stock of the Issuer to
the Contributor, the Preferred Stock will be converted into Common Stock of the Issuer, and the Contributor will
hold approximately 47.7% of the shares of Common Stock of the Issuer. In addition, if all of the shares issuable by
the Issuer pursuant to the Contribution Agreement are issued, and the Warrant described below is exercised in full, the
shares issued will represent approximately 92.4% of the issued and outstanding shares of the Issuer. The Contribution
Agreement contemplates that promptly following the effectiveness of a registration statement with respect thereto, the
Contributor Parties will cause the distribution of the Issuer’s shares it acquired pursuant to the Contribution
Agreement to their respective partners and stockholders.
The acquisition
of control will be effected in a series of contemplated steps, corresponding to the issuance of securities of the Issuer to
the Contributor in consideration for the transfer of the Transferred Interests to the Issuer. Upon the initial closing,
expected to occur on or about May 17, 2017 (the “
Initial Closing
”, and such date, the “
Initial
Closing Date
”), pursuant to the Contribution Agreement (defined below), the current members of the Board of
Directors of the Issuer (the “Board”) will resign, and will be replaced by three persons designated by the
Contributor Parent (two of whom will be independent), three persons designated by the Issuer (one of whom will be
independent) and a seventh director, who shall be independent to be designated by the other directors. In addition, the
current executive officers of the Issuer will resign or be reassigned to non-executive positions, and Suneet Singal will be
designated as Chief Executive Officer of the Issuer. Following the Initial Closing, there are contemplated to be additional
closings pursuant to which, subject to the satisfaction of certain conditions, additional Transferred Interests will be
contributed to the Issuer. The Reporting Persons reserve the right to increase or decrease their respective positions in the
Issuer through, among other things, the purchase or sale of securities of the Issuer on the open market or in private
transactions or otherwise, including the exercise of warrants, on such terms and at such times as the Reporting Persons may
deem advisable. The Reporting Persons reserve the right to change their intention with respect to any and all matters
referred to in this Item 4.
Item 5. Interest in Securities of the
Issuer.
(a) The aggregate
percentage of shares of Common Stock reported owned by each person named herein is based upon 4,361,094 shares of Common
Stock outstanding as of March 31, 2017, which is the total number of shares of Common Stock outstanding as reported by the
Issuer in its Annual Report on Form 10-K for the year ended December 31, 2016, filed by the Issuer with the Securities and
Exchange Commission on March 31, 2017. At the Initial Closing, the Reporting Persons are expected to become the beneficial
owners of 867,858 shares of Common Stock, representing 19.9% of the issued and outstanding shares of Common Stock of the
Issuer prior to the issuance of Common Stock, and 16.6% of the issued and outstanding shares of Common Stock of the Issuer
immediately following the Initial Closing (assuming that no shares of Common Stock are issued by the Issuer during the period
from March 31, 2017 until the Initial Closing). In addition, at the Initial Closing, the Reporting Persons are expected
to become the beneficial owners of shares of nonvoting Series A Convertible Preferred Stock
(“
Preferred Stock
”) of the Issuer that may, as described below, be converted into 3,103,075 shares of
Common Stock of the Issuer. Under the applicable NASDAQ rules to which the Issuer is subject, shareholder approval is
required for the issuance of common stock (or securities convertible into or exercisable for common stock) equal to 20
percent or more of the common stock or 20 percent or more of the voting power outstanding before the issuance. The ability of
the Reporting Persons to acquire more than 20 percent of the Common Stock will therefore be subject to a vote of the
stockholders of the Issuer. As described in the Contribution Agreement, the Reporting Persons may acquire additional shares
of Common Stock, subject to the satisfaction of certain conditions to the contribution of the Transferred Interests. If all
of the Transferred Interests contemplated by the Contribution Agreement (including the optional contributions) are
contributed to the Issuer, and all of the conditions to the exercise of a Warrant for 25,000,000 shares of Common Stock to be
issued pursuant to the Contribution Agreement are satisfied, the Reporting Persons would hold 71,541,512 shares of Common
Stock of the Issuer, representing approximately 94.2% of the outstanding shares of Common Stock (assuming no further
issuances of shares of Common Stock by the Issuer). Under the terms of the Contribution Agreement, the conditions relating to
whether the additional shares of Common Stock will be issued will be determined on or before December 31, 2017, based on the
satisfaction of the conditions set forth therein.
Following
the issuance of the Common Stock to the Contributor, the Contributor Parent and the Contributor are required by the
Contribution Agreement to cause the distribution of such Common Stock to their respective stockholders and partners.
As of the filing date
of this Schedule 13D, the Reporting Persons do not directly beneficially owns any shares of Common Stock of the Issuer.
Each of the Reporting
Persons, as a member of a “group” with the other Reporting Persons for purposes of Rule 13d-5(b)(1) of the Securities
Exchange Act of 1934, as amended (the “
Exchange Act
”), may be deemed to beneficially own the securities of the
Issuer owned by the other Reporting Persons. The filing of this Schedule 13D shall not be deemed an admission that the Reporting
Persons are, for purposes of Section 13(d) of the Exchange Act, the beneficial owners of any securities of the Issuer he or it
does not directly own. Each of the Reporting Persons specifically disclaims beneficial ownership of the securities of the Issuer
reported herein that he or it does not directly own.
(b) the Contributor
Parent and Suneet Singal may be deemed to share the power to vote and dispose of the shares of Common Stock directly beneficially
owned by the Contributor.
(c) Except as set
forth herein and elsewhere in this Schedule 13D, there have been no other transactions in the class of securities reported on that
were effected within the past sixty days.
(d) Not applicable.
(e) Not applicable.
Item
6. Contracts, Arrangements, Understandings or Relationships With Respect to Securities of the Issuer.
Except as otherwise
set forth herein and elsewhere in this Schedule 13D, there are no contracts, arrangements, understandings or similar relationships
existing with respect to the securities of the Issuer between the Issuer and any of the Reporting Persons.
The Contribution Agreement
On March 31, 2017, the Issuer and the Acquiror, entered into
the Contribution Agreement with the Contributor and the Contributor Parent, under which the Contributor may contribute certain
real estate interests to the Acquiror in a series of installments no later than December 31, 2017. In exchange, the Contributor
will receive shares of the Issuer’s Common Stock, newly designated Preferred Stock and a Warrant, as described below.
First Contribution
In the first contribution installment, which is expected
to occur on or about May 17, 2017, the Contributor is obligated to transfer $10 million of interests to the Acquiror,
comprising four vacant land sites set for development into gas stations located in northern California, and a single family
residential development located in Los Lunas, New Mexico. Contributor currently has a 6% interest in the entity which owns
the residential development, and expects to acquire an additional 11.9% interest prior to the Initial Closing Date. The
residential development in New Mexico consists of 251, non-contiguous, single family residential lots and a 10,000 square
foot club house. 37 lots have been finished, and the remaining 214 are platted and engineered lots.
In exchange for such transfer, the Issuer will issue to
Contributor a number of duly authorized, fully paid and non-assessable shares of the Issuer’s Common Stock and
Preferred Stock, determined by dividing the $10 million value of that contribution by a specified per share value, which
represents a 7.5% premium above the volume-weighted average price (“
VWAP
”) of all on-exchange transactions
in the Issuer’s shares executed on NASDAQ during the forty-three (43) NASDAQ trading days prior to the NASDAQ
trading day immediately prior to the public announcement of the transaction by the Issuer and Contributor Parent, as
reported by Bloomberg L.P. (the “
Per Share Value
”). The Per Share Value has been calculated to be $2.51983
per share of the Issuer’s Common Stock. At the Initial Closing, the Contributor is to receive a number of shares equal
to up to 19.9% of the issued and outstanding Common Stock of the Issuer immediately prior to the Initial Closing. The balance
of the consideration will be paid in shares of the Issuer’s Preferred Stock, as described above.
Also at the Initial Closing, the Acquiror will assume the
liabilities associated with these initial contributed interests. On or before the Initial Closing, certain officers and/or
directors of the Issuer – Dr. Dolev Rafaeli, Dennis McGrath, and Dr. Yoav Ben-Dror – will resign from their
positions as officers and/or directors of the Issuer. In addition, certain members of the Board will resign, or the number of
directors on the Board will be increased, so that the Board will ultimately consist of seven (7) persons as set forth in Item
4 hereof.
Second Contribution
Contributor Parent is also required to contribute two additional
property interests valued at $20 million if certain conditions as set forth in the Contribution Agreement are satisfied by December
31, 2017. This second installment is mandatory.
Contributor is obligated to contribute to the Acquiror its
100% ownership interest in a hotel property located in Texas that is currently undergoing renovations to be converted to
a Wyndham Garden Hotel. Before contributing the property to the Acquiror, Contributor must resolve a lawsuit concerning
ownership of the property. Only when Contributor has confirmed that it is the full and undisputed owner of the property may
it contribute that interest to the Acquiror.
In addition, Contributor is obligated to contribute to the
Acquiror its interest in Dutchman’s Bay and Serenity Bay (referred to as the “
Antigua Resort
Developments
”), two planned full service resort hotel developments located in Antigua and Barbuda in which
Contributor expects to own a 75% interest in coordination with the Antigua government. Serenity Bay is a planned
resort comprised of five contiguous parcels (28.33 acres) zoned for hotel and residential use that are planned for
246 units and 80 one, two and three bedroom condo units. Dutchman’s Bay, is a planned condo hotel with
180 guestrooms, 102 two bedroom condos, and 14 three bedroom villas. To acquire the property in Antigua, Contributor must
obtain an amendment to its agreement with the government to extend the time for development of these properties and confirm
that all development conditions in the original agreement with the government have been either satisfied or waived.
In exchange for these interests, the Issuer will issue
to Contributor a number of duly authorized, fully paid and non-assessable shares of the Issuer’s Common Stock, determined
by dividing the $20 million value of that contribution by the Per Share Value. As a condition to the Second Contribution, all necessary
corporate approvals shall have been obtained by the Issuer in order that the shares issuable to the Contributor in connection with
the Second Contribution will be Common Stock.
Optional Contribution
Contributor Parent has the option to contribute either or
both of two additional property interests collectively valued at $66.5 million if certain conditions as set forth in the
Contribution Agreement are satisfied by December 31, 2017. This third installment is optional in Contributor Parent’s
sole discretion.
The Contributor Parent may contribute to the Acquiror its interest
in a resort development project on an island just south of Hilton Head, South Carolina (“
Melrose
”). Contributor
Parent is currently negotiating the acquisition of this property.
Contributor Parent also may contribute to the Acquiror
a golf and surf club development project on the Baja Peninsula in Mexico (“
Punta Brava
”) which it is
negotiating to acquire. Punta Brava is valued by Contributor Parent at $44 million based on Contributor Parent’s
proposed commitment of $5 million upon closing on this property, plus a proposed commitment for an additional $5 million and
a second commitment of $34 million for construction of the project.
In exchange for these interests, the Issuer will issue
to Contributor a number of shares of the Issuer’s Common Stock, determined
by dividing $86,450,000 (130% of the value of that contribution) by the Per Share Value. In addition, the Issuer will issue to
Contributor a five (5) year warrant (the “
Warrant
”) to purchase up to 25,000,000 shares of the Issuer’s
Common Stock at an exercise price of $3.00 per share that shall vest in stages upon the achievement
of the milestone specified in the Contribution Agreement. The number of warrant shares and the exercise price will be equitably
adjusted in the event of a stock split, stock combination, recapitalization or similar transaction.
General Conditions
Prior to each contribution, the Board will determine
whether or not the pre-contribution conditions have been satisfied before accepting the property interests and issuing shares of
the Issuer’s stock to Contributor Parent.
The Contribution Agreement is subject to the usual pre- and
post-closing representations, warranties and covenants, and restricts the Issuer’s conduct to the conduct to that in the
ordinary course of business between the signing and December 31, 2017.
No assurance can be given that the conditions to the
contributions set forth in the Contribution Agreement will be satisfied or that the Contributor or the Contributor Parent
will be able to acquire any of the interests they do not currently own.
Under the Contribution Agreement, amounts due to Dr.
Dolev Rafaeli and Dennis McGrath under their employment agreements, as well as amounts due to Dr. Yoav Ben-Dror for his
services as a member of the Board and officer of the Issuer’s foreign subsidiaries, will be converted to convertible
secured notes (the “
Payout Notes
”) after approval from the Issuer’s stockholders. The Payout Notes
will be due one year after the stockholder approval and carry a ten percent (10%) interest rate. The principal will convert
to shares of the Issuer’s Common Stock at the lower of (i) the Per Share Value or (ii) the VWAP with respect to
on-exchange transactions in the Issuer’s Common Stock executed on the NASDAQ during the thirty (30) trading days prior
to the maturity date as reported by Bloomberg L.P.; provided, however, that the value of the Issuer’s Common Stock
shall in no event be less than $1.75 per share. The Payout Notes will be secured by a security interest in all assets of the
Issuer; provided, however, that such security interest will be subordinated to any (i) claims or liens to the holders of any
debt (including mortgage debt) being assumed by the Issuer as a result of the transaction contemplated by the Contribution
Agreement, and (ii) all post-closing indebtedness incurred by the Issuer or its subsidiaries. The holders of the Payout Notes
will have demand registration rights which requiring the filing of a re-sale registration statement on appropriate form that
registers for re-sale the shares of Common Stock underlying the Payout Notes within thirty (30) days of issuance with best
efforts to cause the same to become effective within one-hundred twenty (120) days of issuance.
Special Meeting of Stockholders
As promptly as possible following the Initial Closing, the
Issuer is required file a proxy statement and hold a special meeting of its stockholders to authorize and approve certain
matters, as set forth in the Contribution Agreement, including the following:
• the issuance
to the Contributor or its designee or designees of the Issuer’s shares in exchange for the contributed assets, and the issuance
of the Warrant and, upon exercise of the Warrant, the underlying shares of the Issuer’s Common Stock in exchange for the
contribution of the optional property interests, if any are made;
• an
amendment and restatement of the Articles of Incorporation of the Issuer, including an increase the number of authorized shares
of common stock, $.01 par value per share, of the Issuer from fifty million (50,000,00) shares to five hundred million (500,000,000)
shares and increase the number of authorized shares of preferred stock, $.01 par value per share, of the Issuer from five million
(5,000,000) shares to fifty million (50,000,000) shares; and
• the
election of a Board to consist of seven (7) persons of whom (i) three (3) shall be designated by the Issuer,
(ii) three (3) shall be designated by Contributor Parent; and (iii) one (1) (the “
Nonaffiliated Director
”)
shall be selected by the other six (6) directors; provided, however, that at least four (4) of the members of the Board as so designated shall be independent directors as provided by the rules of NASDAQ (each an “
Independent
Director
”). Of the Board designees of the parties, one (1) of the Issuer’s designees shall be an Independent
Director, two (2) of the Contributor Parent’s designees shall be Independent Directors and the Nonaffiliated Director
shall be an Independent Director. The compensation committee, nominations and corporate governance committee and audit
committee of the Issuer shall each consist of the Issuer’s designee who is an Independent Director, one of Contributor
Parent’s designees who is an Independent Director and the Nonaffiliated Director.
Certain security holders of the Issuer are subject to
a voting agreement (described below) under which they are obligated to vote in favor of the proposals at the stockholder
meeting.
Termination Fee
The transaction is subject to a termination provision under
which, in the event of a material breach of the terms of the transaction, the breaching company must pay all out-of-pocket expenses
of the non-breaching company incurred up to the date of termination of the transaction.
Voting Agreement
In addition, on March 31, 2017, in connection with its entry
into the Contribution Agreement, the Contributor Parent entered into a Shareholder Voting Support and Confidentiality Agreement
(the “
Voting Agreement
”) with certain holders of securities of the Issuer (“
Issuer Security Holders
”),
pursuant to which such security holders agreed, among other things, to vote in favor of the adoption of the Contribution Agreement
and the transactions contemplated thereby and in favor of the approval of the number of shares or voting power to be issued or
granted by the Issuer to the Contributor Parent or its shareholders or affiliates pursuant to the Agreement. The Voting Agreement
does not require the Issuer Security Holders to vote their shares in the Issuer as directed by the Reporting Persons. The Reporting
Persons disclaim any beneficial ownership interest in the Issuer securities represented by the Issuer Security Holders.
The foregoing summary of the terms
and conditions of the Contribution Agreement and the Voting Agreement does not purport to be complete and is qualified in its entirety
by the terms of the Contribution Agreement and the Voting Agreement, copies of which are included as exhibits hereto and which
are incorporated herein by reference.
Item 7. Material to be Filed as Exhibits.
|
99.1
|
Interest Contribution Agreement, by and among the Issuer, FC Global Realty Operating Partnership,
LLC, First Capital Real Estate Trust Incorporated and First Capital Real Estate Operating Partnership L.P. (incorporated by reference
to Exhibit 10.1 to the Current Report on Form 8-K filed by First Capital Real Estate Trust Incorporated on April 3, 2017).
|
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99.2
|
Shareholder Voting Support and Confidentiality Agreement (incorporated by reference to Exhibit
10.2 to the Current Report on Form 8-K filed by First Capital Real Estate Trust Incorporated on April 3, 2017).
|
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99.3
|
Joint Filing Agreement by and among First Capital Real Estate Trust Incorporated and First Capital
Real Estate Operating Partnership L.P and Suneet Singal, dated April 28, 2017.
|
SIGNATURES
After reasonable inquiry and to the
best of my knowledge and belief, the undersigned certifies that the information set forth in this statement is true, complete
and correct.
DATE:
April 28, 2017
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First Capital Real Estate Trust Incorporated,
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a Maryland corporation
|
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|
|
|
|
|
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By:
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/s/ Suneet Singal
|
|
Name:
|
Suneet Singal
|
|
Title:
|
Chief Executive
|
|
|
|
|
First Capital Real Estate Operating Partnership L.P.,
a Delaware limited partnership
|
|
|
|
|
By:
|
First Capital Real Estate Trust Incorporated
|
|
|
a Maryland corporation, as the general partner of First Capital Real Estate Trust Incorporated
|
|
By:
|
/s/ Suneet Singal
|
|
Name:
|
Suneet Singal
|
|
Title:
|
Chief Executive
|
|
/s/ Suneet Singal
|
|
|
Suneet Singal
|
|
Attention: Intentional misstatements
or omissions of fact constitute Federal criminal violations
(See 18 U.S.C. 1001)