Third-Party Escrow Agreement

Report your participation in an escrow agreement in Part 3.  In addition, report the escrow agreement in Part 2 (see Part 2 of this guide for details).

Employer or Party


Status and Terms


Tristate Bank

Philadelphia, PA

Escrow account with Tristate Bank is from the sale of WQX Systems, LLC.  Under the provisions of the purchase plan with Widgets Unlimited, $2 million is being held in escrow for unforeseen costs and liabilities for matters predating the sale.  The remainder will be distributed to me in December 2019.  There have been no such costs or liabilities reported thus far.


Widgets Unlimited

Grand Rapids, MI

See above.


WQX Systems, LLC

Denver, CO

See above.


For You

Part 3

Report your continued participation in a third-party escrow agreement.  In addition, if you are an Annual or Termination filer, report a third-party escrow agreement in which you participated at any point during the reporting period.

Employer or Party:  Provide the names of the grantee, grantor, and escrow agent (or depositary).

City/State:  Provide the city and state in which each party is located.

Status and Terms:  Describe the terms and status of the escrow agreement.  Specifically, report the purpose of the escrow agreement, including the name of the escrow holder or agent; the nature and amount of the underlying business or real estate transaction; and the timeframe needed to execute the transaction.  In addition, report any anticipated conditions affecting the transaction’s completion.

Date:  Provide the month and year in which the escrow agreement began.