FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
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Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Enerpulse Technologies, Inc. [ ENPT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2014 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock | 11/18/2013 | J4(1) | 2,378,529 | D | $0.00(1) | 0 | I | By SAIL Venture Partners II, LP(2) | |||||||
Common Stock | 11/18/2013 | J4(1) | 2,378,529 | A | $0.00(1) | 2,378,529(3) | I | By SVP II Xtreme Power Joint Venture, LP(4) | |||||||
Common Stock | 05/06/2014 | J4(5) | 1,254,657 | A | $0.00(5) | 1,254,657(3) | I | By SAIL Exit Partners, LLC(6) | |||||||
Common Stock | 06/06/2014 | J4(7) | 2,378,529 | D | $0.00(7) | 0 | I | By SVP II Xtreme Power Joint Venture, LP(4) | |||||||
Common Stock | 06/06/2014 | J4(7) | 2,378,529 | A | $0.00(7) | 3,633,186(3) | I | By SAIL Exit Partners, LLC(6) | |||||||
Common Stock | 12/15/2014 | L | 5,000 | A | $0.5 | 3,638,186(3) | I | By SAIL Exit Partners, LLC(6) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Series B Warrant (Right to Buy) | $2.01 | 11/18/2013 | 4J(1) | 515,944 | 09/04/2013 | (8) | Common Stock | 515,944 | $0.00(1) | 0 | I | By SAIL Venture Partners II, LP(2) | ||
Series C Warrant (Right to Buy) | $2.74 | 11/18/2013 | 4J(1) | 82,054 | 09/04/2013 | (8) | Common Stock | 82,054 | $0.00(1) | 0 | I | By SAIL Venture Partners II, LP(2) | ||
Series D Warrant (Right to Buy) | $2.66 | 11/18/2013 | 4J(1) | 123,911 | 09/04/2013 | 12/31/2017 | Common Stock | 123,911 | $0.00(1) | 0 | I | By SAIL Venture Partners II, LP(2) | ||
Series B Warrant (Right to Buy) | $2.01 | 11/18/2013 | 4J(1) | 515,944 | 09/04/2013 | (8) | Common Stock | 515,944 | $0.00(1) | 515,944(3) | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series C Warrant (Right to Buy) | $2.74 | 11/18/2013 | 4J(1) | 82,054 | 09/04/2013 | (8) | Common Stock | 82,054 | $0.00(1) | 82,054(3) | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series D Warrant (Right to Buy) | $2.66 | 11/18/2013 | 4J(1) | 123,911 | 09/04/2013 | 12/31/2017 | Common Stock | 123,911 | $0.00(1) | 123,911(3) | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series C Warrant (Right to Buy) | $2.74 | 05/06/2014 | 4J(9) | 27,352 | 09/04/2013 | (8) | Common Stock | 27,352 | $0.00(9) | 27,352(3) | I | By SAIL Exit Partners, LLC(6) | ||
Series D Warrant (Right to Buy) | $2.66 | 05/06/2014 | 4J(10) | 191,498 | 09/04/2013 | 12/31/2017 | Common Stock | 191,498 | $0.00(10) | 191,498(3) | I | By SAIL Exit Partners, LLC(6) | ||
Series B Warrant (Right to Buy) | $2.01 | 06/06/2014 | 4J(7) | 515,944 | 09/04/2013 | (8) | Common Stock | 515,944 | $0.00(7) | 0 | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series C Warrant (Right to Buy) | $2.74 | 06/06/2014 | 4J(7) | 82,054 | 09/04/2013 | (8) | Common Stock | 82,054 | $0.00(7) | 0 | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series D Warrant (Right to Buy) | $2.66 | 06/06/2014 | 4J(7) | 123,911 | 09/04/2013 | 12/31/2017 | Common Stock | 123,911 | $0.00(7) | 0 | I | By SVP II Xtreme Power Joint Venture, LP(4) | ||
Series B Warrant (Right to Buy) | $2.01 | 06/06/2014 | 4J(7) | 515,944 | 09/04/2013 | (8) | Common Stock | 515,944 | $0.00(7) | 515,944(3) | I | By SAIL Exit Partners, LLC(6) | ||
Series C Warrant (Right to Buy) | $2.74 | 06/06/2014 | 4J(7) | 82,054 | 09/04/2013 | (8) | Common Stock | 82,054 | $0.00(7) | 109,406(3) | I | By SAIL Exit Partners, LLC(6) | ||
Series D Warrant (Right to Buy) | $2.66 | 06/06/2014 | 4J(7) | 123,911 | 09/04/2013 | 12/31/2017 | Common Stock | 123,911 | $0.00(7) | 315,409(3) | I | By SAIL Exit Partners, LLC(6) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The securities were transferred by SAIL Venture Partners II, LP to SVP II Xtreme Power Joint Venture, LP, an affiliate of SAIL Venture Partners II, LP, in exchange for Class A Membership interests in SVP II Xtreme Power Joint Venture, LP. |
2. These securities are owned directly by SAIL Venture Partners II, LP, of which SAIL Venture Partners II, LLC is the general partner, of which SAIL Venture Management, LLC is the manager. SAIL Venture Partners II, LLC and SAIL Venture Management, LLC are indirect beneficial owners of the reported securities. |
3. The reporting entities disclaim beneficial ownership of these securities except to the extent of their pecuniary interest therein, and this report shall not be deemed an admission that the reporting entities are the beneficial owners of these securities for Section 16 or any other purpose. |
4. These securities are owned directly by SVP II Xtreme Power Joint Venture, LP, of which SAIL Venture Partners II, LLC is the general partner, of which SAIL Venture Management, LLC is the manager. SAIL Venture Partners II, LLC and SAIL Venture Management, LLC are indirect beneficial owners of the reported securities. |
5. The shares were transferred from SAIL Venture Partners, LP, SAIL Sustainable Louisiana II, LP, SAIL 2010 Co-Investment Partners, LP, and SAIL Pre-Exit Acceleration Fund, LP, various affiliates of the reporting entities, to SAIL Exit Partners, LLC, in exchange for Class A Membership interests in SAIL Exit Partners, LLC. The shares transferred were valued at $0.62 per share. |
6. These securities are owned directly by SAIL Exit Partners, LLC, of which SAIL Venture Partners II, LLC is the manager, of which SAIL Venture Management, LLC is the manager. SAIL Venture Partners II, LLC and SAIL Venture Management, LLC are indirect beneficial owners of the reported securities. |
7. The securities were transferred from SVP II Xtreme Power Joint Venture, LP to SAIL Exit Partners, LLC automatically on the effective date of the merger of SVP II Xtreme Power Joint Venture, LP with and into SAIL Exit Partners, LLC. |
8. The warrant does not have an expiration date. |
9. The securities were transferred from SAIL 2010 Co-Investment Partners, LP, an affiliate of the reporting entities, to SAIL Exit Partners, LLC, in exchange for Class A Membership interests in SAIL Exit Partners, LLC. |
10. The securities were transferred from SAIL Pre-Exit Acceleration Fund, LP and SAIL Sustainable Louisiana II, LP, affiliates of the reporting entities, to SAIL Exit Partners, LLC, in exchange for Class A Membership interests in SAIL Exit Partners, LLC. |
Remarks: |
F. Henry Habicht II, Member | 02/12/2015 | |
/s/ F. Henry Habicht II | 02/12/2015 | |
/s/ F. Henry Habicht II | 02/12/2015 | |
/s/ F. Henry Habicht II | 02/12/2015 | |
/s/ H. Henry Habicht II | 02/12/2015 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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. |