-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, LRIUvY6ncAO012WdXNCQPu4J5lKx8AebCiXVroev19nvJPZI4hHgRoyKKDga9IQA Eq9HBCe03ItRc5UgC537+Q== 0001047469-99-018901.txt : 19990511 0001047469-99-018901.hdr.sgml : 19990511 ACCESSION NUMBER: 0001047469-99-018901 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19990510 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FORWARD INDUSTRIES INC CENTRAL INDEX KEY: 0000038264 STANDARD INDUSTRIAL CLASSIFICATION: PLASTICS PRODUCTS, NEC [3089] IRS NUMBER: 131950672 STATE OF INCORPORATION: NY FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13D SEC ACT: SEC FILE NUMBER: 005-45773 FILM NUMBER: 99614889 BUSINESS ADDRESS: STREET 1: 400 POST AVENUE CITY: WESTBURY STATE: NY ZIP: 11590 BUSINESS PHONE: 5163380700 MAIL ADDRESS: STREET 1: 400 POST AVENUE CITY: WESTBURY STATE: NY ZIP: 11590 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: ELLIN ROBERT S CENTRAL INDEX KEY: 0001071292 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 750 LEXINGTON AVE CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2127505858 MAIL ADDRESS: STREET 1: 750 LEXINGTON AVE CITY: NEW YORK STATE: NY ZIP: 10022 SC 13D 1 SCHEDULE 13D UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D (Amendment No. 3) Under the Securities Exchange Act of 1934 FORWARD INDUSTRIES, INC. - -------------------------------------------------------------------------------- (Name of Issuer) COMMON STOCK (.01 PAR VALUE) - -------------------------------------------------------------------------------- (Title of Class of Securities) 34986210 --------------------------- (CUSIP Number) Kenneth Koch, Esq. Squadron, Ellenoff, Plesent & Sheinfeld, LLP 551 Fifth Avenue, New York, NY 10176 - -------------------------------------------------------------------------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) April 27 , 1999 ------------------------------------------------------- (Date of event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-1(b)(3) or (4), check the following box: o NOTE: Six copies of this statement, including all exhibits, should be filed with the Commission. See Rule 13d-1(a) for other parties to whom copies are to be sent. * 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). CUSIP NO. 34986210 - -------------------------------------------------------------------------------- 1 Name of Reporting Person Robert S. Ellin S.S. or I.R.S. Identification No. of Above Person - -------------------------------------------------------------------------------- 2 Check the Appropriate Box if (a) [ ] a Member of a Group (b) [X] - -------------------------------------------------------------------------------- 3 SEC Use Only - -------------------------------------------------------------------------------- 4 Source of Funds PF - -------------------------------------------------------------------------------- 5 Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- 6 Citizenship or Place of Organization U.S.A. - -------------------------------------------------------------------------------- 7 Sole Voting Power 305,500 shares including 216,000 shares underlying warrants --------------------------------------------------------- Number of Shares 8 Shared Voting Power 1,154,617 shares including Beneficially Owned by 571,950 shares underlying Reporting Person With warrants --------------------------------------------------------- 9 Sole Dispositive Power 305,500 shares including 216,000 shares underlying warrants --------------------------------------------------------- 10 Shared Dispositive Power 1,154,617 shares including 571,950 shares underlying warrants - -------------------------------------------------------------------------------- 11 Aggregate Amount Beneficially Owned By Each Reporting Person 1,460,117 shares - -------------------------------------------------------------------------------- 12 Check box if the aggregate Amount in Row (11) Excludes Certain Shares [X] - -------------------------------------------------------------------------------- 13 Percent of Class Represented Amount in Row (11) 21.8% - -------------------------------------------------------------------------------- 14 Type of Reporting Person IN - -------------------------------------------------------------------------------- - 2 - CUSIP NO. 34986210 - -------------------------------------------------------------------------------- 1 Name of Reporting Person Robert Ellin Family 1997 Trust S.S. or I.R.S. Identification No. of Above Person - -------------------------------------------------------------------------------- 2 Check the Appropriate Box if (a) [ ] a Member of a Group (b) [X] - -------------------------------------------------------------------------------- 3 SEC Use Only - -------------------------------------------------------------------------------- 4 Source of Funds PF - -------------------------------------------------------------------------------- 5 Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- 6 Citizenship or Place of Organization U.S.A. - -------------------------------------------------------------------------------- 7 Sole Voting Power 37,500 shares --------------------------------------------------------- Number of Shares 8 Shared Voting Power Beneficially Owned by Reporting Person With --------------------------------------------------------- 9 Sole Dispositive Power 37,500 shares --------------------------------------------------------- 10 Shared Dispositive Power - -------------------------------------------------------------------------------- 11 Aggregate Amount Beneficially Owned By Each Reporting Person 37,500 shares - -------------------------------------------------------------------------------- 12 Check box if the aggregate Amount in Row (11) Excludes Certain Shares [ ] - -------------------------------------------------------------------------------- 13 Percent of Class Represented Amount in Row (11) 0.6% - -------------------------------------------------------------------------------- 14 Type of Reporting Person OO - -------------------------------------------------------------------------------- -3- CUSIP NO. 34986210 - -------------------------------------------------------------------------------- 1 Name of Reporting Person Atlantis Equities, Inc. S.S. or I.R.S. Identification No. of Above Person - -------------------------------------------------------------------------------- 2 Check the Appropriate Box if (a) [ ] a Member of a Group (b) [X] - -------------------------------------------------------------------------------- 3 SEC Use Only - -------------------------------------------------------------------------------- 4 Source of Funds WC - -------------------------------------------------------------------------------- 5 Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- 6 Citizenship or Place of Organization New York - -------------------------------------------------------------------------------- 7 Sole Voting Power --------------------------------------------------------- Number of Shares 8 Shared Voting Power 326,450 shares including Beneficially Owned by 121,950 shares underlying Reporting Person With warrants --------------------------------------------------------- 9 Sole Dispositive Power --------------------------------------------------------- 10 Shared Dispositive Power 326,450 shares including 121,950 shares underlyin warrants - -------------------------------------------------------------------------------- 11 Aggregate Amount Beneficially 326,450 shares Owned By Each Reporting Person - -------------------------------------------------------------------------------- 12 Check box if the aggregate Amount in Row (11) Excludes Certain Shares [ ] - -------------------------------------------------------------------------------- 13 Percent of Class Represented Amount in Row (11) 5.4% - -------------------------------------------------------------------------------- 14 Type of Reporting Person CO - -------------------------------------------------------------------------------- -4- CUSIP NO. 34986210 - -------------------------------------------------------------------------------- 1 Name of Reporting Person Robert Ellin Profit Sharing Plan S.S. or I.R.S. Identification No. of Above Person - -------------------------------------------------------------------------------- 2 Check the Appropriate Box if (a) [ ] a Member of a Group (b) [X] - -------------------------------------------------------------------------------- 3 SEC Use Only - -------------------------------------------------------------------------------- 4 Source of Funds OO - -------------------------------------------------------------------------------- 5 Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- 6 Citizenship or Place of Organization U.S.A. - -------------------------------------------------------------------------------- 7 Sole Voting Power --------------------------------------------------------- Number of Shares 8 Shared Voting Power 553,167 shares including Beneficially Owned by 285,000 shares underlying Reporting Person With warrants --------------------------------------------------------- 9 Sole Dispositive Power --------------------------------------------------------- 10 Shared Dispositive Power 553,167 shares including 285,000 shares underlyin warrants - -------------------------------------------------------------------------------- 11 Aggregate Amount Beneficially 553,167 shares Owned By Each Reporting Person - -------------------------------------------------------------------------------- 12 Check box if the aggregate Amount in Row (11) Excludes Certain Shares [ ] - -------------------------------------------------------------------------------- 13 Percent of Class Represented Amount in Row (11) 8.9% - -------------------------------------------------------------------------------- 14 Type of Reporting Person EP - -------------------------------------------------------------------------------- -5- CUSIP NO. 34986210 - -------------------------------------------------------------------------------- 1 Name of Reporting Person Nancy J. Ellin S.S. or I.R.S. Identification No. of Above Person - -------------------------------------------------------------------------------- 2 Check the Appropriate Box if (a) [ ] a Member of a Group (b) [X] - -------------------------------------------------------------------------------- 3 SEC Use Only - -------------------------------------------------------------------------------- 4 Source of Funds PF - -------------------------------------------------------------------------------- 5 Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) [ ] - -------------------------------------------------------------------------------- 6 Citizenship or Place of Organization U.S.A. - -------------------------------------------------------------------------------- 7 Sole Voting Power --------------------------------------------------------- Number of Shares 8 Shared Voting Power 275,000 shares including Beneficially Owned by 165,000 shares underlying Reporting Person With warrants --------------------------------------------------------- 9 Sole Dispositive Power --------------------------------------------------------- 10 Shared Dispositive Power 275,000 shares including 165,000 shares underlyin warrants - -------------------------------------------------------------------------------- 11 Aggregate Amount Beneficially 275,000 shares Owned By Each Reporting Person - -------------------------------------------------------------------------------- 12 Check box if the aggregate Amount in Row (11) Excludes Certain Shares [ ] - -------------------------------------------------------------------------------- 13 Percent of Class Represented Amount in Row (11) 4.5% - -------------------------------------------------------------------------------- 14 Type of Reporting Person IN - -------------------------------------------------------------------------------- -6- This Amendment No. 3 to Schedule 13D ("Amendment No. 3"), amends the Schedule 13D filed in September 1998 (the "Original 13D"), as amended by Amendment No. 1 filed in October 1998 ("Amendment No.1") and Amendment No. 2 filed in December 1998 ("Amendment No. 2"), filed by Robert S. Ellin, Robert Ellin Family 1997 Trust, Atlantis Equities, Inc., Robert Ellin Profit Sharing Plan and Nancy J. Ellin (the "Filing Persons") and relates to the common stock, par value $.01 per share ("Common Stock"), of Forward Industries, Inc., a New York corporation (the "Company"). Capitalized terms used herein and not defined herein shall have the meanings ascribed to them in the Original 13D and Amendments Nos. 1 and 2. Item 3. SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION. The source of the funds used for purchases made by Robert Ellin Profit Sharing (the "Plan") was funds contributed by or for the benefit of the beneficiaries thereof. See Item 5(a). Item 5. INTEREST IN SECURITIES OF THE ISSUER. Item 5(a) is hereby amended and supplemented by adding the following thereto: (a) On April __, 1999, the Plan made a privately negotiated purchase for $106,667 from a shareholder of 106,667 shares of Common Stock. In addition, the Plan purchased 13,500 shares on the open market for 0.8325 per share on January 5, 1999, and Atlantis Equities purchased 5,000 shares on the open market for $1.25 per share on January 21, 1999. These equity securities, in addition to the 1,372,450 shares of Common Stock previously reported as beneficially owned by the Filing Persons in Amendment No.2 (a total of 1,497,617 shares), represent approximately 22.4% of the outstanding shares of Common Stock of the Company. - 7 - SIGNATURE 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, correct and complete. Dated: April 27, 1999 /s/ Robert S. Ellin ------------------------------------- Robert S. Ellin ROBERT ELLIN FAMILY 1997 TRUST By: /s/ Marvin Ellin, Trustee --------------------------------- Marvin Ellin, Trustee ATLANTIS EQUITIES, INC., By: /s/ Robert S. Ellin --------------------------------- Robert S. Ellin, President ROBERT ELLIN PROFIT SHARING PLAN By: /s/ Robert S. Ellin --------------------------------- Robert S. Ellin, Trustee By: /s/ Nancy J. Ellin --------------------------------- Nancy J. Ellin - 8 - -----END PRIVACY-ENHANCED MESSAGE-----