FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/09/2004 |
3. Issuer Name and Ticker or Trading Symbol
ELECTRO ENERGY INC [ eeei ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) 06/21/2004 |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 497,707 | D | |
Common Stock | 53,719 | I | By HSB Capital(1) |
Common Stock | 428,689 | I | By Trust FBO Thomas L. Kempner(2) |
Common Stock | 428,689 | I | By Trust FBO Alan H. Kempner, Jr.(3) |
Common Stock | 94,115 | I | Held by Shari Popkin Fleischer(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant | 11/24/2003 | 11/24/2008 | Common Stock | 85,950 | $1.16 | D | |
Series A Convertible Preferred | 06/09/2004 | (5) | Common Stock | 115,950 | $0 | I | By Trust FBO Thomas L. Kempner(2) |
Series A Convertible Preferred | 06/09/2004 | (5) | Common Stock | 115,950 | $0 | I | By Trust FBO Alan H. Kempner, Jr.(3) |
Series A Convertible Preferred | 06/09/2004 | (5) | Common Stock | 167,420 | $0 | I | By Matrix USA, LLC(6) |
Explanation of Responses: |
1. Shares are held by HSB Capital, an affiliate of the reporting person. The reporting person expressly disclaims ownership of the common stock owned or acquirable by the other investors. |
2. Shares are held by the Trust FBO Thomas L. Kempner. |
3. Share are held by the Trust FBO Alan H. Kempner, Jr.. |
4. Shares are held by Shari Popkin Fleischer. |
5. None. |
6. Shares held by Matrix USA, LLC. The reporting person expressly disclaims ownership of the common stock owned or acquirable by the other investors. |
/s/Warren Bagatelle | 09/28/2005 | |
** 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 5 (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. |