0001382963-17-000184.txt : 20171204
0001382963-17-000184.hdr.sgml : 20171204
20171204213820
ACCESSION NUMBER: 0001382963-17-000184
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171130
FILED AS OF DATE: 20171204
DATE AS OF CHANGE: 20171204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Shandong Heavy Industry Group Co., Ltd.
CENTRAL INDEX KEY: 0001703252
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35944
FILM NUMBER: 171238533
BUSINESS ADDRESS:
STREET 1: #40-1 YANZI SHAN WEST ROAD
CITY: JINAN, SHANDONG PROVINCE
STATE: F4
ZIP: 250014
BUSINESS PHONE: 0531-82623823
MAIL ADDRESS:
STREET 1: #40-1 YANZI SHAN WEST ROAD
CITY: JINAN, SHANDONG PROVINCE
STATE: F4
ZIP: 250014
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Weichai Power Co., Ltd.
CENTRAL INDEX KEY: 0001703367
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35944
FILM NUMBER: 171238534
BUSINESS ADDRESS:
STREET 1: SECTION A 197, FU SHOU EAST STREET
STREET 2: HIGH TECHNOLOGY INDUSTRIAL DEVELOP. ZONE
CITY: WEIFANG, SHANDONG PROVINCE
STATE: F4
ZIP: 261061
BUSINESS PHONE: 0531-82623823
MAIL ADDRESS:
STREET 1: SECTION A 197, FU SHOU EAST STREET
STREET 2: HIGH TECHNOLOGY INDUSTRIAL DEVELOP. ZONE
CITY: WEIFANG, SHANDONG PROVINCE
STATE: F4
ZIP: 261061
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Weichai America Corp.
CENTRAL INDEX KEY: 0001702521
STATE OF INCORPORATION: IL
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35944
FILM NUMBER: 171238535
BUSINESS ADDRESS:
STREET 1: 3100 GOLF ROAD
CITY: ROLLING MEADOWS
STATE: IL
ZIP: 60008
BUSINESS PHONE: 847-725-7030
MAIL ADDRESS:
STREET 1: 3100 GOLF ROAD
CITY: ROLLING MEADOWS
STATE: IL
ZIP: 60008
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: POWER SOLUTIONS INTERNATIONAL, INC.
CENTRAL INDEX KEY: 0001137091
STANDARD INDUSTRIAL CLASSIFICATION: ENGINES & TURBINES [3510]
IRS NUMBER: 330963637
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 201 MITTEL DRIVE
CITY: WOOD DALE
STATE: IL
ZIP: 60191
BUSINESS PHONE: 630.350.9400
MAIL ADDRESS:
STREET 1: 201 MITTEL DRIVE
CITY: WOOD DALE
STATE: IL
ZIP: 60191
FORMER COMPANY:
FORMER CONFORMED NAME: FORMAT INC
DATE OF NAME CHANGE: 20060901
FORMER COMPANY:
FORMER CONFORMED NAME: FORMAT INC /FA/
DATE OF NAME CHANGE: 20010321
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2017-11-30
0001137091
POWER SOLUTIONS INTERNATIONAL, INC.
PSIX
0001702521
Weichai America Corp.
3100 GOLF ROAD
ROLLING MEADOWS
IL
60008
0
0
1
0
0001703367
Weichai Power Co., Ltd.
SECTION A 197, FU SHOU EAST STREET
HIGH-TECH INDUSTRIAL DEV. ZONE
WEIFANG, SHANDONG PROVINCE
F4
261061
CHINA
0
0
1
0
0001703252
Shandong Heavy Industry Group Co., Ltd.
#40-1 YANZI SHAN WEST ROAD
JINAN, SHANDONG PROVINCE
F4
250014
CHINA
0
0
1
0
Common Stock
2017-11-30
4
C
0
4771248
8.00
A
7700000
I
See Explanation of Responses
Series B Convertible Perpetual Preferred Stock
8.00
2017-11-30
4
C
0
2385624
0
D
Common Stock
4771248
0
I
See Explanation of Responses
Warrants to Purchase Common Stock
2018-09-30
2018-12-31
Common Stock
4055709
4055709
I
See Explanation of Responses
This report is filed jointly by Weichai America Corp., Weichai Power Co., Ltd. and Shandong Heavy Industry Group Co., Ltd. (collectively, the "Reporting Persons"). Weichai America Corp. is the direct owner of the Common Stock referenced in this report and shares the power to vote and the power to dispose of all of such shares of Common Stock with the other Reporting Persons. No individual has beneficial ownership over the Common Stock benefically owned by the Reporting Persons. Each of the Reporting Persons disclaims beneficial ownership of these securities, except to the extent of its pecuniary interest therein. This Form 4 shall not deemed to be an admission that any Reporting Person hereunder is the beneficial owner of any of the reported securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
On November 30, 2017, the Issuer entered into a Securities Exchange Agreement with Weichai America Corp., pursuant to which (i) the 2,385,624 shares of Series B Preferred Stock (such shares of Series B Preferred Stock being convertible into two shares of Common Stock for each share of Series B Preferred Stock) held by Weichai America Corp. were exchanged for 4,771,248 shares of Common Stock and (ii) the 2018 Warrant was amended (the "Amended 2018 Warrant") to (a) provide that the Amended 2018 Warrant is exercisable for Common Stock without the requirement to obtain stockholder approval and is not exercisable for Series B Preferred Stock and (b) permit the Issuer to request the accelerated exercise of the Amended 2018 Warrant to the extent required to meet the funding needs of the Issuer. Other terms of the Amended 2018 Warrant as described in the Form 3 filed with the Securities and Exchange Commission by the Reporting Persons on April 10, 2017 remain the same.
/s/ Huisheng Liu, Chairman, Weichai America Corp.
2017-12-04
/s/ Sun Shaojun, Executive President, Weichai Power Co., Ltd.
2017-12-04
/s/Jiang Kui, President, Shandong Heavy Industry Group Co., Ltd.
2017-12-04