0001617669-22-000085.txt : 20221123 0001617669-22-000085.hdr.sgml : 20221123 20221123093325 ACCESSION NUMBER: 0001617669-22-000085 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221107 FILED AS OF DATE: 20221123 DATE AS OF CHANGE: 20221123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Baum Richard L Jr CENTRAL INDEX KEY: 0001621461 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37480 FILM NUMBER: 221412596 MAIL ADDRESS: STREET 1: 10 KINZEL LANE CITY: WEST ORANGE STATE: NJ ZIP: 07052 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Unique Fabricating, Inc. CENTRAL INDEX KEY: 0001617669 STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLE PARTS & ACCESSORIES [3714] IRS NUMBER: 461846791 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 800 STANDARD PARKWAY CITY: AUBURN HILLS STATE: MI ZIP: 48326 BUSINESS PHONE: 248-853-2333 MAIL ADDRESS: STREET 1: 800 STANDARD PARKWAY CITY: AUBURN HILLS STATE: MI ZIP: 48326 4 1 wf-form4_166921399143992.xml FORM 4 X0306 4 2022-11-07 0 0001617669 Unique Fabricating, Inc. UFAB 0001621461 Baum Richard L Jr C/O UNIQUE FABRICATING, INC. 800 STANDARD PARKWAY AUBURN HILLS MI 48326 1 0 0 0 Common Stock, $0.001 par value 2022-11-07 4 J 0 31539 0 A 368333 D The shares of common stock were among the shares issued as a fee to the placement agent of the Company's debt offering completed on November 7, 2022 and were subsequently distributed to employees of the placement agent. The number of shares issued to the placement agent was determined based on a per share price of $0.52. /s/ Richard L. Baum, Jr 2022-11-22