3 1 d91478e3.txt FORM 3 - HOFFMAN DAVID H -------------------------- OMB APPROVAL -------------------------- -------- OMB Number: 3235-0104 FORM 3 Expires: December 31, 2001 -------- Estimated average burden hours per response.... 0.5 -------------------------- 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Statement Trading Symbol of Original Hoffmann David H. (Month/Day/Year) Reliable Power Systems, Inc. (RPSI) (Month/Day/Year) ---------------------------------------- ------------------------------------ (Last) (First) (Middle) 10/05/01 5. Relationship of Reporting ----------------------- DHR International ---------------------------- Person(s) to Issuer 7. Individual or Joint/ 10 S. Riverside Plaza, Suite 2220 3. I.R.S. Identification (Check all applicable) Group Filing (Check ---------------------------------------- Number of Reporting X Director X 10% Owner Applicable Line) (Street) Person, if an entity ----- ----- X Form filed by Chicago Illinois 60606 (voluntary) Officer Other (specify --- One Reporting -------------------------------------- ----- ----- below) Person (City) (State) (Zip) ---------------------------- (give title below) Form filed by --- More than One ------------------------------ Reporting Person ----------------------------------------------------------------------------------------------------------------------------------- TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 2,134,657 D ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (3-99) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
------------------------------------------------------------------------------------------------------------------------------------ FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of Indirect Security (Instr. 4) and Expiration Securities Underlying or Exercise Form of Beneficial Ownership Date Derivative Security Price of Derivative (Instr. 5) (Month/Day/Year) (Instr. 4) Derivative Security: ------------------------------------------------- Security Direct (D) or Amount or Indirect (I) Date Expiration Number (Instr. 5) Exercisable Date Title of Shares ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ DAVID H. HOFFMANN 10-19-2001 ---------------------------------- ------------ **Signature of Reporting Person Date
** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.