0001144204-13-004861.txt : 20130130 0001144204-13-004861.hdr.sgml : 20130130 20130130171933 ACCESSION NUMBER: 0001144204-13-004861 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130128 FILED AS OF DATE: 20130130 DATE AS OF CHANGE: 20130130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROSE SAMUEL G CENTRAL INDEX KEY: 0001102663 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13111 FILM NUMBER: 13559933 MAIL ADDRESS: STREET 1: 5301 WISCONSIN AVENUE NW STREET 2: SUITE 510 CITY: WASHINGTON STATE: DC ZIP: 20015 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AXION INTERNATIONAL HOLDINGS, INC. CENTRAL INDEX KEY: 0000753048 STANDARD INDUSTRIAL CLASSIFICATION: PLASTICS FOAM PRODUCTS [3086] IRS NUMBER: 840846389 STATE OF INCORPORATION: CO FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 180 SOUTH STREET STREET 2: . CITY: NEW PROVIDENCE STATE: NJ ZIP: 07974 BUSINESS PHONE: 908-542-0888 MAIL ADDRESS: STREET 1: 180 SOUTH STREET STREET 2: . CITY: NEW PROVIDENCE STATE: NJ ZIP: 07974 FORMER COMPANY: FORMER CONFORMED NAME: ANALYTICAL SURVEYS INC DATE OF NAME CHANGE: 19920703 4 1 v333355_4.xml OWNERSHIP DOCUMENT X0306 4 2013-01-28 0 0000753048 AXION INTERNATIONAL HOLDINGS, INC. AXIH 0001102663 ROSE SAMUEL G 5301 WISCONSIN AVENUE NW SUITE 510 WASHINGTON DC 20015 0 0 1 0 8.0% Convertible Note 0.40 2013-01-28 4 P 0 416667.00 416667.00 A 2013-01-28 Common Stock 1041668 2959259.60 D Warrant to Purchase Common Stock 0.60 2013-01-28 4 P 0 1041668 0.00 A 2013-01-28 Common Stock 1041668 7398151 D Principal amount under the 8.0% Convertible Note is due January 28, 2018. Expiration Date is earlier to occur of (i) three years after the date upon which the weighted average price of a share of Common Stock for the ninety consecutive trading days prior to such date is at least $2.00 per share (as such dollar amount to be adjusted for any reverse stock split, combination or reclassification of shares or other similar event), and (ii) five years after the date on which the 8.0% Convertible Note has been repaid in full. /s/ Samuel G. Rose 2013-01-30