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