SEC Form 3
FORM 3 | 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 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 07/21/2015 | 3. Issuer Name and Ticker or Trading Symbol AMERICAN POWER GROUP Corp [ APGI ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, par value $.01 per share | 3,927,968 | I | As Trustee(1) |
Common Stock, par value $.01 per share | 831,195 | I | As Trustee(2) |
Common Stock, par value $.01 per share | 606,099 | I | See footnotes(3) |
Common Stock, par value $.01 per share | 30,000 | I | By Rollover IRA(4) |
Common Stock, par value $.01 per share | 12,000 | I | By ROTH IRA(5) |
Common Stock, par value $.01 per share | 1,000 | I | As Beneficiary of Rollover IRA owned by Spouse(6) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
10% Convertible Preferred Stock, par value $1.00 per share | (7) | (7) | Common Stock, par value $.01 per share | 510,210 | 0.4 | I | See footnotes(3) |
Common Stock Warrants (right to buy) | 10/30/2012 | 05/30/2020 | Common Stock, par value $.01 per share | 1,540,830 | 0.4 | I | See footnotes(3) |
Series B 10% Convertible Preferred Stock, par value $1.00 | 05/28/2015 | 11/28/2020 | Common Stock, par value $.01 per share | 5,000,000 | 0.5 | I | See footnotes(3) |
Common Stock Warrants (right to buy) | 10/30/2012 | 05/30/2020 | Common Stock, par value $.01 per share | 270,000 | 0.5 | I | As Trustee(8) |
Explanation of Responses: |
1. These shares are owned directly by the Van Steenwyk GST Trust and indirectly by Matthew Van Steenwyk, the Trustee of the Van Steenwyk GST Trust. |
2. These shares are owned directly by the Van Steenwyk Issue Trust and indirectly by Matthew Van Steenwyk, the Trustee of the Van Steenwyk Issue Trust. |
3. These shares are directly owned by Arrow, LLC ("Arrow"). The securities reported as directly beneficially owned by Arrow may be deemed to be indirectly beneficially owned by Matthew Van Steenwyk, the managing member of Arrow. |
4. These shares are owned directly by the Matt Van Steenwyk Rollover IRA and indirectly by Matthew Van Steenwyk, owner of the Matt Van Steenwyk Rollover IRA. |
5. These shares are owned directly by the Matt Van Steenwyk ROTH IRA and indirectly by Matthew Van Steenwyk, owner of the Matt Van Steenwyk ROTH IRA. |
6. These shares are owned directly by the Betty Van Steenwyk Rollover IRA and indirectly by Betty Van Steenwyk, owner of the Betty Van Steenwyk Rollover IRA, and Matthew Van Steenwyk, beneficiary of the Betty Van Steenwyk Rollover IRA. |
7. The 10% Convertible Preferred Stock ("Preferred Stock") has no expiration date and is convertible at any time at the respective holder's election. |
8. The 270,000 common stock warrants are owned directly by the Van Steenwyk Issue Trust and indirectly by Matthew Van Steenwyk as Trustee of the Van Steenwyk Issue Trust. |
Matthew Van Steenwyk | 07/22/2015 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |