SEC Form 4 · accession 0001209191-15-030030

Enerpulse Technologies, Inc. · ENPT

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Tim Ford

Director

Period of report

Oct 15, 2013

Accepted (ET)

Mar 27, 2015 · 7:10 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001495899

Table I — non-derivative securities

No Table I lines on this filing.

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Employee Stock Option (Right to Buy)^F1	$3.00	Oct 15, 2013	A	13,234	A	—	Oct 15, 2023	Common Stock	13,234	13,234	D
Employee Stock Option (Right to Buy)^F3,F2	$0.75	Jun 30, 2014	A	4,972	A	—	Jan 3, 2018	Common Stock	4,972	4,972	D
Employee Stock Option (Right to Buy)^F3,F2	$0.9051	Jun 30, 2014	D	4,972	D	—	Jan 3, 2018	Common Stock	4,972	0	D
Employee Stock Option (Right to Buy)^F3,F2	$0.75	Jun 30, 2014	A	9,944	A	—	Jul 18, 2016	Common Stock	9,944	9,944	D
Employee Stock Option (Right to Buy)^F3,F4	$0.9051	Jun 30, 2014	D	9,944	D	—	Jul 18, 2016	Common Stock	9,944	0	D
Employee Stock Option (Right to Buy)^F5,F2	$0.75	Jun 30, 2014	A	13,234	A	—	Oct 15, 2023	Common Stock	13,234	13,234	D
Employee Stock Option (Right to Buy)^F5,F1	$3.00	Jun 30, 2014	D	13,234	D	—	Oct 15, 2023	Common Stock	13,234	0	D
Employee Stock Option (Right to Buy)^F6	$0.50	Aug 6, 2014	A	49,852	A	—	Aug 6, 2024	Common Stock	49,852	49,852	D
6% Senior Secured Convertible Note^F8,F7	$0.20	Feb 20, 2015	P	—	A	—	Feb 20, 2018	Common Stock	25,000	—	D
Warrant (Right to Buy)^F8,F9	$0.20	Feb 20, 2015	P	12,500	A	—	Feb 20, 2020	Common Stock	12,500	12,500	D

Explanation of responses

F1The shares subject to the option shall vest and become exercisable ratably in annual installments over three years beginning on October 15, 2014 until fully vested on October 15, 2016.
F2The shares subject to the option are 100% vested and excercisable.
F3The reporting person agreed to cancellation of an option issued to him on September 4, 2013, in exchange for a new option having a lower exercise price.
F4The shares subject to the cancelled option would have vested and became exercisable ratably in annual installments over three years beginning on July 18, 2011 until fully vested on July 18, 2014.
F5The reporting person agreed to cancellation of an option granted to him on October 15, 2013, in exchange for a new option having a lower exercise price.
F6The shares subject to the option shall vest and become exercisable ratably in annual installments over three years beginning on August 6, 2015 until fully vested on August 6, 2017.
F7All amounts due under the 6% senior secured convertible note are convertible at any time, in whole or in part, at the option of the reporting person into shares of common stock at a fixed, initial conversion price of $0.20 per share, which is subject to adjustment for stock splits, stock dividends, combinations, or similar events or to prevent dillution.
F8The note and warrant were purchased by the reporting person for the aggregate purchase price of $5,000.
F9The warrant is exercisable at any time on or after the date of issuance at an initial exercise price equal to $0.20 per share, subject to adjustment for stock splits, stock dividends, combinations, or similar events or to prevent dillution.