SEC Form 4 · accession 0001493152-18-014615

PEN INC. · PENC

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

Reporting owner

Director

Period of report

Oct 16, 2018

Accepted (ET)

Oct 18, 2018 · 9:08 am EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000891417

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Class A Common Stock^F1	Oct 16, 2018	J	4,000	$0.50	A	43,889	D
Class A Common Stock^F2	Oct 16, 2018	P	33,898	$0.50	A	77,787	I	See Footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Option^F2	$1.00	Oct 16, 2018	P	33,898	A	Oct 6, 2018	Jun 30, 2019	Class A common stock	33,898	34,957	I
Warrant^F2,F3	$1.50	Oct 16, 2018	P	33,898	A	Oct 16, 2018	Oct 16, 2022	Class A common stock	33,898	68,855	I
Warrant Option^F2,F4	$2.00	Oct 16, 2018	P	33,898	A	—	—	Class A common stock	33,898	102,753	I

F1Shares acquired directly were awarded as compensation for service as a director of PEN Inc.
F2Shares acquired indirectly and derivative securities acquired were purchased by a family investment entity that purchased an interest in an entity that acquired the issuer's securities in a private placement. Reporting person has voting control over the family investment entity but reporting person disclaims beneficial ownership of the securities held by the partnership for which he does not have pecuniary interest and this filing should not be construed as an admission that the reporting person is the beneficial owner of these securities.
F3Warrant will expire on the earlier of this date or the date that the Class A common stock has been trading at or above 120% of the exercise price for a period of 90 days.
F4Warrant Option is priced at $0.03 per warrant and can only be purchased after exercise of Option and only for that number of shares purchased as a result of option exercise. If exercised, warrant issued on exercise of Warrant Option will have warrant exercise price of $2.00 per share and will expire on the earlier of 4 days from date of issue or date that the Class A common stock has been trading at or above 120% of the exercise price for a period of 90 days.