- Annual Statement of Changes in Beneficial Ownership (5)
16 Aprile 2012 - 6:39PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ]
Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public
Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Donino Thomas
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2. Issuer Name
and
Ticker or Trading Symbol
ENERTECK CORP [ETCK]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
7 LAKESIDE DRIVE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2011
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(Street)
RYE, NY 10580
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrants
(1)
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$0.60
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5/17/2011
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A
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1000000
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5/17/2011
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5/17/2016
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Common Stock
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1000000
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$0
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1000000
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I
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Through BATL Bioenergy
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Warrants
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$0.60
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5/17/2011
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A
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575000
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5/17/2011
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5/17/2016
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Common Stock
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575000
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$0
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575000
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D
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Warrants
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$0.60
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5/17/2011
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A
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275000
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5/17/2011
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5/17/2016
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Common Stock
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275000
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$0
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275000
(2)
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I
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Through BATL Management LP
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Warrants
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$0.60
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8/9/2011
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A
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28500
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8/9/2011
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8/9/2016
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Common Stock
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28500
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$0
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603500
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D
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Warrants
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$0.60
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8/9/2011
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A
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150000
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8/9/2011
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8/9/2016
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Common Stock
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150000
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$0
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753500
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D
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Warrants
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$0.60
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8/9/2011
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A
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510000
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8/9/2011
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8/9/2016
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Common Stock
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510000
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$0
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1510000
(3)
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I
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Through BATL Bioenergy
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8% Convertible Promissory Note
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10/20/2011
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C
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$70000
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10/20/2011
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10/20/2014
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Common Stock
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$70000
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$695000
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D
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Explanation of Responses:
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(
1)
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This Form 5 is being filed by Thomas Donino.
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(
2)
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This amount reflects the amount of securities held by BATL Management LP ("BML"). Mr. Donino is the sole officer, director and shareholder of BML's general partner. BML is a family limited partnership whose members are certain relatives and trusts for the benefit of certain relatives of Mr. Donino. In accordance with the Instructions of Form 5, the entire amount of the Issuer's securities held by BML is reported herein. Mr. Donino disclaims, for purposes of Section 16 of the Securities Exchange Act of 1934, beneficial ownership of such securities, except to the extent the indirect pecuniary interest therein held by Mr. Donino and members of his immediate family, and this report shall not be deemed an admission that Mr. Donino is the beneficial owner of such securities for purposes of Section 16 or for any other purposes.
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(
3)
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This amount reflects the amount of securities held by BATL Bioenergy LLC ("BBL"). Mr. Donino is the president and managing member of BBL. In accordance with the Instructions of Form 5, the entire amount of the Issuer's securities held by BBL is reported herein. Mr. Donino disclaims, for purposes of Section 16 of the Securities Exchange Act of 1934, beneficial ownership of such securities, except to the extent of his indirect pecuniary interest therein, and this report shall not be deemed an admission that Mr. Donino is the beneficial owner of such securities for purposes of Section 16 or for any other purposes. BML disclaims beneficial ownership over all shares held by BBL.
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(
4)
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The Convertible Note is convertible into shares of common stock at a Variable Conversion Price defined as the average of the 10 lowest prices traded in the common stock from the initial date of the Convertible Note.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Donino Thomas
7 LAKESIDE DRIVE
RYE, NY 10580
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X
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X
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Signatures
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/s/ Thomas Donino
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4/13/2012
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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