Amended Statement of Ownership (sc 13g/a)
14 Fevereiro 2023 - 6:02PM
Edgar (US Regulatory)
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
SCHEDULE
13G/A
UNDER
THE SECURITIES EXCHANGE ACT OF 1934
(Amendment No. 1)*
POLAR
POWER, INC.
(Name
of Issuer)
Common
Stock, par value $0.0001 per share
(Title
of Class of Securities)
73102V105
(CUSIP
Number)
December
31, 2022
(Date
of Event Which Requires Filing of this Statement)
Check
the appropriate box to designate the rule pursuant to which this Schedule is filed:
☐
Rule 13d-1(b)
☐
Rule 13d-1(c)
☒
Rule 13d-1(d)
*
The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject
class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover
page.
The
information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18
of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall
be subject to all other provisions of the Act (however, see the Notes).
CUSIP
No. |
73102V105 |
13G |
Page
2 of 5 |
1 |
NAMES
OF REPORTING PERSON(S)
Arthur D. Sams
|
2 |
CHECK
THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
(a)
☐
(b)
☐ |
3 |
SEC USE ONLY
|
4 |
CITIZENSHIP
OR PLACE OF ORGANIZATION
United
States |
NUMBER
OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH |
5 |
SOLE
VOTING POWER
5,643,600(1) |
6 |
SHARED
VOTING POWER
0 |
7 |
SOLE
DISPOSITIVE POWER
5,643,600(1) |
8 |
SHARED
DISPOSITIVE POWER
0 |
9 |
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
5,643,600(1) |
10 |
CHECK
IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
☐ |
11 |
PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
43.4%(2) |
12 |
TYPE
OF REPORTING PERSON (SEE INSTRUCTIONS)
IN |
(1)
Including 50,000 shares of common stock issuable upon exercise of options.
(2)
Based on 12,999,550 shares of common stock of Polar Power, Inc. (the “Company”), which includes (i) 12,949,550 shares outstanding
as of November 14, 2022, as reported by the Company’s 10-Q filed on November 14, 2022 and (ii) 50,000 shares issuable upon exercise
of options.
CUSIP
No. |
73102V105 |
13G |
Page
3 of 5 |
Item
1(a). Name of Issuer:
Polar
Power, Inc.
Item
1(b). Address of Issuer’s Principal Executive Offices:
The
address of the principal executive offices of Polar Power, Inc. is 249 E. Gardena Boulevard, Gardena, California 90248.
Item
2(a). Name of Person Filing
Arthur
D. Sams
Item
2(b). Address of Principal Business Office or, if None, Residence:
The
address of the principal business office is 249 E. Gardena Boulevard, Gardena, California 90248.
Item
2(c). Citizenship:
United
States
Item
2(d). Title of Class of Securities:
Common
Stock, par value $0.0001 per share
Item
2(e). CUSIP Number:
73102V105
Item
3. If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:
Item
4. Ownership.
|
(a) |
Amount
beneficially owned: |
See
the response to Item 9 on the attached cover page.
See
the response to Item 11 on the attached cover page.
|
(c) |
Number
of shares as to which the person has: |
|
(i) |
Sole
power to vote or to direct the vote: |
See
the response to Item 5 on the attached cover page.
CUSIP
No. |
73102V105 |
13G |
Page
4 of 5 |
|
(ii) |
Shared
power to vote or to direct the vote: |
See
the response to Item 6 on the attached cover page.
|
(iii) |
Sole
power to dispose or to direct the disposition of: |
See
the response to Item 7 on the attached cover page.
|
(iv) |
Shared
power to dispose or to direct the disposition of: |
See
the response to Item 8 on the attached cover page.
Item
5. Ownership of Five Percent or Less of a Class.
If
this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner
of more than five percent of the class of securities, check the following: ☐
Item
6. Ownership of More than Five Percent on Behalf of Another Person.
Not
applicable
Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company.
Not
applicable
Item
8. Identification and Classification of Member of the Group.
Not
applicable
Item
9. Notice of Dissolution of Group.
Not
applicable
Item
10. Certification.
Not
applicable
CUSIP
No. |
73102V105 |
13G |
Page
5 of 5 |
SIGNATURE
After
reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete
and correct.
Dated:
February 14, 2023 |
/s/
Arthur D. Sams |
|
Arthur
D. Sams |
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