FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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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. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
ELEPHANT TALK COMMUNICATIONS CORP [ ETAK ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2012 | ||||||||||||||||||||||||||
4. 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 Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock | 27,132(1) | D | |||||||||||||
Common Stock | 8,967,215 | I | By RWC. See footnote(2) | ||||||||||||
Common Stock | 423,662 | I | By CMV See footnote(3) | ||||||||||||
Common Stock | 1,416,415 | I | By CMV II see footnote(4) | ||||||||||||
Common Stock | 03/06/2012 | A4 | 8,555 | A | (6) | 72,386 | I | By QAT see footnote(5)(6) | |||||||
Common Stock | 04/17/2012 | A4 | 8,626 | A | (6) | 72,386 | I | By QAT see footnote(5)(6) | |||||||
Common Stock | 07/10/2012 | A4 | 10,642 | A | (6) | 72,386 | I | By QAT see footnote(5)(6) | |||||||
Common Stock | 10/12/2012 | A4 | 13,827 | A | (6) | 72,386 | I | By QAT see footnote(5)(6) | |||||||
Common Stock | 12/05/2012 | S4 | 8,058 | D | $0.927 | 1,409,702 | I | By QAT II see footnoted(7) |
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 Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Warrant | $1.26 | 09/30/2008 | 09/30/2013 | Common Stock | 1,416,615 | 1,416,615 | I | By CMV II, see footnote(8) | ||||||
Warrant | $1.47 | 09/30/2008 | 09/30/2013 | Common Stock | 708,207 | 708,207 | I | By CMV II, see footnote(8) | ||||||
Warrant | $1.05 | 08/18/2008 | 08/18/2013 | Common Stock | 110,873 | 110,873 | I | By RWC, see footnote(9) | ||||||
Warrant | $1.26 | 08/18/2008 | 08/18/2013 | Common Stock | 1,219,604 | 1,219,604 | I | By RWC, see footnote(9) | ||||||
Warrant | $1.47 | 08/18/2008 | 08/18/2013 | Common Stock | 609,802 | 609,802 | I | By RWC, see footnote(9) | ||||||
Warrant | $1.05 | 08/18/2008 | 08/18/2013 | Common Stock | 109,973 | 109,973 | I | By QAT, see footnote(10) | ||||||
Warrant | $1.26 | 08/18/2008 | 08/18/2013 | Common Stock | 109,973 | 109,973 | I | By QAT, see footnote(10) | ||||||
Warrant | $1.47 | 08/18/2008 | 08/18/2013 | Common Stock | 54,987 | 54,987 | I | By QAT, see footnote(10) | ||||||
Warrant | $1 | 07/31/2009 | 07/31/2014 | Common Stock | 966,800 | 966,800 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1 | 10/30/2009 | 10/30/2014 | Common Stock | 322,037 | 322,037 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.5 | 06/08/2010 | 02/02/2013 | Common Stock | 118,137 | 118,137 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.45 | 06/08/2010 | 02/24/2013 | Common Stock | 278,049 | 278,049 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.61 | 06/08/2010 | 03/22/2013 | Common Stock | 49,133 | 49,133 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.73 | 06/08/2010 | 03/30/2013 | Common Stock | 162,120 | 162,120 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.5 | 06/10/2010 | 02/02/2013 | Common Stock | 236,274 | 236,274 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.45 | 06/10/2010 | 02/24/2013 | Common Stock | 556,099 | 556,099 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.61 | 06/10/2010 | 03/22/2013 | Common Stock | 98,266 | 98,266 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.73 | 06/10/2010 | 03/30/2013 | Common Stock | 324,241 | 324,241 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.5 | 10/08/2010 | 10/08/2015 | Common Stock | 1,074,031 | 1,074,031 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1.5 | 10/08/2010 | 10/08/2015 | Common Stock | 562,595 | 562,595 | I | By QAT II, see footnote(11) | ||||||
Warrant | $2 | 06/01/2010 | 06/01/2015 | Common Stock | 40,461 | 40,461 | I | By QAT II, see footnote(11) | ||||||
Warrant | $1 | 12/17/2019 | 10/31/2014 | Common Stock | 261,617 | 261,617 | I | By QAT II, see footnote(11) |
Explanation of Responses: |
1. The number of shares the Reporting Person beneficially owns directly does not include the shares sold without proper authorization by a third party in which no sales proceeds were paid to the Reporting Person; |
2. These shares are held by Rising Water Capital, AG ("RWC"). Reporting Person holds a 32.80% ownership interest in RWC and the number of shares shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through RWC. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such shares and thus disclaims beneficial ownership over such shares. The number of shares the Reporting Person beneficially owns indirectly through RWC does not include the shares sold without proper authorization by a third party in which no sales proceeds were paid to RWC; |
3. These shares are held by CMV Invest CVA ("CMV I"). Reporting Person holds a 27.25% ownership interest in CMV I and the number of shares shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through CMV I. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such shares and thus disclaims beneficial ownership over such shares. |
4. These shares are held by CMV Invest II CVA ("CMV II"). Reporting Person holds a 40.75% ownership interest in CMV II and the number of shares shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through CMV II. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such shares and thus disclaims beneficial ownership over such shares. |
5. These shares are held by QAT Investments SA ("QAT"). Reporting Person holds a 30.79% ownership interest in QAT and the number of shares shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through QAT. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such shares and thus disclaims beneficial ownership over such shares. |
6. Shares were issued at no costs to QAT in lieu of certain cash compensation for services provided by Steven van der Velden, Yves Van Sante and Johan Dejager, during the period from fourth quarter of 2011 to the third quarter of 2012, pursuant to certain consulting agreement between the Company and QAT. |
7. These shares are held by QAT II Investments SA ("QAT II"). Reporting Person holds a 24.17% ownership interest in QAT II and the number of shares shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through QAT II. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such shares and thus disclaims beneficial ownership over such shares. |
8. These warrants are held by CMV II. Reporting Person holds a 40.75% ownership interest in CMV II and the number of warrants shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through CMV II. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such warrants and thus disclaims beneficial ownership over such warrants. |
9. These warrants are held by RWC. Reporting Person holds a 32.8% ownership interest in RWC and the number of warrants shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through RWC. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such warrants and thus disclaims beneficial ownership over such warrants. |
10. These warrants are held by QAT. Reporting Person holds a 30.79% ownership interest in QAT and the number of warrants shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through QAT. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such warrants and thus disclaims beneficial ownership over such warrants. |
11. These warrants are held by QAT II. Reporting Person holds a 24.17% ownership interest in QAT II and the number of warrants shown here indicates the Reporting Person's proportionate interest in the Issuer's securities through QAT II. The Reporting Person is not a controlling shareholder nor has or shares the investment control over such warrants and thus disclaims beneficial ownership over such warrants. |
/s/ Steven van der Velden | 03/04/2013 | |
** 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 4 (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. |