SEC Form 5
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.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
VAN DER VELDEN STEVEN PAUL KAREL MARIE

(Last) (First) (Middle)
SCHIPHOL BOULEVARD 249
1118 BH,

(Street)
SCHIPHOL P7

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ELEPHANT TALK COMMUNICATIONS CORP [ ETAK ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
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)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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)
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).
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