0001181431-13-050059.txt : 20130920
0001181431-13-050059.hdr.sgml : 20130920
20130920163645
ACCESSION NUMBER: 0001181431-13-050059
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130918
FILED AS OF DATE: 20130920
DATE AS OF CHANGE: 20130920
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: QUANTUM FUEL SYSTEMS TECHNOLOGIES WORLDWIDE, INC.
CENTRAL INDEX KEY: 0001166380
STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLE PARTS & ACCESSORIES [3714]
IRS NUMBER: 330933072
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 25242 ARCTIC OCEAN DRIVE
CITY: LAKE FOREST
STATE: CA
ZIP: 92630
BUSINESS PHONE: 949-399-4500
MAIL ADDRESS:
STREET 1: 25242 ARCTIC OCEAN DRIVE
CITY: LAKE FOREST
STATE: CA
ZIP: 92630
FORMER COMPANY:
FORMER CONFORMED NAME: QUANTUM FUEL SYSTEMS TECHNOLOGIES WORLDWIDE INC
DATE OF NAME CHANGE: 20020201
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MAZAIKA DAVID M
CENTRAL INDEX KEY: 0001452702
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-49629
FILM NUMBER: 131108271
MAIL ADDRESS:
STREET 1: 11226 VANDEMAN WAY
CITY: SAN DIEGO
STATE: CA
ZIP: 92131
4
1
rrd390697.xml
MAZAIKA CONVERTIBLE NOTE AND WARRANT
X0306
4
2013-09-18
0
0001166380
QUANTUM FUEL SYSTEMS TECHNOLOGIES WORLDWIDE, INC.
QTWW
0001452702
MAZAIKA DAVID M
25242 ARCTIC OCEAN DRIVE
LAKE FOREST
CA
92630
0
1
0
0
Director Strategic Development
Convertible Note
2.3824
2013-09-18
4
P
0
100000
100000
A
2013-09-18
2018-09-17
common stock
100000
100000
D
Warrant
2.30
2013-09-18
4
P
0
31011
0
A
2014-03-18
2019-03-17
common stock
31011
31011
D
The convertible note was purchased in connection with a private placement offering of convertible notes and warrants.
Represents the face value of the convertible note.
The convertible note is convertible into shares of common stock, $0.02 par value, at any time after the date of issuance.
Represents the scheduled maturity date of the convertible note. The maturity date is subject to a put right that may be exercised within a 30 day period following the third anniversary of the issuance date. If the put right is exercised, then the expiration date would be 90 days following the holder's exercise of the put right.
The warrant was issued in connection with the issuance of the convertible note.
/s/ David M. Mazaika
2013-09-20