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POLA Polar Power Inc

0.39
0.0296 (8.21%)
Last Updated: 20:28:11
Delayed by 15 minutes
Share Name Share Symbol Market Type
Polar Power Inc NASDAQ:POLA NASDAQ Common Stock
  Price Change % Change Share Price Bid Price Offer Price High Price Low Price Open Price Shares Traded Last Trade
  0.0296 8.21% 0.39 0.375 0.39 0.399 0.356 0.368 17,355 20:28:11

Annual Statement of Changes in Beneficial Ownership (5)

13/05/2020 9:27pm

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
[X] Form 4 Transactions Reported UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

                                                                                  
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response...
1.0                       
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Sams Arthur D.
2. Issuer Name and Ticker or Trading Symbol

Polar Power, Inc. [POLA]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

__X__ Director                    __X__ 10% Owner
__X__ Officer (give title below)    _____ Other (specify below)
President, CEO, Secretary
(Last)          (First)          (Middle)

249 E. GARDENA BOULEVARD
3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY)
12/31/2019 
(Street)

GARDENA, CA 90248
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed(MM/DD/YYYY)
 
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. Trans. Date2A. Deemed Execution Date, if any3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(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

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. Trans. 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
(MM/DD/YYYY)
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 at End of Issuer's Fiscal Year
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Stock Option (right to buy) $5.47 10/1/2019  D4    100000   (1)4/2/2028 Common Stock 100000 $0.00 50000 D  

Explanation of Responses:
(1) On October 1, 2019, the reporting person canceled the unvested portion of his stock option to purchase up to 150,000 shares of the Issuer's common stock, which amount is equal to 100,000 shares of common stock. One-third of the shares subject to the option vested and became exercisable on April 2, 2019, and one-third of the shares subject to the option would have vested and become exercisable on each of April 2, 2020 and April 2, 2021.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Sams Arthur D.
249 E. GARDENA BOULEVARD
GARDENA, CA 90248
XXPresident, CEO, Secretary

Signatures
/s/ Arthur D. Sams5/13/2020
**Signature of Reporting PersonDate

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