Sec Form 4 Filing - DOUGLAS KEVIN @ QUANTUM FUEL SYSTEMS TECHNOLOGIES WORLDWIDE, INC. - 2016-07-13

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
DOUGLAS KEVIN
2. Issuer Name and Ticker or Trading Symbol
QUANTUM FUEL SYSTEMS TECHNOLOGIES WORLDWIDE, INC. [ QTWW]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) X __ Other (specify below)
13(d)(3) group
(Last) (First) (Middle)
125 E. SIR FRANCIS DRAKE BLVD., STE 400
3. Date of Earliest Transaction (MM/DD/YY)
07/13/2016
(Street)
LARKSPUR, CA94939
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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)
Code V 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 Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Convertible Note $ 2.3824 07/13/2016 J( 7 ) 4,000,000 ( 6 ) 09/18/2013( 4 ) 09/17/2018( 5 ) Common Stock 4,000,000 ( 6 ) ( 7 ) 0 D ( 1 ) ( 2 )
Convertible Note $ 2.3824 07/13/2016 J( 7 ) 6,000,000 ( 6 ) 09/18/2013( 4 ) 09/17/2018( 5 ) Common Stock 6,000,000 ( 6 ) ( 7 ) 0 I ( 2 ) ( 3 ) By James Douglas and Jean Douglas Irrevocable Descendants' Trust
Convertible Note $ 2.3824 07/13/2016 J( 7 ) 600,000 ( 6 ) 06/30/2015( 4 ) 09/17/2018( 5 ) Common Stock 600,000 ( 6 ) ( 7 ) 0 D ( 1 ) ( 2 )
Convertible Note $ 2.3824 07/13/2016 J( 7 ) 900,000 ( 6 ) 06/30/2015( 4 ) 09/17/2018( 5 ) Common Stock 900,000 ( 6 ) ( 7 ) 0 I ( 2 ) ( 3 ) By James Douglas and Jean Douglas Irrevocable Descendants' Trust
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DOUGLAS KEVIN
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR, CA94939
X 13(d)(3) group
Douglas Michelle
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR, CA94939
X 13(d)(3) group
JAMES & JEAN DOUGLAS IRREVOCABLE DESCENDANTS TRUST
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR, CA94939
X 13(d)(3) group
Signatures
/s/ Eileen Wheatman, attorney in fact for Kevin Douglas 07/14/2016
Signature of Reporting Person Date
/s/ Eileen Wheatman, attorney in fact for Michelle Douglas 07/14/2016
Signature of Reporting Person Date
/s/ Eileen Wheatman, attorney in fact for James Douglas and Jean Douglas Irrevocable Descendants' Trust 07/14/2016
Signature of Reporting Person Date
Explanation of Responses:
( 1 )These shares are held directly and jointly by Kevin Douglas and Michelle Douglas.
( 2 )Each of the reporting persons hereunder (individually, a "Reporting Person" and collectively the "Reporting Persons") may be deemed a member of a "group" within the meaning of Section 13(d)(3) of the Securities and Exchange Act of 1934, as amended (the "Exchange Act") or Rule 13d-5 promulgated under the Exchange Act, with one or more of the other Reporting Persons. Although the Reporting Persons are reporting such securities as if they were members of a "group", the filing of this Form 4 shall not be deemed an admission by any Reporting Person that such Reporting Person is a beneficial owner of any securities other than those directly held by such Reporting Person.
( 3 )These shares are held directly by the James Douglas and Jean Douglas Irrevocable Descendants' Trust and indirectly by Kevin Douglas and Michelle Douglas. Kevin Douglas and Michelle Douglas, husband and wife, are each a co-trustee of the James Douglas and Jean Douglas Irrevocable Descendants' Trust.
( 4 )The convertible note is convertible into shares of common stock at any time after the date of issuance.
( 5 )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 July 1, 2017. If the put right is exercised, then the expiration date would be 90 days following the Reporting Person's exercise of the put right.
( 6 )Represents the face value of the convertible note.
( 7 )On July 13, 2016, the convertible notes were canceled in connection with the closing of the Issuer's Section 363 sale of substantially all of its assets pursuant to an Asset Purchase Agreement, as amended, by and among the Issuer, Douglas Acquisitions LLC, the K&M Douglas Trust and the James Douglas and Jean Douglas Irrevocable Descendant's Trust, which was entered into in connection with the Issuer's Chapter 11 bankruptcy case.

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