Sec Form 4 Filing - Peninsula Fund V Limited Partnership @ Unique Fabricating, Inc. - 2015-09-21

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
Peninsula Fund V Limited Partnership
2. Issuer Name and Ticker or Trading Symbol
Unique Fabricating, Inc. [ UFAB]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
500 WOODWARD AVENUE, SUITE 2800
3. Date of Earliest Transaction (MM/DD/YY)
09/21/2015
(Street)
DETROIT, MI48226
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ 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
Common Stock 1,444,632 D
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
Stock Option (Right to Buy) $ 12.5 09/21/2015 J( 1 ) 7,500 08/17/2015( 2 ) 08/17/2025 Common Stock 7,500 $ 0 7,500 ( 3 ) I See footnote 4. ( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Peninsula Fund V Limited Partnership
500 WOODWARD AVENUE
SUITE 2800
DETROIT, MI48226
X
Signatures
Bradley J. Wyatt, Attorney-in-Fact 09/23/2015
Signature of Reporting Person Date
Explanation of Responses:
( 1 )By James Illikman as agent of The Peninsula Fund V Limited Partnership (the "Fund").
( 2 )The stock option vested as to 20% of the shares as of the date of the grant; the option will vest as to 20% of the shares on each of the first, second, third and fourth anniversaries of the grant.
( 3 )The Fund is the beneficial owner of 100% of the subject securities.
( 4 )The subject securities were granted to Mr. Illikman in consideration for his service as a director of the issuer. The Fund acquired beneficial ownership of the securities via letter agreement with James Illikman dated September 21, 2015. Pursuant to the letter agreement, Mr. Illikman agreed to assign any profits recognized upon exercise of the options and sale of the underlying securities to the Fund, in consideration for his employment by the Fund and his nomination by the Fund to serve as a member of the issuer's board of directors. Pursuant to the letter agreement, the Fund also has the authority to direct Mr. Illikman with regard to the exercise of the options and the disposition of the underlying securities in a manner consistent with the NQO award agreement by which they were granted.

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