UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Appreciation Right | 02/22/2017 | 02/22/2026 | Common Stock | 1,500 (3) | $ 11.25 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Buzogany William Alan C/O 201 MITTEL DRIVE WOOD DALE, IL 60191 |
 |  |  See Remarks |  |
/s/ William Alan Buzogany | 01/22/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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). |
(1) | Common Stock in the form of restricted stock granted under the Power Solutions 2012 Incentive Compensation Plan and subject to certain restrictions contained in a Restricted Stock Agreement, dated as of November 30, 2017, between Power Solutions International, Inc. and William Alan Buzogany. Subject to certain conditions, 26,138 shares will vest on March 31, 2018 and 26,139 shares will vest on March 31, 2019. |
(2) | Shares credited to account under Power Great Lakes, Inc. Employees 401(k) Profit Sharing Plan, as of January 11, 2018. |
(3) | Stock appreciation right (the "SAR") granted on February 22, 2016 under the Power Solutions 2012 Incentive Compensation Plan. The SAR vests ratably and becomes exercisable with respect to one-half of the covered shares annually for two years beginning on the first anniversary of the SAR grant date. |
 Remarks: General Counsel/Vice President of Human Resources |