Annual Statement of Changes in Beneficial Ownership (5)
14 Februar 2022 - 10:45PM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
LIEBERMAN WILLIAM K | 2. Issuer Name and Ticker or Trading SymbolAMPCO PITTSBURGH CORP [AP] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
339 SIXTH AVENUE, HEINZ 57 CENTER, SUITE 720 | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2021 |
(Street)
PITTSBURGH, PA 15222
(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
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. 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 |
Common Stock | 9/15/2021 | | G | 57676 | D | $0.00 | 25000 | D (1) | |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. 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 Exercisable | Expiration Date | Title | Amount or Number of Shares |
Series A Warrants (right to buy) | $2.5668 (2) | 9/14/2021 | | G | | 48728 (2) | 9/18/2020 | 8/1/2025 | Common Stock | 21751 | $0.00 | 0 | D (1) | |
Explanation of Responses: |
(1) | The amount of shares previously reported in this column has been updated to reflect joint ownership of all holdings. |
(2) | Each Series A warrant represents the right to purchase 0.4464 shares of common stock at an exercise price of $2.5668 per share and was issued as part of a subscription right issued in a rights offering by the Issuer. The Series A warrants are exercisable only for whole numbers of shares of Common Stock. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
LIEBERMAN WILLIAM K 339 SIXTH AVENUE HEINZ 57 CENTER, SUITE 720 PITTSBURGH, PA 15222 | X |
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Signatures
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/s/ Alicia Marchesano, Attorney-in-Fact | | 2/14/2022 |
**Signature of Reporting Person | Date |
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