SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Michalec Wojciech

(Last) (First) (Middle)
C/O PIONEER POWER SOLUTIONS, INC.
400 KELBY STREET,12TH FLOOR

(Street)
FORT LEE NJ 07024

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/15/2020
3. Issuer Name and Ticker or Trading Symbol
PIONEER POWER SOLUTIONS, INC. [ PPSI ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Interim CFO
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Incentive Stock Option (Right to Buy) (1) 03/06/2024 Common Stock 1,000 10.21 D
Employee Stock Option (Right to Buy) (2) 03/31/2030 Common Stock 10,000 1.679 D
Explanation of Responses:
1. 333 shares of this option vested and became exercisable on March 6, 2015, an additional 333 shares of this option vested and became exercisable on March 6, 2016, and the remaining 334 shares of this option vested and became exercisable on March 6, 2017.
2. The option will vest in full on March 31, 2021, subject to the terms and conditions of the Pioneer Power Solution, Inc. 2011 Long-Term Incentive Plan.
/s/ Wojciech Michalec 04/20/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.