Initial Statement of Beneficial Ownership (3)
May 15 2017 - 5:00PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Webb C Clark
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/4/2017
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3. Issuer Name
and
Ticker or Trading Symbol
P10 Industries, Inc. [PIOE]
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(Last)
(First)
(Middle)
8214 WESTCHESTER DRIVE, SUITE 950
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4. 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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(Street)
DALLAS, TX 75225
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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21650000
(1)
(2)
(3)
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I
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By 210/P10 Acquisition Partners, LLC
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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This Form 3 is being filed by the reporting person in his capacity as as a director of P10 Industries, Inc. (the "Issuer") and in his capacity as an indirect holder of 21,650,000 shares of common stock of the Issuer. The reporting person is the sole member of CCW/LAW Holdings, LLC, which is a member of 210 Capital, LLC ("210 Capital"). 210 Capital is the sole member of 210/P10 Acquisition Partners, LLC, which is a direct holder of 21,650,000 shares of common stock of the Issuer.
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(2)
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The reporting person disclaims beneficial ownership of these shares of the Issuer's common stock except to the extent of his pecuniary interest therein, and the filing of this Form 3 shall not be construed as an admission that such person is a beneficial owner of these shares of the Issuer's common stock for purposes of Section 16 or for any other purpose.
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(3)
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A statement on Schedule 13D was initially jointly filed on May 15, 2017 by the reporting person and other persons with respect to the shares of the Issuer's common stock reported on this Form 3.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Webb C Clark
8214 WESTCHESTER DRIVE, SUITE 950
DALLAS, TX 75225
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X
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Signatures
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/s/ C. Clark Webb
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5/15/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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