| UNITED STATES SECURITIES AND EXCHANGE
COMMISSION |
| OMB APPROVAL |
| OMB Number: |
3235-0076 |
| Estimated average burden hours per
response |
4.00 | | |
| Washington, D.C. 20549 |
| FORM D |
| Notice of Exempt Offering of
Securities |
1. Issuer's Identity
| CIK (Filer ID Number) |
Previous Names |
|
Entity Type |
| 0000891417 |
| Applied Nanotech Holdings,
Inc. | |
|
| X |
Corporation |
| |
Limited Partnership |
| |
Limited Liability Company |
| |
General Partnership |
| |
Business Trust |
| |
Other (Specify) |
|
| |
| Name of Issuer |
| PEN INC. |
| Jurisdiction of Incorporation/Organization |
| DELAWARE |
| Year of Incorporation/Organization |
| X |
Over Five Years Ago |
| |
Within Last Five Years (Specify Year) |
|
| |
Yet to Be
Formed | |
2. Principal Place of Business and Contact Information
| Name of Issuer |
| PEN INC. |
| Street Address 1 |
Street Address 2 |
| 701 BRICKELL AVE., SUITE 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
Phone Number of Issuer |
| MIAMI |
FLORIDA |
33131 |
844-273-6462 |
3. Related Persons
| Last Name |
First Name |
Middle Name |
| Rickert |
Scott |
E |
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
X |
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Hollister |
John |
B |
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
X |
|
Executive Officer |
|
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Rickert |
Jeanne |
M |
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
|
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Berman |
Ronald |
J |
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
|
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Holmes |
Douglas |
Q |
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
|
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Westerman |
Howard |
|
| Street Address 1 |
Street Address 2 |
| 701 Brickell Ave., suite 1550 |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Miami |
FLORIDA |
33131 |
| Relationship: |
|
|
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
| Last Name |
First Name |
Middle Name |
| Sharp |
James |
|
| Street Address 1 |
Street Address 2 |
| One Zeiss Drive |
|
| City |
State/Province/Country |
ZIP/PostalCode |
| Thornwood |
NEW YORK |
10594 |
| Relationship: |
|
|
|
Executive Officer |
X |
|
Director |
|
|
Promoter |
Clarification of Response (if Necessary):
4. Industry Group
| |
Agriculture |
| |
Banking & Financial Services |
| |
| |
Commercial Banking |
| |
Insurance |
| |
Investing |
| |
Investment Banking |
| |
Pooled Investment Fund |
|
Is the issuer registered as an investment
company under the Investment Company Act of 1940?
|
|
|
| |
Other Banking & Financial
Services | |
| |
Business Services |
| |
Energy |
| |
| |
Coal Mining |
| |
Electric Utilities |
| |
Energy Conservation |
| |
Environmental Services |
| |
Oil & Gas |
| |
Other
Energy | | |
| |
Health Care |
|
| |
Biotechnology |
| |
Health Insurance |
| |
Hospitals & Physicians |
| |
Pharmaceuticals |
| |
Other Health
Care | |
| |
Manufacturing |
|
Real Estate |
|
| |
Commercial |
| |
Construction |
| |
REITS & Finance |
| |
Residential |
| |
Other Real
Estate | | |
| |
Retailing |
| |
Restaurants |
|
Technology |
|
| |
Computers |
| |
Telecommunications |
| X |
Other
Technology | |
|
Travel |
|
| |
Airlines & Airports |
| |
Lodging & Conventions |
| |
Tourism & Travel Services |
| |
Other
Travel | |
| |
Other | |
5. Issuer Size
| Revenue Range |
OR |
Aggregate Net Asset Value Range |
|
|
| |
No Aggregate Net Asset
Value | |
|
|
|
|
|
|
| X |
$5,000,001 - $25,000,000 | |
| |
$25,000,001 - $50,000,000 | |
| |
$25,000,001 - $100,000,000 | |
| |
$50,000,001 - $100,000,000 | |
|
|
|
|
|
|
|
|
|
6. Federal Exemption(s) and Exclusion(s) Claimed (select all that
apply)
| |
Rule 504(b)(1) (not (i), (ii) or (iii)) |
|
X |
Rule 505 |
| |
Rule 504 (b)(1)(i) |
X |
Rule 506(b) |
| |
Rule 504 (b)(1)(ii) |
|
Rule 506(c) |
| |
Rule 504 (b)(1)(iii) |
|
Securities Act Section 4(a)(5) |
|
|
|
Investment Company Act Section 3(c) |
|
| |
Section 3(c)(1) |
|
Section 3(c)(9) |
| |
Section 3(c)(2) |
|
Section 3(c)(10) |
| |
Section 3(c)(3) |
|
Section 3(c)(11) |
| |
Section 3(c)(4) |
|
Section 3(c)(12) |
| |
Section 3(c)(5) |
|
Section 3(c)(13) |
| |
Section 3(c)(6) |
|
Section 3(c)(14) |
| |
Section 3(c)(7) |
| |
7. Type of Filing
| X |
New Notice |
Date of First Sale |
2016-07-25 |
|
First Sale Yet to Occur |
| |
Amendment |
|
8. Duration of Offering
| Does the Issuer intend this offering to last more than one
year? |
|
|
9. Type(s) of Securities Offered (select all that apply)
| X |
Equity |
|
Pooled Investment Fund Interests |
| |
Debt |
|
Tenant-in-Common Securities |
| |
Option, Warrant or Other Right to Acquire Another
Security |
|
Mineral Property Securities |
| |
Security to be Acquired Upon Exercise of Option, Warrant
or |
|
Other (describe) |
| |
Other Right to Acquire Security |
|
|
10. Business Combination Transaction
Is this offering being made in connection with a business
combination transaction, such as a merger, acquisition or exchange
offer? |
|
|
Clarification of Response (if Necessary):
11. Minimum Investment
| Minimum investment accepted from any outside investor |
$ |
0 |
USD |
12. Sales Compensation
| Recipient |
| Recipient CRD Number |
|
|
None | |
| Carleton McKenna Advisors LLC. |
159230 |
| (Associated) Broker or Dealer |
|
|
None |
| Paul H. Carleton | |
| (Associated) Broker or Dealer CRD Number |
|
|
None |
| 707186 | |
| Street Address 1 |
Street Address 2 |
| 1801 EAST 9TH ST, SUITE 1425 |
|
| City |
State/Province/Country |
ZIP/Postal Code |
| CLEVELAND |
OHIO |
44114 |
| State(s) of Solicitation |
|
|
All States |
|
|
Non-US/Foreign | |
|
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|
AL |
|
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AK |
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AZ |
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AR |
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CA |
|
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CO |
|
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CT |
|
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|
DE |
|
|
|
DC |
|
X |
|
FL |
|
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|
GA |
|
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|
HI |
|
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|
ID |
|
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IL |
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IN |
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|
IA |
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KS |
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KY |
|
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LA |
|
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ME |
|
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MD |
|
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MA |
|
X |
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MI |
|
|
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MN |
|
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|
MS |
|
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|
MO |
|
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MT |
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NE |
|
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NV |
|
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NH |
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NJ |
|
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NM |
|
X |
|
NY |
|
|
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NC |
|
|
|
ND |
|
X |
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OH |
|
|
|
OK |
|
|
|
OR |
|
X |
|
PA |
|
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RI |
|
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SC |
|
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SD |
|
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TN |
|
X |
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TX |
|
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UT |
|
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VT |
|
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VA |
|
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WA |
|
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WV |
|
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WI |
|
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WY |
|
|
|
PR | |
13. Offering and Sales Amounts
| Total Offering Amount |
$ |
|
USD |
|
| Total Amount Sold |
$ |
50,000 |
USD |
| Total Remaining to be Sold |
$ |
|
USD |
|
Clarification of Response (if Necessary):
Offering has been terminated
14. Investors
|
|
Select if securities in the offering have been
or may be sold to persons who do not qualify as accredited investors, and
enter the number of such non-accredited investors who already have
invested in the offering. |
|
|
Regardless of whether securities in the offering have been
or may be sold to persons who do not qualify as accredited investors,
enter the total number of investors who already have invested in the
offering: |
|
15. Sales Commissions & Finder's Fees Expenses
Provide separately the amounts of sales commissions and finders
fees expenses, if any. If the amount of an expenditure is not known, provide an
estimate and check the box next to the amount.
| Sales Commissions |
|
$ |
4,000 |
USD |
|
| Finders' Fees |
|
$ |
0 |
USD |
|
Clarification of Response (if Necessary):
$2,000 in cash, balance paid by delivery of five-year warrant to
purchase common equity,
16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has
been or is proposed to be used for payments to any of the persons required to be
named as executive officers, directors or promoters in response to Item 3 above.
If the amount is unknown, provide an estimate and check the box next to the
amount.
Clarification of Response (if Necessary):
Signature and Submission
Please verify the information you have entered and review the
Terms of Submission below before signing and submitting this notice.
Terms of Submission
| In submitting this notice, each identified issuer
is: |
| |
|
• |
|
Notifying the SEC and/or each State in which this notice is
filed of the offering of securities described and undertaking to furnish
them, upon written request, in the accordance with applicable law, the
information furnished to offerees.* |
|
• |
|
Irrevocably appointing each of the Secretary of the SEC and
the Securities Administrator or other legally designated officer of the
State in which the issuer maintains its principal place of business and
any State in which this notice is filed, as its agents for service of
process, and agreeing that these persons may accept service on its behalf,
of any notice, process or pleading, and further agreeing that such service
may be made by registered or certified mail, in any Federal or state
action, administrative proceeding, or arbitration brought against the
issuer in any place subject to the jurisdiction of the United States, if
the action, proceeding or arbitration (a) arises out of any activity in
connection with the offering of securities that is the subject of this
notice, and (b) is founded, directly or indirectly, upon the provisions
of: (i) the Securities Act of 1933, the Securities Exchange Act of 1934,
the Trust Indenture Act of 1939, the Investment Company Act of 1940, or
the Investment Advisers Act of 1940, or any rule or regulation under any
of these statutes; or (ii) the laws of the State in which the issuer
maintains its principal place of business or any State in which this
notice is filed. |
|
• |
|
Certifying that, if the issuer is claiming a Regulation D
exemption for the offering, the issuer is not disqualified from relying on
Regulation D for one of the reasons stated in Rule 505(b)(2)(iii) or Rule
506(d). |
| |
Each Issuer identified above has read this notice, knows the
contents to be true, and has duly caused this notice to be signed on its behalf
by the undersigned duly authorized person.
For signature, type in the signer's name or other letters or
characters adopted or authorized as the signer's signature.
| Issuer |
Signature |
Name of Signer |
Title |
Date |
| PEN INC. |
/s/ Jeanne M. Rickert |
Jeanne M Rickert |
General Counsel & Secretary |
2016-07-27 |
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.
* This undertaking does not affect any limits Section 102(a) of
the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No.
104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to
require information. As a result, if the securities that are the subject of this
Form D are "covered securities" for purposes of NSMIA, whether in all instances
or due to the nature of the offering that is the subject of this Form D, States
cannot routinely require offering materials under this undertaking or otherwise
and can require offering materials only to the extent NSMIA permits them to do
so under NSMIA's preservation of their anti-fraud authority.