SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 6-K
Report of Foreign Private Issuer
Pursuant to Rule 13a-16 or 15d-16 of
the Securities Exchange Act of 1934
For the month of February 2016
Commission File Number: 001-37602
Fuling Global Inc.
(Registrant’s name)
Southeast Industrial Zone, Songmen Town
Wenling, Zhejiang Province
People’s Republic of China 317511
(Address of principal executive offices)
Indicate by check mark whether the registrant files or will file annual reports under cover of Form 20-F or Form 40-F.:
| Form 20-F x | Form 40-F o |
Indicate by check mark if the registrant is submitting the Form 6-K on paper as permitted by Regulation S-T Rule 101(b)(1): o
Indicate by check mark if the registrant is submitting the Form 6-K on paper as permitted by Regulation S-T Rule 101(b)(7): ¨
Explanatory Note:
As a foreign private issuer, Fuling Global Inc. (NASDAQ trading symbol: FORK) (“Issuer”) is exempted from Section 16 of the Exchange Act by Rule 3a12-3. The Issuer voluntarily provides following information of Annual Statement of Changes in Beneficial Ownership of Securities for fiscal year ended December 31, 2015.
I. Guilan Jiang
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | Director, COO, 10% Owner |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | Not applicable |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | Not applicable |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | Not applicable | |
| (A) or (D) | Not applicable | |
| Price | Not applicable | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 5,541,668 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | I |
| 10. | Nature of Indirect Beneficial Ownership | Held through Silver Trillion Investments Limited |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
II. Sujuan Zhu
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | Director, 10% Owner |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | Not applicable |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | Not applicable |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | Not applicable | |
| (A) or (D) | Not applicable | |
| Price | Not applicable | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 2,216,667 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | I |
| 10. | Nature of Indirect Beneficial Ownership | Held through Celestial Sun Holdings Limited |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
III. Jian Cao
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | Director |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | 11/02/2015 |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | A - Grant, award or other acquisition pursuant to Rule 16b-3(d) |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | 4,000 | |
| (A) or (D) | A | |
| Price | $0 (1) | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 4,000 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | D |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
IV. Hong (Simon) He
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | Director |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | 11/02/2015 |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | A - Grant, award or other acquisition pursuant to Rule 16b-3(d) |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | 4,000 | |
| (A) or (D) | A | |
| Price | $0 (1) | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 4,000 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | D |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
(1) Awarded in connection with entry into an engagement agreement.
V. Yau On Johann Tse
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | Director |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | 11/02/2015 |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | A - Grant, award or other acquisition pursuant to Rule 16b-3(d) |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | 4,000 | |
| (A) or (D) | A | |
| Price | $0 (1) | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 4,000 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | D |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
VI. Silver Trillion Investments Limited
| 1. | Address |
c/o Guilan Jiang Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | 10% Owner |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | Not applicable |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | Not applicable |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | Not applicable | |
| (A) or (D) | Not applicable | |
| Price | Not applicable | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 5,541,668 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | D |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
(1) Awarded in connection with entry into an engagement agreement.
VII. Celestial Sun Holdings Limited
| 1. | Address |
c/o Sujuan Zhu Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | 10% Owner |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | Not applicable |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | Not applicable |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | Not applicable | |
| (A) or (D) | Not applicable | |
| Price | Not applicable | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 2,216,667 |
| 9. | Ownership Form: Direct (D) or Indirect (I) | D |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
VIII. Xinfu Hu
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 |
| 2. | Relationship to Issuer | CEO |
| 3. | Title of security | Ordinary shares |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||
| 4. | Transaction date (Month/ Day/ Year) | Not applicable |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable |
| 6. | Transaction Code | Not applicable |
| 7. | Securities Acquired (A) or Disposed of (D) | |
| Amount | Not applicable | |
| (A) or (D) | Not applicable | |
| Price | Not applicable | |
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | Zero |
| 9. | Ownership Form: Direct (D) or Indirect (I) | Not applicable |
| 10. | Nature of Indirect Beneficial Ownership | Not applicable |
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |
IX. Gilbert Lee
| 1. | Address |
c/o Fuling Global Inc. Southeast Industrial Zone Songmen Town Wenling, Zhejiang Province, China 317511 | ||
| 2. | Relationship to Issuer | CFO | ||
| 3. | Title of security | Ordinary shares | ||
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||
| 4. | Transaction date (Month/ Day/ Year) | 11/02/2015 | 11/18/2015 | |
| 5. | Deemed Execution Date, if any (Month/ Day/ Year) | Not applicable | ||
| 6. | Transaction Code | A - Grant, award or other acquisition pursuant to Rule 16b-3(d) | ||
| 7. | Securities Acquired (A) or Disposed of (D) | |||
| Amount | 15,667 | 38 | ||
| (A) or (D) | A | A | ||
| Price | $0 (2) | $0 (2) | ||
| 8. | Amount of Securities Beneficially Owned at end of Issuer’s Fiscal Year | 15,705 | ||
| 9. | Ownership Form: Direct (D) or Indirect (I) | D | ||
| 10. | Nature of Indirect Beneficial Ownership | Not applicable | ||
| Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | Not applicable | |||
(2) Awarded in connection with entry into an employment agreement.
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
| FULING GLOBAL INC. | ||
| Date: February 16, 2016 | By: | /s/ Gilbert Lee |
| Name: | Gilbert Lee | |
| Title: | Chief Financial Officer | |