UNITED STATES SECURITIES
AND EXCHANGE COMMISSION
Washington, D.C.

FORM D

OMB APPROVAL
OMB Number: 3235-0076
Estimated Average burden hours per response: 4.0
Notice of Exempt Offering of Securities


1. Issuer's Identity
CIK (Filer ID Number) Previous Name(s)   o None Entity Type
0000047307
HICKOK ELECTRICAL INSTRUMENT CO
 
x Corporation
o Limited Partnership
o Limited Liability Company
o General Partnership
o Business Trust
o Other
Name of Issuer
  HICKOK INC
Jurisdiction of Incorporation/Organization
OHIO
 
Year of Incorporation/Organization
  x Over Five Years Ago
  o Within Last Five Years (Specify Year)  
  o Yet to Be Formed  



2. Principal Place of Business and Contact Information
Name of Issuer  
  HICKOK INC  
Street Address 1 Street Address 2
  10514 DUPONT AVE  
City State/Province/Country ZIP/Postal Code Phone No. of Issuer
  CLEVELAND   OHIO   44108   2165418060  



3. Related Persons
Last Name First Name Middle Name
Bauman Robert L.
Street Address 1 Street Address 2
10514 Dupont Avenue
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44108
Relationship: x Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Bauman Patrick R.
Street Address 1 Street Address 2
10514 Dupont Avenue
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44108
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Hart George R.
Street Address 1 Street Address 2
10514 Dupont Avenue
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44108
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Zoloty Gregory M.
Street Address 1 Street Address 2
10514 Dupont Avenue
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44108
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
   
 
Last Name First Name Middle Name
Crawford Edward F.
Street Address 1 Street Address 2
6065 Parkland Boulevard
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44124
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Elliott Jennifer A.
Street Address 1 Street Address 2
1178 Bellingham Drive
City State/Province/Country ZIP/Postal Code
Oceanside CALIFORNIA 90257
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Hudson T. Harold
Street Address 1 Street Address 2
1240 Lakeway Drive
City State/Province/Country ZIP/Postal Code
Southlake TEXAS 76092
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Martin James T.
Street Address 1 Street Address 2
12700 Lake Avenue
City State/Province/Country ZIP/Postal Code
Lakewood OHIO 44107
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
 
Last Name First Name Middle Name
Rosen Steven H.
Street Address 1 Street Address 2
1660 West 2nd Street
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44113
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Slade Janet H.
Street Address 1 Street Address 2
5862 Briar Hill Drive
City State/Province/Country ZIP/Postal Code
Solon OHIO 44139
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Smith Kirin M
Street Address 1 Street Address 2
708 Greenwich Street
City State/Province/Country ZIP/Postal Code
New York NEW YORK 10014
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
   
Last Name First Name Middle Name
Allen James F.
Street Address 1 Street Address 2
10514 Dupont Avenue
City State/Province/Country ZIP/Postal Code
Cleveland OHIO 44108
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
   
 


4. Industry Group
o Agriculture   Health Care o Retailing
  Banking & Financial Services   o Biotechnology o Restaurants
  o Commercial Banking   o Health Insurance   Technology
  o Insurance   o Hospitals & Physicians   o Computers
  o Investing   o Pharmaceuticals   o Telecommunications
  o Investment Banking   o Other Health Care   o Other Technology
  o Pooled Investment Fund

        Travel
  o Other Banking & Financial Services x Manufacturing   o Airlines & Airports
  Real Estate   o Lodging & Conventions
  o Commercial   o Tourism & Travel Services
  o Construction   o Other Travel
  o REITS & Finance o Other
  o Residential  
  o Other Real Estate  
o Business Services  
  Energy  
  o Coal Mining  
  o Electric Utilities  
  o Energy Conservation  
  o Environmental Services  
  o Oil & Gas  
  o Other Energy  


5. Issuer Size
Revenue Range Aggregate Net Asset Value Range
o No Revenues o No Aggregate Net Asset Value
o $1 - $1,000,000 o $1 - $5,000,000
o $1,000,001 - $5,000,000 o $5,000,001 - $25,000,000
x $5,000,001 - $25,000,000 o $25,000,001 - $50,000,000
o $25,000,001 - $100,000,000 o $50,000,001 - $100,000,000
o Over $100,000,000 o Over $100,000,000
o Decline to Disclose o Decline to Disclose
o Not Applicable o Not Applicable


6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
o Rule 504(b)(1) (not (i), (ii) or (iii)) o Rule 505
o Rule 504 (b)(1)(i) x Rule 506
o Rule 504 (b)(1)(ii) o Securities Act Section 4(5)
o Rule 504 (b)(1)(iii) o Investment Company Act Section 3(c)

7. Type of Filing
x New Notice Date of First Sale   2012-12-30 o First Sale Yet to Occur
o Amendment

8. Duration of Offering
Does the Issuer intend this offering to last more than one year? x Yes o No

9. Type(s) of Securities Offered (select all that apply)
o Pooled Investment Fund Interests x Equity
o Tenant-in-Common Securities x Debt
o Mineral Property Securities x Option, Warrant or Other Right to Acquire Another Security
x Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security o Other (describe)
   


10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? o Yes x No
 
Clarification of Response (if Necessary)  
   

11. Minimum Investment
Minimum investment accepted from any outside investor $   250000   USD

12. Sales Compensation
Recipient Recipient CRD Number o None
   
(Associated) Broker or Dealer o None (Associated) Broker or Dealer CRD Number o None
   
Street Address 1 Street Address 2
   
City State/Province/Country ZIP/Postal Code
     
State(s) of Solicitation o All States
 
 



13. Offering and Sales Amounts
Total Offering Amount $   966880   USD o Indefinite
Total Amount Sold $   0   USD  
Total Remaining to be Sold $   966880   USD o Indefinite
 
Clarification of Response (if Necessary)
  Remaining amounts to be sold represents (i) 200,000 shares underlying two Warrants, exercisable at $2.50 per share, (ii) up to $466,879.88 in principal amount of convertible debentures issuable prior to December 30, 2013 and (iii) [continued in Item 15]


14. Investors
o Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
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: 2


15. Sales Commissions & Finders' 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 $   0   USD o Estimate
Finders' Fees $   0   USD o Estimate
 
Clarification of Response (if Necessary)
  [continued from Item 13] up to 252,237 shares issuable upon conversion of such convertible debentures


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.
  $   0   USD o Estimate
 
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 clicking SUBMIT below to file this notice.
Terms of Submission  
  In submitting this notice, each Issuer named above 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, 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 it 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 the Issuer is not disqualified from relying on any Regulation D exemption it has identified in Item 6 above for one of the reasons stated in Rule 505(b)(2)(iii).
 
 
  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
HICKOK INC Robert L. Bauman Robert L. Bauman President and Chief Executive Officer 2013-01-11

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