FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
|||||||||||||||
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
INTERCLOUD SYSTEMS, INC. [ ICLD ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
3. Date of Earliest Transaction
(Month/Day/Year) 06/25/2013 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 06/25/2013 | C | 20,645 | A | (1) | 23,920 | D | |||
Common Stock | 06/25/2013 | C | 3,991 | A | (2) | 27,912 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series B Convertible Preferred Stock(1) | (1) | 06/25/2013 | C | 293 | (1) | (1) | Common Stock | 20,645 | (1) | 0 | D | ||||
Series E Convertible Preferred Stock | (2) | 08/06/2013 | C | 25 | (2) | (2) | Common Stock | 3,991 | (2) | 0 | D | ||||
Warrant to purchase Common Stock | $500 | 09/18/2012 | 09/18/2014 | Common Stock | 2,014(3) | 2,014(3) | D |
Explanation of Responses: |
1. On June 25, 2013, the Reporting Person converted 263 shares of Series B Convertible Preferred Stock, par value $0.0001 per share, of the Issuer ("Series B Preferred Stock") into 20,645 shares of common stock, par value $0.0001 per share, of the Issuer ("Common Stock"). Each share of Series B Preferred Stock was convertible into such number of shares of Common Stock equal to 0.00134% of the outstanding shares of Common Stock on a fully-diluted basis at the time of conversion. |
2. On August 6, 2013, the Reporting Person converted 25 shares of Series E Convertible Preferred Stock, par value $0.001 per shares ("Series E Preferred Stock"), into 3,991 shares of Common Stock. All outstanding shares of Series E Preferred Stock were convertible in the aggregate into such number of shares of Common Stock equal to 9.8% of the outstanding shares of Common Stock at the time of conversion on a fully-diluted basis. |
3. Represents a warrant owned by the Reporting Person, exercisable for a number of shares of Common Stock equal to approximately 0.000367% of the outstanding shares of Common Stock on a fully-diluted basis as of the exercise date, at an exercise price of $500.00 per share. As of the date of this report, the warrant is exercisable for 2,014 shares of Common Stock. |
Remarks: |
The number of and transaction prices of the shares of Common Stock reported in this Form 4 have been adjusted to reflect a one (1)-for-four (4) reverse stock split of the Common Stock effected by the Issuer on August 1, 2013. |
/s/ Charles Miller | 08/22/2013 | |
** 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 4 (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. |