0000950123-01-506720.txt : 20011009
0000950123-01-506720.hdr.sgml : 20011009
ACCESSION NUMBER: 0000950123-01-506720
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20010917
FILED AS OF DATE: 20010926
COMPANY DATA:
COMPANY CONFORMED NAME: MILLER LLOYD I III
CENTRAL INDEX KEY: 0000949119
STANDARD INDUSTRIAL CLASSIFICATION: []
OWNER
FILING VALUES:
FORM TYPE: 3
BUSINESS ADDRESS:
STREET 1: 4650 GORDON DRIVE
CITY: NAPLES
STATE: FL
ZIP: 33940
BUSINESS PHONE: 9412628577
SUBJECT COMPANY:
COMPANY DATA:
COMPANY CONFORMED NAME: SYNERGY BRANDS INC
CENTRAL INDEX KEY: 0000870228
STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & GENERAL LINE [5141]
IRS NUMBER: 222993066
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-19409
BUSINESS ADDRESS:
STREET 1: 40 UNDERHILL BLVD
CITY: SYOSSET
STATE: NY
ZIP: 11791
BUSINESS PHONE: 5166821980
MAIL ADDRESS:
STREET 1: 40 UNDERHILL BLVD
CITY: SYOSSET
STATE: NY
ZIP: 11791
FORMER COMPANY:
FORMER CONFORMED NAME: DELTA VENTURES INC
DATE OF NAME CHANGE: 19600201
FORMER COMPANY:
FORMER CONFORMED NAME: KRANTOR CORP
DATE OF NAME CHANGE: 19930328
3
1
y53529e3.txt
FORM 3
1
OMB APPROVAL
-------------------------
OMB Number: 3235-0104
-------------------------
Expires: October 31, 2001
-------------------------
Estimated average burden
hours per response...0.5
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
________________________________________________________________________________
1. Name and Address of Reporting Person*
Miller, III Lloyd I.
--------------------------------------------------------------------------------
(Last) (First) (Middle)
4550 Gordon Drive
--------------------------------------------------------------------------------
(Street)
Naples FL 34102
--------------------------------------------------------------------------------
(City) (State) (Zip)
________________________________________________________________________________
2. Date of Event Requiring Statement (Month/Day/Year)
September 17,2001
________________________________________________________________________________
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
###-##-####
________________________________________________________________________________
4. Issuer Name and Ticker or Trading Symbol
Synergy Brands Inc.-SYBR
________________________________________________________________________________
5. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [X] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
________________________________________________________________________________
6. If Amendment, Date of Original (Month/Day/Year)
________________________________________________________________________________
7. Individual or Joint/Group Filing (Check applicable line)
[X] Form Filed by One Reporting Person
[ ] Form Filed by More than One Reporting Person
================================================================================
Table I -- Non-Derivative Securities Beneficially Owned
================================================================================
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5)
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 193,239(1) I By Lloyd I. Miller, Trust A-4
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 62,100(1) I By Milfam II, L.P.
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 47,008(1) I By Lloyd I. Miller, Trust C
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 82,000(1) I By Wife
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 240,000(1) I By Milfam I, L.P.
------------------------------------------------------------------------------------------------------------------------------------
Common Stock 156,452 D
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
(Over)
2
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
================================================================================
5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Warrants 9/17/01 9/24/06 Common Stock 60,000(1) I By Milfam I, L.P.
------------------------------------------------------------------------------------------------------------------------------------
Warrants 9/17/01 9/24/06 Common Stock 20,000(1) I By Wife
------------------------------------------------------------------------------------------------------------------------------------
Warrants 9/17/01 9/24/06 Common Stock 20,000 D
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
====================================================================================================================================
Reminder: report on a separate line for each class of securities beneficially owned directly or indirectly.
Explanation of Responses:
(1)The reporting person disclaims beneficial ownership of these securities, and
this report shall not be deemed an admission that the reporting person is the
beneficial owner of such securities for the purposes of Section 16 or for any
other purpose, except to the extent of his pecuniary interest therein.
/s/ Lloyd I. Miller, III 9/26/01
--------------------------------------------- -----------------------
**Signature of Reporting Person Date
* If the form is filed by more than one reporting person, see Instruction
5(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 provided is insufficient, see Instruction 6 for procedure.
Page 2