4/A 1 y85047a1e4za.htm AMENDMENT TO FORM 4 AMENDMENT TO FORM 4
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 4

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940

o 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*
(Last, First, Middle)
2. Issuer Name and Ticker or
Trading Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Miller, III, Lloyd I.
  Synergy Brands Inc. - SYBR
  ###-##-####
  4550 Gordon Drive
4. Statement for (Month/Day/Year) 5. If Amendment, Date of Original (Month/Day/Year)
    March 31, 2003
  April 2, 2003 (2)
  (Street) 6. Relationship of Reporting Person(s) to Issuer (Check All Applicable) 7. Individual or Joint/Group Filing
(Check Applicable Line)
  Naples, FL 34102
(City)                (State)           (Zip)
  o  Director x  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
       
     

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).
 

 


 


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
Transactions(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   03/31/2003 03/31/2003   X   10,000   A $2.50     10,000(1)     I   By Lloyd I. Miller, III, Trust A-3

  Common Stock   03/31/2003   03/31/2003   X   20,000   A $2.50     154,282(1)     D  

  Common Stock   03/31/2003   03/31/2003   X   20,000   A $2.50     80,000(1)     I   By Milfam I, L.P.

  Common Stock   03/31/2003   03/31/2003   X   10,000   A $2.50     10,000(1)     I   By Lloyd I. Miller, III, Trust A-2

  Common Stock               338,421(1)     I   By Lloyd I. Miller, III, Trust A-4

  Common Stock               41,200(1)     I   By Milfam II, L.P.

  Common Stock               15,952(1)     I   By Lloyd I. Miller, III, Trust C

  Common Stock             35,500(1)     I   By Dail Miller

                   

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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)

                      Code V   (A) (D)

  Unit Subscription (right to buy)   $2.50     03/31/2003   03/31/2003   X   20,000

  Unit Subscription (right to buy)   $2.50     03/31/2003   03/31/2003   X   20,000

  Unit Subscription (right to buy)   $2.50     03/31/2003   03/31/2003   X   10,000

  Unit Subscription (right to buy)   $2.50     03/31/2003   03/31/2003   X   10,000

  Common Stock Warrants (right to buy)   $5.00     9/24/01       5,000

  Common Stock Warrants (right to buy)   $5.00     9/24/01       15,000

  Common Stock Warrants (right to buy)   $5.00     9/24/01       5,000

  Common Stock Warrants (right to buy)   $5.00     12/30/02       31,250

             

             

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount
of Underlying Securities

(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 of
Derivative Security:
Direct (D) or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  Immed.   Common Stock 20,000   $10.00       -0-     D  

  Immed.   Common Stock 20,000   $10.00       -0-     I   By Milfam I, L.P.

  Immed.   Common Stock 10,000   $10.00       -0-     I   By Lloyd I. Miller, III, Trust A-2

  Immed.   Common Stock 10,000   $10.00       -0-     I   By Lloyd I. Miller, III, Trust A-3

  Immed. 9/24/06   Common Stock 5,000         5,000(1)     I   By Dail Miller

  Immed. 9/24/06   Common Stock 15,000         15,000(1)     I   By Milfam I, L.P.

  Immed. 9/24/06   Common Stock 5,000         5,000     D  

  Immed. 9/30/12   Common Stock 31,250         31,250(1)     I   By Lloyd I. Miller, III, Trust A-4

                 

                 

Explanation of Responses:

(1) The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Act or otherwise, the beneficial owner of any equity securities covered by this filing.

(2) On April 2, 2003, the reporting person mistakenly filed a Form 4 reporting an acquisition of a total of 240,000 shares of common stock. The shares of common stock actually acquired was 60,000. As of April 10, 2003, the reporting person beneficially owned 741,605 shares of common stock, including warrants.

/s/ Lloyd I. Miller, III   April 10, 2003

**Signature of Reporting Person
 
Date


**   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.
 

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