-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Axx+q4HqiRPXY+94Wyot3D3UVuEzrNcc7IgEfeQK2iO+BIzeONmeBKphj/DVB55V 6wjHMWdHahheQZdvnWojIw== 0001209191-04-006134.txt : 20040203 0001209191-04-006134.hdr.sgml : 20040203 20040203102936 ACCESSION NUMBER: 0001209191-04-006134 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLER LLOYD I III CENTRAL INDEX KEY: 0000949119 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19409 FILM NUMBER: 04561237 BUSINESS ADDRESS: STREET 1: 4650 GORDON DRIVE CITY: NAPLES STATE: FL ZIP: 33940 BUSINESS PHONE: 9412628577 ISSUER: 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 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: KRANTOR CORP DATE OF NAME CHANGE: 19930328 FORMER COMPANY: FORMER CONFORMED NAME: DELTA VENTURES INC DATE OF NAME CHANGE: 19600201 5 1 doc5.xml FORM 5 SUBMISSION X0201 5 2003-12-31 0 0 0 0000870228 SYNERGY BRANDS INC SYBR 0000949119 MILLER LLOYD I III 4550 GORDON DRIVE NAPLES FL 34102 0 0 1 0 Common Stock 404273.0000 I By Lloyd I. Miller, III, Trust A-4 Common Stock 15952.0000 I By Lloyd I. Miller, III, Trust C Common Stock 160000.0000 I By Milfam I, L.P. Common Stock 45900.0000 I By Milfam II, L.P. Common Stock 10000.0000 I By Lloyd I. Miller, III, Trust A-2 Common Stock 10000.0000 I By Lloyd I. Miller, III, Trust A-3 Common Stock 40000.0000 D Common Stock 114282.0000 I By Flint Trust Common Stock Warrants (right to buy) 0 2001-09-24 2006-09-24 Common Stock 0 0 I By Dail Miller Common Stock Warrants (rights to buy) 5.0000 2001-09-24 2006-09-24 Common Stock 15000.0000 15000.0000 I By Milfam I, L.P. Common Stock Warrants (right to buy) 5.0000 2001-09-24 2006-09-24 Common Stock 5000.0000 5000.0000 D Common Stock Warrants (right to buy) 5.0000 2002-12-30 2012-09-30 Common Stock 31250.0000 31250.0000 I By Lloyd I. Miller, III, Trust A-4 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. Acquisition of 80,000 securities by the reporting person was initially reported in a Form 4 filed on 7/7/03. The reporting person inadvertently did not report such 80,000 securities held directly by the reporting person in the Form 4 filings filed thereafter between 12/9/03 and 1/2/04. On 12/16/03, 114,282 securities held directly by the reporting person were transferred to the Flint Trust. Such transaction only effected a change in the form of beneficial ownership without changing the reporting person's pecuniary interest in such securities. As of January 1, 2004, the reporting person no longer has beneficial ownership for securities held by Dail Miller, the ex-wife of the reporting person. /s/Lloyd I. Miller, III 2004-02-03 -----END PRIVACY-ENHANCED MESSAGE-----