-----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, QKgmepk/zURBtYHww12sSQwE0AUaTkxwkpQGbK1RekY7lir4a6UgiQGzVyew04kO SLpjfGUOVhTshOJUQ8v/BQ== 0001209191-05-012616.txt : 20050228 0001209191-05-012616.hdr.sgml : 20050228 20050228193123 ACCESSION NUMBER: 0001209191-05-012616 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050224 FILED AS OF DATE: 20050228 DATE AS OF CHANGE: 20050228 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLER LLOYD I III CENTRAL INDEX KEY: 0000949119 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19409 FILM NUMBER: 05647562 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 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2005-02-24 0 0000870228 SYNERGY BRANDS INC SYBR 0000949119 MILLER LLOYD I III 4550 GORDON DRIVE NAPLES FL 34102 1 0 1 0 Common Stock 2005-02-24 2005-02-24 4 J 0 10000 A 350000 I By Milfam I L.P. Common Stock 2005-02-24 2005-02-24 4 J 0 10000 A 164282 D Common Stock 2005-02-24 2005-02-24 4 J 0 5000 A 15000 I By Lloyd I. Miller, III, Trust A-2 Common Stock 2005-02-24 2005-02-24 4 J 0 5000 A 15000 I By Lloyd I. Miller, III, Trust A-3 Common Stock 404272 I By Lloyd I. Miller, III, Trust A-4 Common Stock 15952 I By Lloyd I. Miller, III, Trust C Common Stock 45900 I Milfam II LP Series A Class B Preferred Stock 5000 D Series A Class B Preferred Stock 2500 I By Lloyd I. Miller, III, Trust A-2 Series A Class B Preferred Stock 2500 I By Lloyd I. Miller, III, Trust A-3 Series A Class B Preferred Stock 205000 I Milfam I LP Common Stock Warrants (right to buy) 5.00 2001-09-24 2006-09-24 Common Stock 5000 5000 D Common Stock Warrants (right to buy) 5.00 2001-09-24 2006-09-24 Common Stock 5000 15000 I By Milfam I LP Common Stock Warrants (right to buy) 5.00 2001-09-24 2006-09-24 Common Stock 5000 31250 I By Lloyd I. Miller, III, Trust A-4 Each of the reporting person ("Mr. Miller"), Milfam I LP ("Milfam"), Trust A-2 ("A-2") and Trust A-3 ("A-3" and together with Mr. Miller, Milfam, A-2 and A-3, the "Investors") is party to a Subscription Agreement dated as of March 31, 2003 with the issuer (the "Agreements") pursuant to which the Investors subscribed to the issuer's unregistered Series A Class B Preferred Stock (the "Preferred Stock") and unregistered restricted Common Stock (the "Common Stock"). These shares were issued to the Investors pursuant to Section 15(a) of the Agreements. 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. On November 3, 2004, the reporting person filed a Form 4 which included the reporting person's holdings of Series A Class B Preferred Stock (the "Preferred Stock"). Due to a clerical error, the holdings of Preferred Stock did not take into account the issuer's reverse stock split effected on February 20, 2004. On February 28, 2005, the reporting person, directly and through Trust A-2, Trust A-3 and Milfam I LP, owned 15,000, 2,500, 2,500 and 205,000, shares of Preferred Stock, respectively. /s/ David J. Hoyt Attorney-in-fact 2005-02-28 -----END PRIVACY-ENHANCED MESSAGE-----