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 |
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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)
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2. Issuer Name and Ticker or Trading Symbol
Celsius Holdings, Inc. [ CSUHD ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 12/01/2009 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | 01/07/2010 | P | 0 | A | $0 | 500(1) | D | |||
Common Stock | 12/23/2009 | C | 434,300 | A | $1 | 489,920 | I | See note 2(2) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Preferred Stock | $1 | 12/23/2009 | C | $434,300 | 05/01/2009 | 12/31/2013 | Common Stock | 434,300 | $1,000 | 0(3) | I | none | |||
Series A Preferred Stock | $1.6 | 12/31/2009 | J(4) | 1.1 | 12/31/2009 | 02/01/2013 | Common Stock | 13,750 | $1.6 | $330,100(6) | I | see note 5(5) | |||
Convertible note | $4.6 | 12/01/2009 | P | $100,000(7) | 12/01/2009 | 09/08/2012 | Common Stock | 21,739 | $4.6 | $500,000(7) | I | see note 8(8) | |||
Convertible note | $4.8 | 12/21/2009 | P | $50,000 | 12/21/2009 | 09/08/2012 | Common Stock | 10,417(7) | $4.6 | $550,000(10) | I | see note 9(9) |
Explanation of Responses: |
1. Showing number of shares owned directly on separate line |
2. William Milmoe, an individual, holds beneficial ownership of 10% of the 559,201 shares of common stock, which is held by CD Financial, LLC, and beneficially holds as indicated in Table II) 10% of 4,343,000 shares of common stock, which are held by CDS Ventures of South Florida, LLC, the beneficial ownership of which is held by CD Financial, LLC of which William Milmoe holds 10% beneficial ownership. |
3. The amount of 0 derivative securities is only for Series B Preferred Shares, and it does not include other preferred shares or convertible debt |
4. Dividend of Series A Convertible Preferred Stock |
5. William Milmoe, an individual, holds beneficial ownership of 10% of the $3,301,000 of Series A Convertible Preferred Stock, which are held by CDS Ventures of South Florida, LLC, the beneficial ownership of which is held by CD Financial, LLC of which William Milmoe holds 10% beneficial ownership. |
6. The $330,100 of Series A Convertible Preferred Stock is convertible into a maximum of 206,313 shares of common stock. |
7. William Milmoe, an individual, holds beneficial ownership of 10% of the convertible debt. |
8. William Milmoe, an individual, holds beneficial ownership of 10% of the $1,000,000 convertible debt (which is convertible into common stock as indicated in Table II) which are held by CDS Ventures of South Florida, LLC, the beneficial ownership of which is held by CD Financial, LLC of which William Milmoe holds 10% beneficial ownership. |
9. William Milmoe, an individual, holds beneficial ownership of 10% of the $500,000 convertible debt (which is convertible into common stock as indicated in Table II) which are held by CDS Ventures of South Florida, LLC, the beneficial ownership of which is held by CD Financial, LLC of which William Milmoe holds 10% beneficial ownership. |
10. In total, William Milmoe is the beneficial owner of 16.505 shares of Series A Convertible Preferred Stock, convertible into a maximum of 206,313 shares of common stock, and he is also the beneficial owner of $550,000 of convertible debt, which at yesterday's market rate of $5.05 would be convertible into 108,911 shares of common stock. The two types of derivative securities totals into 315,224 shares of common stock. |
/s/ Jan Norelid | 01/07/2010 | |
** 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. |