SEC Form 4
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*
Milmoe William H.

(Last) (First) (Middle)
3299 N.W. 2ND AVENUE

(Street)
BOCA RATON FL 33431

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Celsius Holdings, Inc. [ CELH ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/17/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 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 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 01/17/2019 F V 39,011(1) A $0.8 21,475,906 I See Footnote(2)
Common Stock 09/12/2019 P 500,000 A $3.6 21,975,906 I See Footnote(2)
Common Stock 09/12/2019 C V 1,492,385(3) A $3.39 23,468,291 I See Footnote(2)
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) 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
Stock Option (Right to Buy) $0.8 01/17/2019 M V 50,000 04/24/2015 04/24/2019 Common Stock 50,000 $0 180,000 D
Stock Option (Right to Buy) $3.73 01/24/2019 A V 50,000 (4) 01/24/2029 Common Stock 50,000 $0 230,000 D
Convertible Note $3.39 09/12/2019 C V 1,492,385 12/14/2018 12/14/2020 Common Stock 1,492,385 $5,000,000 0 I Holder of convertible note was CD Financial, LLC
Explanation of Responses:
1. Represents a "net exercise" of outstanding stock options to purchase 50,000 shares of common stock. The reporting person received 39,011 shares of common stock and surrendered 10,989 shares of common stock underlying the options in payment of the exercise price.
2. A total of 134,611 shares of common stock are held individually by Mr. Milmoe. The balance are held by CD Financial, LLC and CDS Ventures of South Florida, LLC. Mr. Milmoe is a Manager of both entities.
3. Represents the conversion of the outstanding principal and interest under that certain convertible promissory note previously issued to CD Financial, LLC on December 14, 2018.
4. The stock options vest in three equal installments beginning on January 24, 2020.
/s/ William H. Milmoe 09/12/2019
** 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).
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