Statement of Changes in Beneficial Ownership (4)
June 02 2020 - 4:43PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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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1. Name and Address of Reporting Person
*
Ross Jack |
2. Issuer Name and Ticker or Trading Symbol
Synergy CHC Corp.
[
SNYR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner __X__ Officer (give title below) _____ Other (specify below) President, CEO and CFO |
(Last)
(First)
(Middle)
3435 OCEAN PARK BLVD. #107 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/19/2020 |
(Street)
SANTA MONICA, CA 90405
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 5/19/2020 | | P | | 3000000 | A | $0.15 | 4625034 | I | Gowan Capital Inc. (1) |
Common Stock | | | | | | | | 43780750 | I | Gowan Private Equity Inc. (2) |
Common Stock | | | | | | | | 3208649 | I | Dunhill Distribution Group, Inc. (3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | The shares of Common Stock are owned directly by Gowan Capital Inc., which is controlled by the Reporting Person. The Reporting Person is the indirect beneficial owner of the reported securities. |
(2) | The shares of Common Stock are owned directly by Gowan Private Equity Inc., which is controlled by the Reporting Person. The Reporting Person is the indirect beneficial owner of the reported securities. |
(3) | The shares of Common Stock are owned directly by Dunhill Distribution Group, Inc., which is controlled by the Reporting Person. The Reporting Person is the indirect beneficial owner of the reported securities. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Ross Jack 3435 OCEAN PARK BLVD. #107 SANTA MONICA, CA 90405 | X | X | President, CEO and CFO |
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Signatures
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/s/ W. David Mannheim, by Power of Attorney | | 6/2/2020 |
**Signature of Reporting Person | Date |
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