Initial Statement of Beneficial Ownership (3)
November 09 2021 - 9:45AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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FONTENOT SEAN PAUL |
2. Date of Event Requiring Statement (MM/DD/YYYY)
9/15/2021
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3. Issuer Name and Ticker or Trading Symbol
CalEthos, Inc. [BUUZ]
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(Last)
(First)
(Middle)
1202 WALNUT AVENUE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
LONG BEACH, CA 90813
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
10% OID Convertible Promissory Note | 9/15/2021 | 8/31/2022 | Common Stock | 3080000 | $1.25 | I | See Footnote (1) |
Series A Stock Purchase Warrant | 9/15/2021 | 8/31/2024 | Common Stock | $1540000 | $1.87 | I | See Footnote (1) |
Explanation of Responses: |
(1) | The reported securities are owned by Nanosha Investments LLC, a company of which the reporting person is the principal member. The reporting person disclaims beneficial ownership of these securities,
except to the extent of his pecuniary interest therein. |
Remarks: *Subsequent to the event date in Box 2 above, on 10/7/21, the reporting person was elected to the Issuer's Board of Directors and his additional insider status will be reflected on future filings on Form 4. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
FONTENOT SEAN PAUL 1202 WALNUT AVENUE LONG BEACH, CA 90813 |
| X |
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Signatures
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/s/ Sean P. Fontenot | | 11/9/2021 |
**Signature of Reporting Person | Date |
CalEthos (PK) (USOTC:BUUZ)
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