| FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL 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). | |||||||||||||||||
| Form 3 Holdings Reported. | |||||||||||||||||
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Form 4 Transactions Reported. | ||||||||||||||||
| Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
GILLA INC. [ GLLA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2014 | ||||||||||||||||||||||||||
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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 at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
| Amount | (A) or (D) | Price | |||||||||||||
| Common Stock | 03/11/2014 | J4 | 900,000 | A | (1) | 5,762,661(4) | I(4) | By GraySim Family Trust | |||||||
| Common Stock | 11/04/2014 | M4 | 2,142,857 | A | (2) | 5,762,661(4) | I(4) | By GraySim Family Trust | |||||||
| Common Stock | 11/04/2014 | M4 | 111,233 | A | (2) | 5,762,661(4) | I(4) | By GraySim Family Trust | |||||||
| Common Stock | 11/04/2014 | M4 | 2,857,143 | A | (3) | 3,430,321(4) | I(4) | By Woodham Group Inc. | |||||||
| Common Stock | 11/04/2014 | M4 | 123,178 | A | (3) | 3,430,321(4) | I(4) | By Woodham Group Inc. | |||||||
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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) | |||
| (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
| Unsecured Subordinated Convertible Debentures | (2) | 11/04/2014 | 4M | 100,000 | 09/03/2013 | 01/31/2016 | Common Stock | 1,428,571 | (2) | 0 | I | By GraySim Family Trust | ||
| Unsecured Subordinated Convertible Debentures | (2) | 11/04/2014 | 4M | 50,000 | 09/03/2013 | 01/31/2016 | Common Stock | 714,286 | (2) | 0 | I | By GraySim Family Trust | ||
| Unsecured Subordinated Convertible Debentures | (3) | 11/04/2014 | 4M | 200,000 | 12/23/2013 | 01/31/2016 | Common Stock | 2,857,143 | (3) | 0 | I | By Woodham Group Inc. | ||
| Explanation of Responses: |
| 1. On March 11, 2014, the GraySim Family Trust, an entity affiliated with Mr. Graham Simmonds, the Chief Executive Officer and as a member of the Board of Directors of Gilla Inc. (the "Company"), received a grant of 900,000 shares of the Company's Common Stock from a shareholder of the Company in consideration of his contributions to the successful completion of the Company's acquisition of Snoke Distribution Canada Ltd. on November 21, 2012. |
| 2. On September 3, 2013, the GraySim Family Trust purchased $100,000, of Unsecured Subordinated Convertible Debentures (the "Debentures") from the Company. The Debentures had a maturity date of January 31, 2016 and bore interest at a rate of 12% per annum, which was payable quarterly in arrears. The Debentures were convertible into the Company's Common Stock at a fixed conversion rate of $0.10 per share at any time prior to the maturity date. On October 28, 2013, the conversion price of the Debentures were reduced to $0.07 per share. On December 23, 2013, the Issuer issued additional Debentures in the amount of $50,000 to GraySim in consideration for services rendered by Simmonds as an officer and director of the Issuer. On November 4, 2014, GraySim Family Trust converted the debentures into 2,142,857 shares of Common Stock at a conversion price of $0.07 per share and converted the interest due on the debentures into 111,233 shares of Common Stock at a conversion price of $0.15 per share. |
| 3. On December 23, 2013, the Woodham Group Inc. purchased $200,000 of Debentures from the Company. The Debentures were convertible into the Company's Common Stock at a fixed conversion rate of $0.07 per share at any time prior to the maturity date. On November 4, 2014, the Woodham Group Inc. converted the debentures into 2,857,143 shares of Common Stock at a conversion price of $0.07 per share and converted the interest due on the debentures into 123,178 shares of Common Stock at a conversion price of $0.15 per share. |
| 4. As of November 4, 2014 Mr. Simmonds may be deemed to be the beneficial holder of 9,267,982 shares of the Company's Common Stock, including (A) 75,000 shares held directly by him; (B) 3,430,321 shares held indirectly through Woodham Group Inc.; and (C) 5,762,661 shares held by GraySim Family Trust. |
| /s/ Graham Simmonds | 03/05/2015 | |
| ** 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. | ||