Amended Statement of Beneficial Ownership (sc 13d/a)
23 Março 2018 - 10:50AM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C. 20549
SCHEDULE 13D
Under the Securities Exchange Act of 1934
(Amendment No. 6)*
Crystal Rock Holdings, Inc.
(Name of Issuer)
Common Stock, par value $0.001 per share
(Title of Class of Securities)
22940F103
(CUSIP Number)
Peter K. Baker
Crystal Rock Holdings, Inc.
1050 Buckingham Street
Watertown, Connecticut 06795
With a copy to:
William R. Kolb
Foley Hoag LLP
155 Seaport Boulevard
Boston, MA 02210
(617) 832-1000
(Name, Address and Telephone Number of Person
Authorized to Receive Notices and Communications)
March 23, 2018
(Date of Event which Requires Filing of this Statement)
If the filing person has previously filed a statement on Schedule 13G to report the acquisition
that is the subject of this Schedule 13D, and is filing this schedule because of §§240.13d-1(e), 240.13d-1(f) or 240.13d-1(g),
check the following box. [ ]
Note:
Schedules filed in paper format shall include a signed original and five
copies of the schedule, including all exhibits. See §240.13d-7 for other parties to whom copies are sent.
*The remainder of this cover page shall be filled out for a reporting person’s
initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information
which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be
"filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to
the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
CUSIP No. 22940F103
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13D
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Page 2 of 5 Pages
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1.
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Names of Reporting Persons
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John B. Baker
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions)
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(a)
☐
(b)
☐
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions) OO, PF
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization United States
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With
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7.
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Sole Voting Power 0
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8.
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Shared Voting Power 0
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9.
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Sole Dispositive Power 0
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10.
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Shared Dispositive Power 0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person 0
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions)
☐
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13.
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Percent of Class Represented by Amount in Row (11) 0.0%
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14.
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Type of Reporting Person (See Instructions) IN
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CUSIP No. 22940F103
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13D
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Page 3 of 5 Pages
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1.
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Names of Reporting Persons.
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Peter K. Baker
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions)
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(a)
☐
(b)
☐
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions) OO, PF
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
☐
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6.
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Citizenship or Place of Organization United States
|
Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With
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7.
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Sole Voting Power 0
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8.
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Shared Voting Power 0
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9.
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Sole Dispositive Power 0
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10.
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Shared Dispositive Power 0
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person 0
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions)
☐
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13.
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Percent of Class Represented by Amount in Row (11) 0.0%
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14.
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Type of Reporting Person (See Instructions) IN
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CUSIP No. 22940F103
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Page 4 of 5 Pages
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This Amendment No. 6 to the joint statement on Schedule 13D
with respect to the shares of common stock, par value $0.001 per share (the “
Shares
”), of Crystal Rock Holdings,
Inc., a Delaware corporation (the “
Issuer
”), initially filed by Henry Baker, John B. Baker, Peter K. Baker and
Ross S. Rapaport, individually and in his capacity as trustee of U/T/A dated 12/16/91 F/B/O Joan Baker et al., Peter K. Baker Life
Insurance Trust and John B. Baker Life Insurance Trust (the “
Trust
”), on July 13, 2005, as amended by Amendment
No. 1 on Schedule 13D filed on August 23, 2005, as amended by Amendment No. 2 on Schedule 13D filed on September 16,
2005, as amended by Amendment No. 3 on Schedule 13D filed on August 6, 2014, as amended by Amendment No. 4 on Schedule
13D filed on February 13, 2018 and as amended by Amendment No. 5 on Schedule 13D filed on February 28, 2018 (such joint statement,
as so amended and as amended herein, the “
Schedule 13D
”), amends the Schedule 13D as set forth herein. Henry
Baker and Ross S. Rapaport, individually and in his capacity as trustee of the Trust, are no longer reporting persons on the Schedule
13D, and this Amendment No. 6 is being filed by John B. Baker and Peter K. Baker (collectively, the “
Reporting Persons
”).
Except as amended hereby, the Schedule 13D remains in full force and effect.
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Item 5.
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Interest in Securities of the Issuer
.
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Item 5 is hereby amended and restated to read in its entirety as follows:
(a, b) The percentages of beneficial ownership reported
in this Item 5, and on each Reporting Person’s cover page to this Schedule 13D, are based on a total of 21,358,411 Shares
issued and outstanding as of February 12, 2018, as represented by the Issuer in the Acquisition Agreement. All of the Share numbers
reported below, and on each Reporting Person’s cover page to this Schedule 13D, are as of March 23, 2018, unless otherwise
indicated. The cover page to this Schedule 13D for each Reporting Person is incorporated by reference in its entirety into this
Item 5(a, b).
As a result of the consummation of the Offer, and the effectiveness
of the Merger of Purchaser with and into the Issuer on March 23, 2018 pursuant to the Acquisition Agreement, the Reporting Persons
no longer beneficially own, or may be deemed to beneficially own, any Shares.
(c) Except as
otherwise described in this Schedule 13D, none of the Reporting Persons has effected any transaction in the Shares since February
28, 2018 (the date on which Amendment No. 5 to the Schedule 13D was filed).
(d) Not applicable.
(e) On March 23,
2018, each of the Reporting Persons ceased to be the beneficial owner of more than 5% of the outstanding Shares.
[signature page follows]
CUSIP No. 22940F103
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Page 5 of 5 Pages
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SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief,
I certify that the information set forth in this statement is true, complete and correct.
March 23, 2018
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JOHN B. BAKER
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/s/ John B. Baker
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John B. Baker
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PETER K. BAKER
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/s/ Peter K. Baker
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Peter K. Baker
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