Sec Form 4 Filing - Koretsky Frank @ CLS Holdings USA, Inc. - 2017-10-09

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Koretsky Frank
2. Issuer Name and Ticker or Trading Symbol
CLS Holdings USA, Inc. [ CLSH]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
11767 SOUTH DIXIE HIGHWAY, #115
3. Date of Earliest Transaction (MM/DD/YY)
10/09/2017
(Street)
MIAMI, FL33156
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 1,870,988 I ( 1 ) See footnote
Common Stock 12,097,264 D
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Convertible Promissory Note $ 0.25 10/09/2017 J( 2 ) 10/09/2017 ( 3 ) Common Stock 119,998 ( 4 ) $ 29,999.5 119,998 I ( 1 ) See footnote
Convertible Promissory Note $ 0.25 08/23/2017 ( 5 ) Common Stock 2,486,632 ( 4 ) 2,486,632 I ( 1 ) See footnote
Convertible Promissory Note $ 0.25 08/23/2017 ( 5 ) Common Stock 280,000 ( 4 ) 280,000 I ( 1 ) See footnote
Convertible Promissory Note $ 0.25 ( 6 ) 03/31/2017 ( 7 ) Common Stock 480,000 ( 4 ) 480,000 I ( 1 ) See footnote
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Koretsky Frank
11767 SOUTH DIXIE HIGHWAY, #115
MIAMI, FL33156
X X
Signatures
/s/ Frank Koretsky 10/12/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Owned by Newcan Investment Partners LLC, an entity wholly owned by the Reporting Person.
( 2 )This Note bears interest at the rate of 10% per annum. At the election of the Reporting Person, all principal and accrued interest under the Note may be converted into the Issuer's common stock. For each $0.25 converted, the Reporting Person will receive one share of common stock.
( 3 )The Note is convertible, at the election of the Reporting Person, at any time prior to payment or prepayment in full and matures on October 8, 2020.
( 4 )Excludes shares issuable at the election of the Reporting Person upon conversion of accrued interest (both past and future) into shares of common stock.
( 5 )The Note is convertible, at the election of the Reporting Person, at any time prior to payment or prepayment in full and matures on August 22, 2020.
( 6 )Convertible Note was amended to delete the requirement to issue warrants upon conversion.
( 7 )The Note is convertible, at the election of the Reporting Person, at any time prior to payment or prepayment in full and matures on April 1, 2020.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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