SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
ROUHANA WILLIAM J JR

(Last) (First) (Middle)
132 E. PUTNAM AVENUE
FLOOR 2W

(Street)
COS COB CT 06807

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/17/2017
3. Issuer Name and Ticker or Trading Symbol
Chicken Soup for the Soul Entertainment, Inc. [ CSSE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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
Class W warrants 08/17/2017 06/30/2021 Class A common stock 157,500 7.5 I by Trema, LLC(1)
Class B common stock (2) (2) Class A common stock 159,432(2) (2) I by Trema, LLC(1)
Class B common stock (2) (2) Class A common stock 7,654,506(2) (2) I by Chicken Soup for the Soul Productions, LLC(3)
1. Name and Address of Reporting Person*
ROUHANA WILLIAM J JR

(Last) (First) (Middle)
132 E. PUTNAM AVENUE
FLOOR 2W

(Street)
COS COB CT 06807

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Chicken Soup for the Soul Productions, LLC

(Last) (First) (Middle)
132 E. PUTNAM AVENUE
FLOOR 2W

(Street)
COS COB CT 06807

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Chicken Soup for the Soul Holdings, LLC

(Last) (First) (Middle)
132 E. PUTNAM AVENUE
FLOOR 2W

(Street)
COS COB CT 06807

(City) (State) (Zip)
Explanation of Responses:
1. Trema, LLC is controlled by Mr. Rouhana.
2. The Class B common stock is convertible into the Issuer's Class A common stock as described under the heading "Description of Securities - Common Stock" in the Issuer's offering statement on Form 1-A (File No. 024-10704) and has no expiration date.
3. The ultimate parent of Chicken Soup for the Soul Productions, LLC is Chicken Soup for the Soul Holdings, LLC, which in turn is ultimately controlled by Mr. Rouhana.
Remarks:
/s/ William J. Rouhana, Jr. 08/17/2017
/s/ William J. Rouhana, Jr., CEO 08/17/2017
/s/ William J. Rouhana, Jr., CEO 08/17/2017
** 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 5 (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).
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