CUSIP
No. 129176 10 5
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1
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NAMES
OF REPORTING PERSONS
I.R.S.
IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Andrew Gordon
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2
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CHECK
THE APPROPRAITE 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
00
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5
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CHECK
BOX 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
1,144,908
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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
1,144,908
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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
1,144,908
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12
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CHECK
BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES ¨
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13
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PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
21%
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14
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TYPE
OF REPORTING PERSON
IN
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CUSIP
No. 129176 10 5
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(a)
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Name: Andrew
Gordon
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(b)
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Business
Residence: 3475 Victory Boulevard, Staten Island,
NY 10314
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(c)
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Present
Occupation: Mr.
Gordon is the President, Chief Executive Officer, Chief Financial Officer
and Treasurer of Coffee Holding Co.,
Inc.
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(d)
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During
the last five years, Mr. Gordon has not been convicted in a criminal
proceeding (excluding traffic violations or similar
misdemeanors).
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(e)
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During
the past five years, Mr. Gordon has not been a party to a civil proceeding
of a judicial or administrative body of competent jurisdiction and as a
result of such proceeding was or is subject to a judgment, decree or final
order enjoining future violations of, or prohibiting or mandating
activities subject to, federal or state securities laws or finding any
violation with respect to such
laws.
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(f)
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Citizenship: United
States
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CUSIP
No. 129176 10 5
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(a-b)
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Mr.
Gordon beneficially owns (with sole voting and dispositive power)
1,144,908 shares of Common Stock, which represents approximately 21.0% of
the outstanding Common Shares of the
Issuer.
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(c)
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Other
than with respect to the 120,000 shares of Common Stock of the Issuer
acquired by Mr. Gordon as custodian for his minor children, no person or
entity other than Mr. Gordon has the right to receive, or the power to
direct the receipt of dividends from, or the proceeds from the sale of the
shares of the Issuer’s Common Stock reported in this
Schedule
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(d)
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Not
applicable.
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CUSIP
No. 129176 10 5
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Page of 5 of 5 Pages
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By:
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/s/ Andrew Gordon | |
Andrew Gordon | |||