-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, I8/agZcYMJaUrjbsqxlB7KCWmLnV/D6kOved+kBT/IvnZhwwJPck5fUx49lgFq8O lOp/9Pd0C+CzPwewVqW5Pg== 0001078782-09-001294.txt : 20090819 0001078782-09-001294.hdr.sgml : 20090819 20090819130043 ACCESSION NUMBER: 0001078782-09-001294 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20090819 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: KROMMENHOEK ADAM R CENTRAL INDEX KEY: 0001470068 FILING VALUES: FORM TYPE: SC 13D MAIL ADDRESS: STREET 1: 245 HOBBLE CREEK CANYON CITY: SPRINGVILLE STATE: UT ZIP: 84663 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Blue Moose Media Inc CENTRAL INDEX KEY: 0001307579 IRS NUMBER: 201431677 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-84968 FILM NUMBER: 091023485 BUSINESS ADDRESS: STREET 1: 3113 ST CHRISTOPHER COURT CITY: ANTIOCH STATE: CA ZIP: 94509 BUSINESS PHONE: 877-841-0236 MAIL ADDRESS: STREET 1: 3113 ST CHRISTOPHER COURT CITY: ANTIOCH STATE: CA ZIP: 94509 SC 13D 1 bluemoose13dkrommenhoek.htm SCHEDULE 13D 13D

SECURITIES AND EXCHANGE COMMISSION


Washington, D.C. 20549


Schedule 13D

Under the Securities Exchange Act of 1934


BLUE MOOSE MEDIA, INC.

(Name of Issuer)


Common Stock, $0.001 par value

(Title of Class of Securities)


095704 201

 (CUSIP Number)

Adam R. Krommenhoek

145 Hobble Creek Cyn.

Springville, UT 84663

 (Name, Address and Telephone Number of Person Authorized to Receive Notices

and Communications)


August 18 , 2009

(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 Sections 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 Section 240.13d-7(b) for other parties to whom copies are to be sent.


 

*The remainder of this cover page shall be filled out for the 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. 095704 201


(1)

Names of Reporting Persons and I.R.S. Identification Nos. of Such Persons (entities only)


Adam R. Krommenoek


(2)

Check the Appropriate Box if a Member of a Group (See Instructions)

(a)


(b)


(3)

SEC Use Only ___________________________________________________________

 

(4)

Source of Funds (See Instructions):

 

PF

 

(5)

Check if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e)

 

N/A

 

(6)

Citizenship or Place of Organization

 

United States

 

Number of

Shares

Beneficially

Owned by

Each

Reporting

Person with:

(7) Sole Voting Power:

20,000,000

 

 

 

(8) Shared Voting Power:

 

0

 

 

 

(9) Sole Dispositive Power:

 

20,000,000

 

 

(10) Shared Dispositive Power:

 

0

 

 

 


(11)

Aggregate Amount Beneficially Owned by Each Reporting Person:

 

20,000,000 shares of common stock, $.001 par value

 

(12)

Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions)

[___]

 

(13)

Percent of Class Represented by Amount in Row (11):

 

93.58%

 

(14)

Type of Reporting Person (See Instructions):

 

IN



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Item 1.

Security and Issuer.


Name and address of principal executive offices of Issuer:

 

Blue Moose Media, Inc.

3113 St. Christopher Ct.

Antioch, CA  94509


Item 2.

Identity and Background.

 

(a)

Name of person filing:


Adam R. Krommennoek


(b)

Residence or Business Address:


245 Hobble Creek Cyn.

Springville, UT  84663


(c)

Principal occupation:


(d)

Criminal proceedings:

 

During the last five years, Adam R. Krommenhoek has not been convicted in any criminal proceeding.


(e)

Civil Proceedings:


During the last five years, Adam R. Krommenhoek has not been a party to any civil proceedings of a judicial or administrative body of competent jurisdiction as a result of which that person would have been subject to any 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.


(f)

Citizenship or Place of Organization:


United States


Item 3.

Source and Amount of Funds or Other Consideration.


On August 12, 2009, the Company sold 20,000,000 shares of restricted common stock for $20,000 cash to Adam R. Krommenhoek, an accredited investor.  The shares were sold without registration and pursuant to an exemption under Regulation D, Rule 506 and Section 4(2) of the Securities Act of 1933, as amended.  No brokers or commission were paid on the transaction.


Item 4.

Purpose of the Transaction.


Adam R. Krommenhoek does not have any plans or proposals that relates to or would result in any of the actions enumerated in Item 4 of Schedule 13D.

 



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Item 5.

Interests in Securities of the Issuer.


(a)

Adam R. Krommenhoek owns 20,000,000 shares of the Issuer’s common stock which is 93.58% of the total issued and outstanding common stock of the Issuer.

 

 

 

 (b)

Adam R. Krommenhoek has sole voting and dispositive powers with respect to all shares of the Issuer’s common stock held in his own name.

 

 

 

(c)

N/A

 

 

(d)

N/A


(e)

N/A


Item 6. Contracts, Arrangements, Understandings or Relationships With Respect to Securities of the Issuer.


None.


Item 7. Material to be Filed as Exhibits.

 

None.

 


 

SIGNATURE


After reasonable inquiry and to the best of the Reporting Person’s knowledge and belief, the Reporting Person certifies that the information set forth in this statement is true, complete and correct.

 

 

 

 

 

 

Date: August 18, 2009

 

/s/  Adam R. Krommenhoek

 


Adam R. Krommenhoek

 

 




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