0001144204-15-035482.txt : 20150604
0001144204-15-035482.hdr.sgml : 20150604
20150604150959
ACCESSION NUMBER: 0001144204-15-035482
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150602
FILED AS OF DATE: 20150604
DATE AS OF CHANGE: 20150604
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TWINLAB CONSOLIDATED HOLDINGS, INC.
CENTRAL INDEX KEY: 0001590695
STANDARD INDUSTRIAL CLASSIFICATION: MEDICINAL CHEMICALS & BOTANICAL PRODUCTS [2833]
IRS NUMBER: 463951742
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 632 BROADWAY
STREET 2: SUITE 201
CITY: NEW YORK
STATE: NY
ZIP: 10012
BUSINESS PHONE: (212) 651-8500
MAIL ADDRESS:
STREET 1: 632 BROADWAY
STREET 2: SUITE 201
CITY: NEW YORK
STATE: NY
ZIP: 10012
FORMER COMPANY:
FORMER CONFORMED NAME: MIRROR ME, INC.
DATE OF NAME CHANGE: 20131031
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Van Andel David L
CENTRAL INDEX KEY: 0001620362
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55181
FILM NUMBER: 15912852
MAIL ADDRESS:
STREET 1: 3133 ORCHARD VISTA DRIVE SE
CITY: GRAND RAPIDS
STATE: MI
ZIP: 49546
4
1
v412259_form4.xml
OWNERSHIP DOCUMENT
X0306
4
2015-06-02
0
0001590695
TWINLAB CONSOLIDATED HOLDINGS, INC.
TLCC
0001620362
Van Andel David L
3133 ORCHARD VISTA DRIVE SE
GRAND RAPIDS
MI
49546
1
0
1
0
common stock, par value $0.001
2015-06-02
4
P
0
3289474
.76
A
18515328
I
owned through a Trust
common stock, par value $0.001
2015-06-02
4
P
0
3289474
.76
A
29879474
I
owned through a limited liability company
Warrant (right to buy)
.385
2015-06-02
4
J
0
12987012
0
A
2015-06-02
2017-09-30
Common stock, par value $0.001
12987012
12987012
I
Owned through a Trust
Warrant (right to buy)
.01
2015-06-02
4
J
0
3289474
0
A
2015-06-02
2020-05-31
Common stock, par value $0.001
3289474
3289474
I
Owned through a Trust
Warrant (right to buy)
.01
2015-06-02
4
J
0
3289474
0
A
2015-06-02
2020-05-31
Common stock, par value $0.001
3289474
3289474
I
Owned through limited liability company
Warrant (right to buy)
.76
2015-06-02
4
D
0
5777411
0
D
2014-09-05
2017-09-05
Common stock, par value $0.001
5777411
0
D
These shares and warrants are owned by the David L. Van Andel Trust u/a dated November 30, 1993 (the "Trust"), of which the reporting person is the sole trustee and the principal beneficiary.
These shares and warrants are owned by Little Harbor, LLC, a Nevada limited liability company ("LH LLC"), of which the reporting person is the sole manager and a holder as sole trustee of the David L. Van Andel Trust u/a dated November 30, 1993 of 80.5% of the membership interests. The reporting person disclaims beneficial ownership of any shares held by LH LLC that would exceed his percentage interest in LH LLC.
The per share exercise price is subject to adjustment under certain circumstances.
The warrants were issued to the Trust pursuant to a Stock Purchase Agreement, dated as of June 2, 2015.
The number of shares issuable upon exercise of the warrant is subject to adjustment under certain circumstances.
The warrant was issued to LH LLC pursuant to a Stock Purchase Agreement, dated as of June 2, 2015. The reporting person disclaims beneficial ownership of any shares issuable to LH LLC under the warrant that would exceed his percentage interest in LH LLC. See Note 2.
The warrant was canceled by mutual agreement of the reporting person and the issuer. LH LLC was issued the warrants described above as consideration for the cancellation.
/s/ David L. Van Andel, Manager
2015-06-04