[ ]
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Rule 13d-1(b)
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[X]
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Rule 13d-1(c)
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[ ]
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Rule 13d-1(d)
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CUSIP NO. 300863107
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Page 2 of 5 Pages
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1
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NAME OF REPORTING PERSON
S.S. or I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
(ENTITIES ONLY)
Ted Korin
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
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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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CITIZENSHIP OR PLACE OF ORGANIZATION
United States of America
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH:
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5
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SOLE VOTING POWER
5,089,641
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6
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SHARED VOTING POWER
-0-
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7
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SOLE DISPOSITIVE POWER
5,089,641
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8
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SHARED DISPOSITIVE POWER
-0-
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
5,089,641
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ]
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
12.1
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12
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TYPE OF REPORTING PERSON*
IN
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Item 1(a).
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Name of Issuer:
Excelsis Investments, Inc.
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Item 1(b).
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Address of Issuer's Principal Executive Offices:
801 West Bay Drive, Suite 470
Largo, Florida 33770
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Item 2(a).
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Names of Persons Filing:
Ted Korin
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Item 2(b).
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Address of Principal Business Office or, if none, Residence:
800 Woodbury Road, Suite H
Woodbury, New York 11797
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Item 2(c).
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Citizenship:
United States of America
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Item 2(d).
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Title of Class of Securities:
Common stock, par value $0.001 per share
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Item 2(e).
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CUSIP Number:
300863107
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Item 3.
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Type of Reporting Person:
Not applicable.
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Item 4.
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Ownership.
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Item 4(a).
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Amount Beneficially Owned:
5,089,641
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Item 4(b).
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Percent of Class:
12.1%
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Item 4(c).
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Number of shares as to which such persons have:
(i) sole power to vote or to direct the vote: 5,089,641
(ii) shared power to vote or to direct the vote: -0-
(iii) sole power to dispose or to direct the disposition of: 5,089,641
(iv) shared power to dispose or to direct the disposition of: -0-
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Items 5-9.
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Not applicable.
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Item 10.
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Certifications:
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October 30, 2015
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/s/ Ted Korin | |
Ted Korin | |||