0001010412-17-000017.txt : 20170427 0001010412-17-000017.hdr.sgml : 20170427 20170427123722 ACCESSION NUMBER: 0001010412-17-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170426 FILED AS OF DATE: 20170427 DATE AS OF CHANGE: 20170427 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BEAR LAKE RECREATION INC CENTRAL INDEX KEY: 0001074871 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 870620495 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 4685 S. HIGHLAND DRIVE #202 CITY: SALT LAKE CITY STATE: UT ZIP: 84117 BUSINESS PHONE: 801-278-9424 MAIL ADDRESS: STREET 1: 4685 S. HIGHLAND DRIVE #202 CITY: SALT LAKE CITY STATE: UT ZIP: 84117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BASSHAM WAYNE ROBERT CENTRAL INDEX KEY: 0001304679 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-49671 FILM NUMBER: 17787494 MAIL ADDRESS: STREET 1: 8867 SOUTH CAPELLA WAY CITY: SANDY STATE: UT ZIP: 84093 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-04-26 1 0001074871 BEAR LAKE RECREATION INC BLKE 0001304679 BASSHAM WAYNE ROBERT 8867 SOUTH CAPELLA WAY SANDY UT 84093 0 0 0 1 Former President and director Common Stock 2017-04-26 4 S 0 181634 0.022 D 104082 D Common Stock 2017-04-26 4 S 0 82416 0.02 D 21666 D Common Stock 2017-04-26 4 S 0 6666 0.02 D 15000 D These shares reflect a 3.5 for 1 reverse stock split effective October 23, 2006. The previous ownership reported was 1,000,000 shares beneficially owned, which after the reverse and rounding equals 285,716 shares beneficially owned. 181,634 shares were cancelled to the Company for an aggregate price of $4,000 pursuant to a Common Stock Purchase Agreement dated April 5, 2017 (the "Agreement"), and filed with the Securities and Exchange Commission on that date; the Agreement was closed and completed on April 26, 2017, at which time Mr. Bassham's resignation as an officer and director of the Company became effective. Mr. Bassham sold 82,416 shares to a person who may be deemed to have been a related party of the Company at $0.02 per share for an aggregate purchase price of $1,648.32. Mr. Bassham also sold 6,666 shares to a former legal counsel of the Company at $0.02 per share for an aggregate purchase price of $133.32. The Agreement required that the remaining 15,000 shares owned by Mr. Bassham be pledged to the Company for a period of 12 months under an Indemnification Escrow Agreement and an Indemnification Agreement. The Agreement required that the remaining 15,000 shares owned by Mr. Bassham be pledged to the Company for a period of 12 months under an Indemnification Escrow Agreement and an Indemnification Agreement. /s/ Wayne Bassham 2017-04-27