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