-----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, G/XhiDzTS/if51/Kuj7TNXQxRdqF2NP1RaxY1I8tfsXziJusHV+XoaBkcbEqBLI1 W9+jT93njKd0dSAuUqE7JA== 0000927356-98-001924.txt : 19981118 0000927356-98-001924.hdr.sgml : 19981118 ACCESSION NUMBER: 0000927356-98-001924 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980930 FILED AS OF DATE: 19981116 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NUTRITION FOR LIFE INTERNATIONAL INC CENTRAL INDEX KEY: 0000913614 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-DRUGS PROPRIETARIES & DRUGGISTS' SUNDRIES [5122] IRS NUMBER: 760416176 STATE OF INCORPORATION: TX FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-26362 FILM NUMBER: 98752491 BUSINESS ADDRESS: STREET 1: 9101 JAMEEL RD STREET 2: STE 180 CITY: HOUSTON STATE: TX ZIP: 77040 BUSINESS PHONE: 7134601976 MAIL ADDRESS: STREET 1: 9101 JAMEEL RD STREET 2: STE 180 CITY: HOUSTON STATE: TX ZIP: 77040 COMPANY DATA: COMPANY CONFORMED NAME: MITCHAM JANA CENTRAL INDEX KEY: 0001008509 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 9101 JAMEEL STREET 2: SUITE 180 CITY: HOUSTON STATE: TX ZIP: 77040 BUSINESS PHONE: 7133295800 MAIL ADDRESS: STREET 1: 9101 JAMEEL STREET 2: SUITE 180 CITY: HOUSTON STATE: TX ZIP: 77040 5 1 FORM 5 FOR JANA MITCHAM U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 OMB APPROVAL ----------------------------- [_] Check this box if no longer OMB NUMBER: 3235-0362 subject to Section 16. Form 4 Expires: September 30, 1998 or Form 5 obligations may Estimated average burden continue. SEE Instruction 1(b). hours per response ...... 1.0 ----------------------------- [_] Form 3 Holdings Reported [_] Form 4 Transaction Reported ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person Mitcham Jana - -------------------------------------------------------------------------------- (Last) (First) (Middle) 10618 Great Plains - -------------------------------------------------------------------------------- (Street) Houston TX 77064 - -------------------------------------------------------------------------------- (City) (State) (Zip) Nutrition For Life International, Inc. - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol - -------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) Septemeber 1998 - -------------------------------------------------------------------------------- 4. Statement for Month/Year - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Day/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) X Director 10% Owner ----- ------ X Officer (give Other (Specify ----- title below) ------ below) Executive Vice President and Secretary ---------------------------------------- - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Reporting (Check applicable line) X Form Filed by One Reporting Person ----- Form Filed by More than One Reporting Person ----- - --------------------------------------------------------------------------------
Table 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1. Title of Security 2. Trans- 3. Trans- 4. Secuirties Acquired (A) 5. Amount of 6. Ownership 7. Nature (Instr. 3) action action or Disposed of (D) Securities Form: of Indirect Date Code Beneficially Direct Beneficial (Instr. 8) (Instr. 3,4 and 5) Owned at End (D) or Ownership (Month/ -------------------------- Of Issuer's Indirect (Instr. 4) Day/ Amount (A) or Price Fiscal Year (I) Year) (D) (Instr. 3 and 4) (Instr. 4) - -------------------------- ---------- ------ ---- -------- ------ ------ ---------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ ------------- - -------------------------- ---------- ------ ---- -------- ------ ------ -------------- ------------ -------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) SEC 2270 (3/91) ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security 2. Conversion 3. Transaction 4. Transacation 5. Number of Derivative 6. Date Exercisable (Instr. 3) or Exercise Date Code Securities Acquired (A) and Expiration Price of (Month Day (Instr. 8) or Disposed of (D) Date Derivative Year) (Instr. 3, 4, and 5) (Month, Day Security Year) -------------------------- ------------------- (A) (D) Date Expiration Exer- Date cisable - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- Right to Buy $ 5.13 03/23/98 A 20,000 09/23/98 03/22/01 - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- ------------------- - ------------------------------- -------------- -------------- -------- ----- --------------- ---------- -------------------
7. Title and Amount of 8. Price of Derivative 9. Number of Derivative 10. Ownership of 11. Nature of the Underlying Securities Security (Instr. 5) Securities Beneficially Derivate Securitiy: Indirect Beneficial (Instr. 3 AND 4) Owned at End of Year Direct (D) or Ownership (Instr. 4) Instr. 4) Indirect (I) (Instr. 4) - ------------------------ Title Amount or Number of Shares - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ Common Stock 20,000 133,400 D - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ 8,400 I By Husband - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------ - ------------------------ ---------------------- -------------------------- --------------------------- ------------------------
Explanation of Responses: **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Jana Mitcham November 16, 1998 _______________________________ _________________ **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, See Instruction 6 for procedure. Page 2 SEC 2270 (3/91) -----END PRIVACY-ENHANCED MESSAGE-----