SEC Form 5 · accession 0001161351-15-000004
MIX 1 LIFE, INC. · MIXX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Christopher Larson
Officer — CFO · Director · 10% Owner
Period of report
Aug 31, 2015
Accepted (ET)
Nov 2, 2015 · 8:00 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001501112
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Oct 27, 2015 | P | 10,650 | $1.11 | A | 103,952 | D | |
| Common StockF2 | holding | — | — | — | 1,711,984 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The amount of shares owned directly is as of the date of this filing.
- F2Indirect Ownership includes 150 shares in the name of Mr. Larson's minor child, 78,500 common shares held in the name of Thomas Lake & Company, a corporation controlled by Mr. Larson, and 1,633,334 common shares held in the name of Mix Development Group LLC, an Arizona limited liability company controlled by Mr. Larson.