SEC Form 5 · accession 0001642341-15-000001
MIX 1 LIFE, INC. · MIXX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Stephen A VandeLoo
Director
Period of report
Aug 31, 2015
Accepted (ET)
Oct 29, 2015 · 12:07 pm EDT
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 Stock | holding | — | — | — | 1,667 | D | ||
| Common StockF1 | holding | — | — | — | 8,335 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Indirect Ownership includes 8,335 shares in the name of Advanced Beverage Concepts ("ABC"), a Georgia corporation. Mr. Vande Loo is the CEO and sole shareholder of ABC and has voting dispositive control over the shares held by ABC.