SEC Form 4 · accession 0001144204-15-057967
TWINLAB CONSOLIDATED HOLDINGS, INC. · TLCC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David L Van Andel
Director · 10% Owner
Period of report
Sep 30, 2015
Accepted (ET)
Oct 2, 2015 · 6:36 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001590695
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| common stock, par value $0.001F1 | Sep 30, 2015 | X | 3,289,474 | $0.01 | A | 34,791,814 | I | owned through a Trust |
| common stock, par value $0.001F2 | Sep 30, 2015 | X | 3,289,474 | $0.01 | A | 33,168,948 | I | owned through limited liability company |
| common stock, par value $0.001F3 | Oct 2, 2015 | P | 41,379,310 | $0.29 | A | 48,332,266 | I | owned through limited liability company |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant (right to buy)F4,F5 | $0.01 | Sep 30, 2015 | X | 3,289,474 | D | Jun 2, 2015 | May 31, 2020 | Common stock, par value $0.001 | 3,289,474 | 0 | I |
| Warrant (right to buy)F6,F7 | $0.01 | Sep 30, 2015 | X | 3,289,474 | D | Jun 2, 2015 | May 31, 2020 | Common stock, par value $0.001 | 3,289,474 | 0 | I |
Explanation of responses
- F1These shares are owned by the David L. Van Andel Trust u/a dated November 30, 1993 (the "DVA Trust"), of which the reporting person is the sole trustee and the principal beneficiary.
- F2These shares are owned by Little Harbor LLC, a Nevada limited liability company ("LH LLC"), of which the reporting person is the sole manager and a holder as sole trustee of the DVA Trust of 80.5% of the membership interests. The reporting person disclaims beneficial ownership of any shares held by LH LLC that would exceed his percentage interest in LH LLC.
- F3These shares are owned by Great Harbor Capital, LLC, a Delaware limited liability company, of which the reporting person is the sole manager and a holder as sole trustee of the DVA Trust of 100% of the membership interests.
- F4The warrant was issued to the DVA Trust pursuant to a Stock Purchase Agreement, dated as of June 2, 2015.
- F5The warrant was owned by the DVA Trust.
- F6The warrant was issued to LH LLC pursuant to a Stock Purchase Agreement dated as of June 2, 2015.
- F7The warrant was owned by LH LLC.