0001437749-21-028327.txt : 20211210
0001437749-21-028327.hdr.sgml : 20211210
20211210170130
ACCESSION NUMBER: 0001437749-21-028327
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210930
FILED AS OF DATE: 20211210
DATE AS OF CHANGE: 20211210
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ZIVC, LLC
CENTRAL INDEX KEY: 0001554639
STATE OF INCORPORATION: CO
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35608
FILM NUMBER: 211486088
BUSINESS ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
BUSINESS PHONE: 800-817-9415
MAIL ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: EIVC 2, LLC
CENTRAL INDEX KEY: 0001554638
STATE OF INCORPORATION: CO
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35608
FILM NUMBER: 211486089
BUSINESS ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
BUSINESS PHONE: 800-817-9415
MAIL ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HIVC 2, LLC
CENTRAL INDEX KEY: 0001554642
STATE OF INCORPORATION: CO
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35608
FILM NUMBER: 211486087
BUSINESS ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
BUSINESS PHONE: 800-817-9415
MAIL ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KIVC 2, LLC
CENTRAL INDEX KEY: 0001554640
STATE OF INCORPORATION: CO
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35608
FILM NUMBER: 211486090
BUSINESS ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
BUSINESS PHONE: 800-817-9415
MAIL ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Natural Grocers by Vitamin Cottage, Inc.
CENTRAL INDEX KEY: 0001547459
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-GROCERY STORES [5411]
IRS NUMBER: 841444517
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0930
BUSINESS ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
BUSINESS PHONE: 877-986-4600
MAIL ADDRESS:
STREET 1: 12612 W. ALAMEDA PARKWAY
CITY: LAKEWOOD
STATE: CO
ZIP: 80228
5
1
rdgdoc.xml
FORM 5
X0306
5
2021-09-30
0
0
0001547459
Natural Grocers by Vitamin Cottage, Inc.
NGVC
0001554640
KIVC 2, LLC
12612 W. ALAMEDA PARKWAY
LAKEWOOD
CO
80228
1
13D Group Member
0001554638
EIVC 2, LLC
12612 W. ALAMEDA PARKWAY
LAKEWOOD
CO
80228
1
13D Group Member
0001554639
ZIVC, LLC
12612 W. ALAMEDA PARKWAY
LAKEWOOD
CO
80228
1
13D Group Member
0001554642
HIVC 2, LLC
12612 W. ALAMEDA PARKWAY
LAKEWOOD
CO
80228
1
13D Group Member
Common Stock
2020-12-31
5
J
0
572097
0
D
0
I
By KIVC 2, LLC
Common Stock
2020-12-31
5
J
0
616254
0
D
0
I
By ZIVC, LLC
Common Stock
2020-12-31
5
J
0
295249
0
D
0
I
By EIVC 2, LLC
Common Stock
2020-12-31
5
J
0
478788
0
D
0
I
By HIVC 2, LLC
Exempt pro rata distribution of shares previously held by the reporting person (KIVC 2, LLC) to its members upon its dissolution for estate planning purposes.
Exempt pro rata distribution of shares previously held by the reporting person (ZIVC, LLC) to its members upon its dissolution for estate planning purposes.
Exempt pro rata distribution of shares previously held by the reporting person (EIVC 2, LLC) to its members upon its dissolution for estate planning purposes.
Exempt pro rata distribution of shares previously held by the reporting person (HIVC 2, LLC) to its members upon its dissolution for estate planning purposes.
/s/ Kemper Isely, by Power of Attorney
2021-12-10