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