0001144204-15-054607.txt : 20150911
0001144204-15-054607.hdr.sgml : 20150911
20150911144731
ACCESSION NUMBER: 0001144204-15-054607
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150910
FILED AS OF DATE: 20150911
DATE AS OF CHANGE: 20150911
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TWINLAB CONSOLIDATED HOLDINGS, INC.
CENTRAL INDEX KEY: 0001590695
STANDARD INDUSTRIAL CLASSIFICATION: MEDICINAL CHEMICALS & BOTANICAL PRODUCTS [2833]
IRS NUMBER: 463951742
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 632 BROADWAY
STREET 2: SUITE 201
CITY: NEW YORK
STATE: NY
ZIP: 10012
BUSINESS PHONE: (212) 651-8500
MAIL ADDRESS:
STREET 1: 632 BROADWAY
STREET 2: SUITE 201
CITY: NEW YORK
STATE: NY
ZIP: 10012
FORMER COMPANY:
FORMER CONFORMED NAME: MIRROR ME, INC.
DATE OF NAME CHANGE: 20131031
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Van Andel David L
CENTRAL INDEX KEY: 0001620362
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55181
FILM NUMBER: 151103199
MAIL ADDRESS:
STREET 1: 3133 ORCHARD VISTA DRIVE SE
CITY: GRAND RAPIDS
STATE: MI
ZIP: 49546
4
1
v420152_form4.xml
OWNERSHIP DOCUMENT
X0306
4
2015-09-10
0
0001590695
TWINLAB CONSOLIDATED HOLDINGS, INC.
TLCC
0001620362
Van Andel David L
3133 ORCHARD VISTA DRIVE SE
GRAND RAPIDS
MI
49546
1
0
1
0
common stock, par value $0.001
2015-09-10
4
X
0
12987012
0.385
A
31502340
I
owned through a Trust
Warrant (right to buy)
0.385
2015-09-10
4
X
0
12987012
0
D
2015-06-02
2017-09-30
Common stock, par value $0.001
12987012
0
I
Owned through a Trust
These shares and warrant are owned by the David L. Van Andel Trust u/a dated November 30, 1993 (the "Trust"), of which the reporting person is the sole trustee and the principal beneficiary.
The warrant was issued to the Trust pursuant to a Stock Purchase Agreement, dated as of June 2, 2015.
/s/ David L. Van Andel
2015-09-11