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