Annual Statement of Changes in Beneficial Ownership (5)
January 15 2015 - 12:44PM
Edgar (US Regulatory)
FORM 5
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X
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Schissler Matthew Lawrence
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2. Issuer Name
and
Ticker or Trading Symbol
Intelligent Living America, Inc. [ILIV]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
7380 S. EASTERN AVE, #124376
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2014
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(Street)
LAS VEGAS, NV 89123
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form Filed by One Reporting Person
_
X
_ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Stock
(1)
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11/26/2012
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P
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83333333
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A
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(2)
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83333333
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D
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Common Stock
(1)
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7/8/2013
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P
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10000000
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A
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$0.001
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93333333
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D
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Common Stock
(1)
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8/1/2013
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S
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1702000
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D
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$0.0007
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91631333
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D
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Common Stock
(1)
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12/30/2013
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S
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6675732
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D
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$0.0005
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84955601
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D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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(1) Red Bowl Living Trust is the record owner of these shares. Matthew Schissler is trustee of the Red Bowl Living Trust and has voting and investment power with respect to the shares owned by the Red Bowl Living Trust. Matthew Schissler disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein.
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(
2)
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(2) 83,333,333 shares of common stock, valued at $250,000, were issued to the Reporting Person on behalf of Pyrenees Investments LLC as compensation for consulting services. Matthew Schissler is the managing member of Pyrenees Investments LLC.
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Remarks:
(3) As of March 2014, Matthew Schissler resigned from the board of directors of the Issuer.
(4) As of May 7, 2014, Matthew Schissler ceased to be an indirect beneficial owner of ten percent (10%) of the issued and outstanding shares of the Issuer and the Red Bowl Living Trust ceased to be a direct beneficial owner of ten percent (10%) of the issued and outstanding shares of the Issuer. The Reporting Persons are no longer subject to Section 16 reporting.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Schissler Matthew Lawrence
7380 S. EASTERN AVE
#124376
LAS VEGAS, NV 89123
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X
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X
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Red Bowl Living Trust
7380 SOUTH EASTERN AVE. #124376
LAS VEGAS, NV 89123
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X
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Signatures
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/s/ Matthew Lawrence Schissler
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1/15/2015
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**
Signature of Reporting Person
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Date
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/s/ Matthew Lawrence Schissler, Trustee Red Bowl Trust
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1/15/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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