Statement of Beneficial Ownership (sc 13d)
January 31 2017 - 10:52AM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13D
Under the Securities Exchange Act of
1934
RELIV INTERNATIONAL INC.
(Name of Issuer)
COMMON STOCK, $.001 PAR VALUE
(Title of Class of Securities)
75952 R 100
(CUSIP Number)
Robert L. Montgomery, Chief Executive Officer
136 Chesterfield Industrial Boulevard,
Chesterfield, Missouri 63005 (636)537-9715
(Name, Address and Telephone Number of Person
Authorized to Receive Notices and Communications)
January 31, 2017
(Date of Event which Requires Filing
of this Statement)
If the filing person has previously filed a statement on Schedule
13G to report the acquisition which is the subject of this Section 13D, and is filing this schedule because of
'
240.13d-1(e), 240.13d-1(f) or 240.13d-1(g) check the following box ☐.
Note: Schedules filed in paper format shall include a signed
original and five copies of the Schedule, including all exhibits. See
'
240.13d-7 for other parties to whom copies are to be sent.
*The remainder of this cover page shall be filled out for a
reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment
containing information which would alter disclosure provided in a prior cover page.
The information required in the remainder of this cover page
shall not be deemed to be
A
filed
@
for the purpose of Section 18 of the Securities Exchange Act of 1934 (
A
Act
@
)
or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however,
see the Notes).
CUSIP No. 75952 R 100
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13D
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1
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NAME OF REPORTING PERSON
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S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE
PERSON
Robert L. Montgomery
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
*
(a) ☐ (b)
☐
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OO
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5
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CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED
PURSUANT TO ITEM 2(d) OR 2(e)
☐
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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United States
NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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7
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SOLE VOTING POWER
508,020 Shares of Common Stock
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8
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SHARED VOTING POWER
None
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9
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SOLE DISPOSITIVE POWER
508,020 Shares of Common Stock
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10
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SHARED DISPOSITIVE POWER
None
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING
PERSON
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508,020 Shares of Common Stock
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12
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CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN
SHARES
*
☐
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 11
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Approximately 27.53% of the issued and outstanding
Common Stock
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14
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TYPE OF REPORTING PERSON
*
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IN
*SEE INSTRUCTIONS
CUSIP No. 75952 R 100
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13D
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SCHEDULE 13D
ITEM 1. Security and Issuer.
This Statement relates to shares of Common
Stock (“Common Stock”) of Reliv International, Inc. (the “Company”). The Company’s principal executive
offices are located at 136 Chesterfield Industrial Boulevard, Chesterfield, Missouri 63005.
ITEM 2. Identity and Background.
This Statement is filed by Robert L. Montgomery
whose address is 17945 Wild Horse Creek Road, Chesterfield, Missouri 63005. Mr. Montgomery is the Chief Executive Officer of the
Company. The address of the Company’s principal executive offices is 136 Chesterfield Industrial Boulevard, Chesterfield,
Missouri 63005. Mr. Montgomery is a citizen of the United States of America.
During the past five years, Mr. Montgomery
has not been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors), nor has Mr. Montgomery
been a party to a civil proceeding of a judicial or administrative body of competent jurisdiction and as a result of such proceeding
was or is subject to a judgment, decree or final order enjoining future violations of, or prohibiting or mandating activities subject
to, federal or state securities laws or finding any violation with respect to such laws.
ITEM 3. Source and Amount of Funds or Other Consideration.
Mr. Montgomery purchased 63,215 (pre-reverse
split of 1:7) shares of Common Stock in the Company in 2016, including 34,534 shares included in the previous Schedule 13D. The
total consideration paid was $50,512.59, excluding commissions. As of the date of this statement, no arrangements with third parties
have been made with respect to financing the acquisition of additional shares.
ITEM 4. Purpose of Transaction.
Mr. Montgomery acquired the shares of Common
Stock indicated herein solely for investment purposes. Mr. Montgomery may elect to acquire additional shares of Common Stock or
to sell shares. Any such determination may be based on a number of factors, including the continued employment of Mr. Montgomery
by the Company, the continued attractiveness of investment in the Company at then prevailing market prices, the number of shares
of Common Stock that are available for purchase, the price or prices thereof, general market conditions and other similar factors.
While Mr. Montgomery reserves the right
to develop plans or proposals in the future with respect to the following items, at the present time Mr. Montgomery has no plans
or proposals that relate to or would result in any of the following:
(a)
An extraordinary corporate transaction, such as a merger, reorganization or liquidation, involving the Company or any of
its subsidiaries;
(b)
Sale or transfer of a material amount of assets of the Company or any of its Subsidiaries;
(c)
Any change in the present Board of Directors or management of the Company, including any plans or proposals to change the
number or term of directors or to fill any existing vacancies on the Board;
(d)
Any material change in the present capitalization or dividend policy of the Company;
(e)
Any other material change in the Company’s business or corporate structure;
(f)
Changes in the Company’s charter, bylaws or instruments corresponding thereto or other actions which may impede the
acquisition of control of the Company by any person;
(g)
Causing a class of securities of the Company to be delisted from a national securities exchange or cease to be authorized
to be quoted in an inter-dealer quotation system of a registered national securities association;
(h)
A class of equity securities in the Company becoming eligible for termination of registration pursuant to Section 12(g)(4)
of the Securities Exchange Act of 1934, as amended; or
(i)
Any action similar to any of those enumerated above.
CUSIP No. 75952 R 100
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13D
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ITEM 5. Interest in Securities of the Issuer.
Under the rules and regulations of the Securities
and Exchange Commission, Mr. Montgomery may be deemed to be the beneficial owner of a total of 508,020 shares of Common Stock of
the Company, representing approximately 27.53% of the issued and outstanding shares of Common Stock.
The percentage of outstanding shares of Common
Stock of the Company set out in the preceding paragraph is computed based on a total of 1,845,160 shares of Common Stock outstanding
as of January 31, 2017.
During the past 60 days, Mr. Montgomery has
not purchased any shares of Common Stock of the Company.
ITEM 6. Contracts, Arrangements,
Understandings or Relationships With Respect to Securities of the Issuer.
Mr. Montgomery is not a party to any contract,
arrangement, understanding or relationship with any other person with respect to shares of Common Stock, including but not limited
to transfer or voting of any of the securities, finder’s fees, joint ventures, loan or option arrangement, puts or calls,
guarantees of profits, divisions of profits or loss, or the giving or withholding of proxies.
ITEM 7. Material to be Filed as Exhibits.
Not applicable.
Signature
After reasonable inquiry and to the best of my knowledge and
belief, I certify that the information set forth in this statement is true, complete and correct.
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January 31, 2017
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Date
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/s/ Robert L. Montgomery
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Robert L. Montgomery
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