SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Isely Zephyr

(Last) (First) (Middle)
C/O NATURAL GROCERS BY VITAMIN COTTAGE
INC. 12612 W. ALAMEDA PARKWAY

(Street)
LAKEWOOD CO 80228

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/24/2012
3. Issuer Name and Ticker or Trading Symbol
Natural Grocers by Vitamin Cottage, Inc. [ NGVC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Co-President
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
Remarks:
Immediately prior to the closing of the issuer's initial public offering, the issuer's existing parent corporation, Vitamin Cottage Natural Food Markets, Inc. ("VC"), will merge with a wholly-owned subsidiary of the issuer resulting in a holding company structure with the issuer becoming the parent of VC. The reporting person currently holds directly only VC shares. All shares of capital stock of VC will be converted into shares of common stock of the issuer at the closing of the merger. The proportionate interests among the existing security holders will not be altered in any material respect in the merger, and the conversion of the securities in the merger is exempt from Section 16(b) pursuant to Rule 16b-7. Exhibit Index Exhibit 24 - Power of Attorney
No securities are beneficially owned.
/s/ Kemper Isely, by Power of Attorney 07/24/2012
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.