Initial Statement of Beneficial Ownership (3)
16 March 2018 - 2:11AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
BORUFF SCOTT M
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/13/2018
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3. Issuer Name
and
Ticker or Trading Symbol
GRASSHOPPER STAFFING, INC. [TCKF]
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(Last)
(First)
(Middle)
3847 RIVER VISTA WAY
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
___
X
___ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Chief Executive Officer /
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(Street)
LOUISVILLE, TN 37777
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, par value $0.001
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11664854
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I
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See Note
(1)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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The shares of common stock of Grasshopper Staffing, Inc. report in Table 1 of this Form 3 are held of record by Platinum Equity Advisors, LLC ("Platinum Equity"). Mr. Boruff is the Manager of Platinum Equity. In his position as Manager of Platinum Equity, Mr. Boruff has shared right to direct the vote and disposition of securities owned by Platinum Equity. Mr. Boruff disclaims beneficial ownership of the reported shares of common stock except to the extent of his pecuniary interest therein, and the inclusion of such shares in this Form 3 shall not be deemed an admission of beneficial ownership of all of the reported shares for any purpose.
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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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BORUFF SCOTT M
3847 RIVER VISTA WAY
LOUISVILLE, TN 37777
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X
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X
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Chief Executive Officer
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Signatures
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Scott M. Boruff
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3/14/2018
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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 5(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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