SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
WIERSMA KEVIN J

(Last) (First) (Middle)
14730 OAK LANE

(Street)
WAYZATA MN 55391

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MEDTOX SCIENTIFIC INC [ TOX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
V.P., COO - Labs, and CFO
3. Date of Earliest Transaction (Month/Day/Year)
08/05/2005
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/05/2005 A 61(1) A $7.1 22,143 D
Common Stock 08/05/2005 A 4,352(1) A $7.33 26,495 D
Restricted Stock 20,805 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Incentive Stock Option (right to buy) $1.5 04/16/1999(2) 04/16/2009 Common Stock 22,917 22,917 D
Incentive Stock Option (right to buy) $4.2545 05/01/2001(2) 05/01/2011 Common Stock 21,999 21,999 D
Incentive Stock Option (right to buy) $6.5796 11/01/2000(2) 11/01/2010 Common Stock 18,333 18,333 D
Non-Qualified Stock Option (right to buy) $3.7 09/11/2003 12/31/2013 Common Stock 30,000 30,000 D
Non-Qualified Stock Option (right to buy) $3.9545 08/13/1999(2) 08/13/2009 Common Stock 9,168 9,168 D
Non-Qualified Stock Option (right to buy) $4.4067 01/01/2003(2) 01/01/2013 Common Stock 15,000 15,000 D
Non-Qualified Stock Option (right to buy) $4.7727 03/01/1998(2) 03/01/2008 Common Stock 9,168 9,168 D
Non-Qualified Stock Option (right to buy) $6.8485 01/01/2002(2) 01/01/2012 Common Stock 9,900 9,900 D
Explanation of Responses:
1. Shares are attributable to a performance based non-qualified deferred compensation plan investment with three year vesting and subject to a substantial risk of forfeiture. Shares have been acquired either in a private transaction or in the open market and are exempt under Rule 16b-3.
2. Options vest daily beginning on DATE EXERCISABLE and continue vesting over a 3 year period.
Kevin J. Wiersma 08/09/2005
** 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 4 (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.
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