0001019687-15-001603.txt : 20150424
0001019687-15-001603.hdr.sgml : 20150424
20150424165309
ACCESSION NUMBER: 0001019687-15-001603
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121001
FILED AS OF DATE: 20150424
DATE AS OF CHANGE: 20150424
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Medytox Solutions, Inc.
CENTRAL INDEX KEY: 0001374536
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-TESTING LABORATORIES [8734]
IRS NUMBER: 900902741
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 400 S. AUSTRALIAN AVENUE, SUITE 800
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
BUSINESS PHONE: 561-855-1626
MAIL ADDRESS:
STREET 1: 400 S. AUSTRALIAN AVENUE, SUITE 800
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
FORMER COMPANY:
FORMER CONFORMED NAME: CASINO PLAYERS, INC.
DATE OF NAME CHANGE: 20060905
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FORHAN WILLIAM
CENTRAL INDEX KEY: 0001274239
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54346
FILM NUMBER: 15792368
MAIL ADDRESS:
STREET 1: 400 SOUTH AUSTRALIAN AVENUE
STREET 2: 8TH FLOOR
CITY: WEST PALM BEACH
STATE: X1
ZIP: 33401
4
1
forhan_f4-042415.xml
FORM 4
X0306
4
2012-10-01
0
0001374536
Medytox Solutions, Inc.
MMMS
0001274239
FORHAN WILLIAM
400 S. AUSTRALIAN AVENUE, SUITE 800
WEST PALM BEACH
FL
33401
1
1
1
0
CEO and Chairman
Common Stock
2012-12-27
2012-12-27
4
J
0
4449975
D
2500025
D
Common Stock
2012-12-28
2012-12-28
4
G
0
100000
0
D
2400025
D
Common Stock
2013-12-31
2013-12-31
4
J
0
53076
A
2453101
D
Restricted Stock
2014-03-13
2014-03-13
4
A
0
30000
0
A
2483101
D
Common Stock
2014-09-11
2014-09-11
4
J
0
1241550
.0001
D
1241551
D
Series C Preferred Stock
2012-12-27
2012-12-27
4
J
0
261147
A
261147
D
Series C Preferred Stock
2013-12-31
2013-12-31
4
J
0
261147
D
0
D
Options to Purchase Common Stock
2.50
2012-10-01
4
A
0
1000000
0
A
2012-10-01
2017-12-21
Common Stock
1000000
1000000
D
Options to Purchase Common Stock
5.00
2012-10-01
4
A
0
1000000
0
A
2012-10-01
2017-12-31
Common Stock
1000000
1000000
D
Options to Purchase Common Stock
10.00
2012-10-01
4
A
0
1000000
0
A
2012-10-01
2022-12-31
Common Stock
1000000
1000000
D
Represents shares of Common Stock cancelled by the Issuer and the issuance by Issuer of shares of Series C Preferred Stock.
Represents shares of Common Stock issued upon conversion of shares of Series C Preferred Stock, pursuant to the terms of the Series C Preferred Stock
Represents options to purchase shares of Common Stock granted in connection with the Reporting Person entering into an employment agreement with the Issuer. Pursuant to the terms of the Agreement for the Retirement as CEO and Release of any and all Claims, effective September 11, 2014, by and between the Issuer and the Reporting Person, the expiration date of the options was changed to August 31, 2016. The Reporting Person ceased serving as the Issuer's CEO and Chairman as of September 11, 2014.
Pursuant to the terms of the Agreement for the Retirement as CEO and Release of any and all Claims, effective September 11, 2014, by and between the Issuer and the Reporting Person, the Reporting Person agreed to the cancellation of 1,241,550 shares of the Issuer's Common Stock. The value ascribed to the cancellation of such shares was the par value thereof.
/s/ William G. Forhan
2015-04-24