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