0001213900-12-003614.txt : 20120702
0001213900-12-003614.hdr.sgml : 20120702
20120702185606
ACCESSION NUMBER: 0001213900-12-003614
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120629
FILED AS OF DATE: 20120702
DATE AS OF CHANGE: 20120702
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hariri Robert J
CENTRAL INDEX KEY: 0001398815
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53298
FILM NUMBER: 12941649
MAIL ADDRESS:
STREET 1: 341 MENDHAM ROAD
CITY: BERNARDSVILLE
STATE: NJ
ZIP: 07924
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: MYOS Corp
CENTRAL INDEX KEY: 0001402479
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-MISCELLANEOUS RETAIL [5900]
IRS NUMBER: 208758875
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 45 HORSEHILL ROAD
STREET 2: SUITE 106
CITY: CEDAR KNOLLS
STATE: NJ
ZIP: 07927
BUSINESS PHONE: 973-509-0444
MAIL ADDRESS:
STREET 1: 45 HORSEHILL ROAD
STREET 2: SUITE 106
CITY: CEDAR KNOLLS
STATE: NJ
ZIP: 07927
FORMER COMPANY:
FORMER CONFORMED NAME: Atlas Therapeutics Corp
DATE OF NAME CHANGE: 20100719
FORMER COMPANY:
FORMER CONFORMED NAME: Rough Tide Marine Operations, Inc.
DATE OF NAME CHANGE: 20100528
FORMER COMPANY:
FORMER CONFORMED NAME: Marvin's Place, Inc.
DATE OF NAME CHANGE: 20070608
4
1
f4062912hariri_myos.xml
OWNERSHIP DOCUMENT
X0306
4
2012-06-29
0
0001402479
MYOS Corp
MYOS
0001398815
Hariri Robert J
C/O MYOS CORPORATION
45 HORSEHILL ROAD, SUITE 106
CEDAR KNOLLS
NJ
07927
1
0
1
0
Common Stock
2012-06-29
4
C
0
828375
0.20
A
9378375
D
Common Stock
2012-06-29
4
J
0
507306
0.20
A
9885681
D
18% Convertible Promissory Note
0.20
2012-06-29
4
C
0
150000
0
D
2011-11-29
Common Stock
150000
0
D
Reflects the conversion of the 18% Convertible Promissory Note in the amount of $150,000 (including accrued interest) issued to the reporting person in November 2011 into shares of common stock at a conversion price of $0.20 per share.
Reflects the exchange of outstanding debt in the amount of $99,500 (including accrued interest) due to the reporting person for shares of common stock at a conversion price equal to $0.20 per share.
The 18% Convertible Promissory Note is due at the earlier of (i) May 29, 2012 and (ii) the consummation by the Company of a debt or equity financing in excess of $2,000,000.
/s/ Robert Hariri
2012-07-02