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