0001140361-11-054952.txt : 20111123 0001140361-11-054952.hdr.sgml : 20111123 20111123171810 ACCESSION NUMBER: 0001140361-11-054952 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111122 FILED AS OF DATE: 20111123 DATE AS OF CHANGE: 20111123 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MEDTOX SCIENTIFIC INC CENTRAL INDEX KEY: 0000739944 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 953863205 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 402 WEST COUNTY ROAD D CITY: ST PAUL STATE: MN ZIP: 55112 BUSINESS PHONE: 6126367466 MAIL ADDRESS: STREET 1: 402 WEST COUNTY ROAD D CITY: ST PAUL STATE: MN ZIP: 55112 FORMER COMPANY: FORMER CONFORMED NAME: EDITEK INC DATE OF NAME CHANGE: 19940902 FORMER COMPANY: FORMER CONFORMED NAME: ENVIRONMENTAL DIAGNOSTICS INC DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WIERSMA KEVIN J CENTRAL INDEX KEY: 0001187451 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-11394 FILM NUMBER: 111225949 MAIL ADDRESS: STREET 1: 402 WEST COUNTY RD D CITY: ST PAUL STATE: MN ZIP: 55112 4 1 doc1.xml FORM 4 X0304 4 2011-11-22 0 0000739944 MEDTOX SCIENTIFIC INC MTOX 0001187451 WIERSMA KEVIN J 402 WEST COUNTY ROAD D ST. PAUL MN 55112 0 1 0 0 V.P., COO-Labs, and CFO Common Stock 2011-11-22 4 M 0 9900 6.8485 A 123634 D Common Stock 2011-11-22 4 F 0 4955 13.68 D 118679 D Common Stock 2011-11-22 4 F 0 1844 13.68 D 116835 D Non-Qualified Stock Option (right to buy)\ 6.8485 2011-11-22 4 M 0 9900 13.68 D 2002-01-01 2012-01-01 Common Stock 9900 0 D Kevin J Wiersma 2011-11-22