SEC Form 4 · accession 0001019687-15-004023
Medytox Solutions, Inc. · MMMS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
William Forhan
10% Owner
Period of report
Nov 2, 2015
Accepted (ET)
Nov 12, 2015 · 8:08 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001374536
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Nov 2, 2015 | D | 1,241,551 | — | D | 0 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Options to Purchase Common StockF2 | $2.50 | Nov 2, 2015 | D | 1,000,000 | D | Oct 1, 2012 | Aug 31, 2016 | Common Stock | 1,000,000 | 0 | D |
| Options to Purchase Common StockF2 | $5.00 | Nov 2, 2015 | D | 1,000,000 | D | Oct 1, 2012 | Aug 31, 2016 | Common Stock | 1,000,000 | 0 | D |
| Options to Purchase Common StockF2 | $10.00 | Nov 2, 2015 | D | 1,000,000 | D | Oct 1, 2012 | Aug 31, 2016 | Common Stock | 1,000,000 | 0 | D |
Explanation of responses
- F1Disposed of pursuant to merger agreement among Medytox Solutions, Inc. ("Medytox"), CollabRx Merger Sub, Inc. ("Merger Sub") and Rennova Health, Inc. ("Rennova") (f/k/a/ CollabRx, Inc.) in exchange for 508,587 shares of Rennova common stock.
- F2Cancelled pursuant to merger agreement and related transactions among Medytox , Merger Sub and Rennova.