UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Epizon Ltd. SUITE 104A, SAFFREY SQUARE, BANK LANE PO BOX N-9306 NASSAU, C5 000000 |
X | |||
The Shanovan Trust SUITE 104A, SAFFREY SQUARE, BANK LANE PO BOX N-9306 NASSAU, BAHAMAS, C5 000000 |
X |
Epizon Ltd., By: /s/ P. Wilhelm F. Toothe, trustee of The Shanoven Trust | 01/11/2016 | |
**Signature of Reporting Person | Date | |
The Shanoven Trust, By: /s/ P. Wilhelm F. Toothe, trustee | 01/11/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Received in connection with the merger transaction with Medytox Solutions, Inc. ("Medytox"), in exchange for 4,600,000 shares of Medytox common stock, based upon an exchange ratio of 0.4096377408003329 per share. |
(2) | Received in connection with the merger transaction with Medytox in exchange for 1,000 shares of Medytox Series B Preferred Stock. |
Remarks: Exhibit List - Exhibit 99 - Joint Filer Information |