Statement of Changes in Beneficial Ownership (4)
November 13 2014 - 3:34PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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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1. Name and Address of Reporting Person
*
Ivany Derek
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2. Issuer Name
and
Ticker or Trading Symbol
Myriad Interactive Media, Inc.
[
MYRY
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CEO, CFO
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(Last)
(First)
(Middle)
7 INGRAM DRIVE SUITE 128
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3. Date of Earliest Transaction
(MM/DD/YYYY)
1/13/2014
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(Street)
TORONTO, A6 M6M 2L7
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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1/10/2014
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J
(1)
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1729730
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A
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$0
(1)
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7841750
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I
(2)
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SyzyGy Creations, LLC
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Common Stock
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2/21/2014
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A
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3862400
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A
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$0
(3)
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11704150
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I
(3)
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SyzyGy Creations, LLC
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Common Stock
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7/29/2014
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S
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300000
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D
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$0.01
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11404150
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D
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Common Stock
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7/29/2014
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S
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73000
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D
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$0.01
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11331150
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D
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Common Stock
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7/29/2014
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S
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27000
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D
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$0.0103
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11304150
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D
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Common Stock
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7/30/2014
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S
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250000
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D
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$0.0105
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11054150
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D
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Common Stock
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7/30/2014
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S
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103000
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D
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$0.0105
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10951150
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D
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Common Stock
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7/30/2014
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S
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47000
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D
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$0.0106
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10904150
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D
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Common Stock
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7/31/2014
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S
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178400
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D
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$0.0116
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10725750
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D
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Common Stock
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7/31/2014
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S
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121600
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D
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$0.01
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10604150
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D
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Common Stock
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10/21/2014
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P
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435000
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A
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$0.0033
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11039150
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D
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Common Stock
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10/21/2014
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P
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333150
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A
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$0.0034
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11372300
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D
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Common Stock
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10/21/2014
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P
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160000
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A
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$0.003
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11532300
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D
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Common Stock
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10/21/2014
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P
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36850
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A
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$0.0034
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11569150
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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On October 18, 2007, the Issuer adopted its 2007 Stock Option Plan (the "Plan"). On July 25, 2008 the sale of all shares issuable upon exercise of options granted under the Plan was registered with the United States Securities and Exchange Commission (the "Commission") under a Registration Statement on Form S-8 (the "Registration Statement"). The Registration Statement became effective upon filing on July 25, 2008. On July 24, 2013, pursuant to the terms of the Plan, the Company granted Derek Ivany options to purchase 3,000,000 shares of the common stock in the Company at a price of $0.005 per share. On January 10, 2014, Mr. Ivany elected to make a cashless exercise of 2,000,000 of these options. Pursuant to Mr. Ivany's notice of cashless exercise, the Shares were issued to him on January 14, 2014 on certificate no. 2076. Due to their registration as part of the Plan on Form S-8, the Shares do not bear a restrictive legend.
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(
2)
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On May 5, 2014, the Reporting Person transferred the Shares to Syzygy Creations, LLC. The Reporting Person is the Managing Member of Syzygy Creations, LLC.
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(
3)
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On February 21, 2014, pursuant to an agreement with the Reporting Person, the Issuer owed the Reporting Person $96,560 in accrued consulting fees. The Issuer's Board of Directors approve the issuance of 3,862,400 shares of its common stock in full payment and satisfaction of the compensation due and owing. Further, the Reporting Person directed to have the shares issued in the name of Syzygy Creations, LLC.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Ivany Derek
7 INGRAM DRIVE SUITE 128
TORONTO, A6 M6M 2L7
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X
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X
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CEO, CFO
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Signatures
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/s/ Derek Ivany
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11/12/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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