Initial Statement of Beneficial Ownership (3)
November 09 2016 - 4:03PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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
*
Accelmed Growth Partners, L.P.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
11/3/2016
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3. Issuer Name
and
Ticker or Trading Symbol
COGENTIX MEDICAL INC /DE/ [CGNT]
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(Last)
(First)
(Middle)
6 HACHOCHLIM STREET, 6TH FLOOR
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
HERZLIYA PITUACH, L3 46120
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $0.01 par value per share
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16129033
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D
(1)
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Common Stock, $0.01 par value per share
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16129033
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I
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By: Accelmed Growth Partners (GP), L.P.
(1)
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Common Stock, $0.01 par value per share
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16129033
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I
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By: Accelmed Growth Partners (AGP) Ltd.
(1)
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Common Stock, $0.01 par value per share
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16129033
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I
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By: Accelmed Growth Partners Management Ltd.
(1)
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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These shares are held directly by Accelmed Growth Partners, L.P. and may be deemed to be beneficially owned indirectly by (i) Accelmed Growth Partners (GP), L.P., the general partner of Accelmed Growth Partners, L.P., (ii) Accelmed Growth Partners (AGP) Limited, the general partner of Accelmed Growth Partners (GP), L.P., and (iii) Accelmed Growth Partners Management Ltd., which has certain voting and dispositive power over the shares pursuant to a management agreement. Each of Accelmed Growth Partners (GP), L.P., Accelmed Growth Partners (AGP) Limited, and Accelmed Growth Partners Management Ltd. disclaims such beneficial ownership except to the extent of its pecuniary interest in the shares.
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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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Accelmed Growth Partners, L.P.
6 HACHOCHLIM STREET, 6TH FLOOR
HERZLIYA PITUACH, L3 46120
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X
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Accelmed Growth Partners (GP), L.P.
6 HACHOCHLIM STREET, 6TH FLOOR
HERZLIYA PITUACH, L3 46120
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X
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Accelmed Growth Partners (AGP) Ltd
6 HACHOCHLIM STREET, 6TH FLOOR
HERZLIYA PITUACH, L3 46120
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X
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Accelmed Growth Partners Management Ltd.
6 HACHOCHLIM STREET, 6TH FLOOR
HERZLIYA PITUACH, L3 46120
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X
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Signatures
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Accelmed Growth Partners, L.P. By: Accelmed Growth Partners (GP), L.P., its general partner By: Accelmed Growth Partners (AGP) Ltd., its general partner By: /s/ Uri Geiger, Managing Partner
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11/9/2016
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**
Signature of Reporting Person
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Date
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Accelmed Growth Partners (GP), L.P. By: Accelmed Growth Partners (AGP) Ltd., it general partner By: /s/ Uri Geiger, Managing Partner
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11/9/2016
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**
Signature of Reporting Person
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Date
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Accelmed Growth Partners (AGP) Ltd. By: /s/ Uri Geiger, Managing Partner
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11/9/2016
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**
Signature of Reporting Person
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Date
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Accelmed Growth Partners Management Ltd. By: /s/ Uri Geiger, Managing Partner
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11/9/2016
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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 5(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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