Amended Statement of Ownership (sc 13g/a)
December 26 2019 - 4:31PM
Edgar (US Regulatory)
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
SCHEDULE
13G/A
Under
the Securities Exchange Act of 1934
(Amendment
No. 1)
(Rule
13d-102)
INFORMATION
TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b), (c) AND (d) AND
AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(b)
Under
the Securities Exchange Act of 1934
WIZE
PHARMA, INC.
|
(Name
of Issuer)
|
|
Common
Stock, NIS 0.001 par value
|
(Title
of Class of Securities)
|
|
97751M207
|
(CUSIP
Number)
|
|
December
20, 2019
|
(Date
of Event Which Requires Filing of this Statement)
|
Check
the appropriate box to designate the rule pursuant to which this Schedule is filed:
|
☐
|
Rule 13d-1(b)
|
|
|
|
|
☒
|
Rule 13d-1(c)
|
|
|
|
|
☐
|
Rule 13d-1(d)
|
*
The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to
the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided
in a prior cover page.
The
information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section
18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the Notes).
1
|
Name
of Reporting Persons/
I.R.S. Identification Nos. of above persons (entities only).
Jonathan
Rubini
|
2
|
Check
the Appropriate Box if a Member of a Group
(a)
☐
(b)
☐
|
3
|
SEC
Use only
|
4
|
Citizenship
or Place of Organization
United
States
|
Number
of
Shares
|
5
|
Sole
Voting Power
2,714,776
(1)
|
Beneficially
Owned by
Each
|
6
|
Shared
Voting Power
0
|
Reporting
Person With:
|
7
|
Sole
Dispositive Power
2,714,776
(1)
|
|
8
|
Shared
Dispositive Power
0
|
9
|
Aggregate
Amount Beneficially Owned by Each Reporting Person
2,714,776
(1)
|
10
|
Check
if the Aggregate Amount in Row (9) Excludes Certain Shares ☐
|
11
|
Percent
of Class Represented by Amount in Row (9)
16.82%(2)
|
12
|
Type
of Reporting Person :
IN
|
|
|
|
|
|
(1)
|
Includes
2,455,739 shares of common stock and 259,037 shares of common stock issuable upon warrants exercisable within 60 days. Does not
include an aggregate of 4,602,074 shares of common stock issuable upon conversion of Series A Preferred Stock or exercisable of
warrants that are either subject to an ownership blocker or not exercisable within 60 days.
|
|
(2)
|
Based
on 15,885,628 shares of Common Stock outstanding as of December 23, 2019 and 259,037 shares of common stock issuable upon the
exercise of warrants held by Mr. Rubini within 60 days of the date hereof.
|
Item
1.
(a)
|
Name
of Issuer: WIZE PHARMA, INC. (the "Issuer").
|
|
|
(b)
|
Address
of Issuer’s Principal Executive Offices:
24 Hanagar Street, Hod Hasharon, Israel 4527708
|
Item
2.
(a)
|
Name
of Person Filing:
|
This
Statement is filed by:
(1)
Jonathan Rubini
The
foregoing is referred to as the "Reporting Person" in this Statement.
(b)
|
Address
of Principal Business Offices or, if none, Residence:
|
Jonathan
Rubini – 813 D Street Anchorage, Alaska 99501
(c)
|
Place
of Organization:
|
Not
applicable.
(d)
|
Title
of Class of Securities:
|
Common
Stock, $0.001 par value (the “Common Stock”).
97751M207
Item
3.
|
If
this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b) or (c), check whether the person filing is a:
|
Not
applicable.
See
items 5-11 of the cover pages hereto for beneficial ownership, percentage of class and dispositive power of the Reporting Person.
Item
5.
|
Ownership
of 5 Percent or Less of a Class
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the
beneficial owner of more than 5 percent of the class of securities, check the following [ ].
|
Item
6.
|
Ownership
of More than 5 Percent on Behalf of Another Person
Not applicable.
|
Item
7.
|
Identification
and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control
Person
Not applicable.
|
|
Item
8.
|
Identification
and Classification of Members of the Group
Not applicable.
|
Item
9.
|
Notice
of Dissolution of Group
|
Not applicable.
By
signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are
not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were
not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
SIGNATURES
After
reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true,
complete and correct.
December
26, 2019
|
/s/ Jonathan
Rubini
|
|
Jonathan
Rubini
|
4