Statement of Changes in Beneficial Ownership (4)
November 15 2017 - 4:06PM
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).
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
Kamer Allen
|
2. Issuer Name
and
Ticker or Trading Symbol
DarioHealth Corp.
[
DRIO
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
|
(Last)
(First)
(Middle)
9 HALAMISH STREET
|
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/13/2017
|
(Street)
CAESAREA INDUSTRIAL PARK, L3 3088900
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security
(Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code
(Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
|
7. Nature of Indirect Beneficial Ownership (Instr. 4)
|
Code
|
V
|
Amount
|
(A) or (D)
|
Price
|
Common Stock
|
11/13/2017
|
|
A
|
|
496031
(1)
|
A
|
$0
|
1388889
(1)
|
I
|
See Footnote
(1)
|
Common Stock
|
|
|
|
|
|
|
|
6639
|
D
|
|
Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 3)
|
2. Conversion or Exercise Price of Derivative Security
|
3. Trans. Date
|
3A. Deemed Execution Date, if any
|
4. Trans. Code
(Instr. 8)
|
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
6. Date Exercisable and Expiration Date
|
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
|
8. Price of Derivative Security
(Instr. 5)
|
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
|
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
|
11. Nature of Indirect Beneficial Ownership (Instr. 4)
|
Code
|
V
|
(A)
|
(D)
|
Date Exercisable
|
Expiration Date
|
Title
|
Amount or Number of Shares
|
Warrant to purchase Common Stock
|
$3.50
|
11/13/2017
|
|
J
|
|
|
892858
|
7/10/2017
|
1/9/2022
|
Common Stock
|
892858
|
$0
|
0
|
I
|
See Footnote
(1)
|
Explanation of Responses:
|
(1)
|
On November 13, 2017, DarioHealth Corp. (the "Company") and OurCrowd Digital Health L.P. ("OurCrowd") entered into a warrant exchange agreement whereby OurCrowd agreed to surrender a warrant to purchase 892,858 shares of the Company's common stock in exchange for 496,031 restricted shares of the Company's common stock. The amounts shown represent the beneficial ownership or the issuer's securities by OurCrowd, which may be deemed attributable to Mr. Kamer because Mr. Kamer is a Managing Partner of OurCrowd. Mr. Kamer disclaims beneficial ownership of the securities set forth herein except to the extent of their pecuniary interest therein.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
Kamer Allen
9 HALAMISH STREET
CAESAREA INDUSTRIAL PARK, L3 3088900
|
X
|
X
|
|
|
Signatures
|
/s/ Allen Kamer
|
|
11/15/2017
|
**
Signature of Reporting Person
|
Date
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
|
*
|
If the form is filed by more than one reporting person,
see
Instruction 4(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).
|
Note:
|
File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
|
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.
|
DarioHealth (NASDAQ:DRIO)
Historical Stock Chart
From Aug 2024 to Sep 2024
DarioHealth (NASDAQ:DRIO)
Historical Stock Chart
From Sep 2023 to Sep 2024