SEC Form 4 · accession 0001144204-17-036442
DarioHealth Corp. · DRIO
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Erez Raphael
Officer — Chief Executive Officer · Director · 10% Owner
Period of report
Jul 10, 2017
Accepted (ET)
Jul 11, 2017 · 4:10 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001533998
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jul 10, 2017 | A | 17,036 | $0.00 | A | 438,736 | D | |
| Common StockF2 | holding | — | — | — | 757,509 | I | By Dicilyon Consulting and Investment Ltd. |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The reporting person was awarded such securities in exchange for waiving compensation owed for the third quarter of 2017 in the amount of $39,388.96.
- F2The amount shown represents the beneficial ownership of the issuer's securities held by Dicilyon Consulting and Investment Ltd. which may be deemed to be attributable to Mr. Raphael because Mr. Raphael possesses voting and dispositive power over the securities held by Dicilyon Consulting and Investment Ltd. by virtue of a proxy. Mr. Raphael disclaims beneficial ownership of the securities set forth herein.