SEC Form 4 · accession 0001415889-16-005612
Medovex Corp. · MDVX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Jarrett S Gorlin
Officer — CHIEF EXECUTIVE OFFICER · Director
Period of report
Apr 19, 2016
Accepted (ET)
Apr 21, 2016 · 6:05 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001591165
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Apr 19, 2016 | P | 44,081 | $1.225 | A | 561,118 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant to purchase shares of Common StockF2 | $1.30 | Apr 19, 2016 | P | 22,040 | A | Oct 19, 2016 | Apr 19, 2021 | Common Stock | 22,040 | 62,840 | D |
Explanation of responses
- F1Represents shares held by The Jarrett S. & Rebecca L. Gorlin Family Limited Partnership. Mr. Gorlin disclaims beneficial ownership of these shares.
- F2The Warrant is initially exercisable six months following the date of issuance (04/19/2016) for a period of five (5) years from the date of issuance