SEC Form 4 · accession 0001415889-17-000267
Medovex Corp. · MDVX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jarrett S Gorlin
Officer — CHIEF EXECUTIVE OFFICER · Director
Period of report
Feb 9, 2017
Accepted (ET)
Feb 14, 2017 · 7:52 pm EST
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,F2,F3,F4 | Feb 9, 2017 | P | 67,307 | $1.04 | A | 617,172 | 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 StockF5,F6,F7 | $1.50 | Feb 9, 2017 | P | 33,654 | A | Feb 9, 2017 | Feb 9, 2022 | Common Stock | 33,654 | 95,968 | D |
Explanation of responses
- F1The shares were purchased as part of a private placement unit offering for $1.04 per unit, each unit consisting of one share of common stock and one-half of a warrant to purchase one share of common stock at an exercise price per share equal to $1.50 per share for a period of five (5) years.
- F2Includes 487,337 shares held by The Jarrett S. & Rebecca L. Gorlin Family Limited Partnership. Mr. Gorlin disclaims beneficial ownership of these shares.
- F3Includes 9,615 shares held by JARRETT GORLIN C/F LOGAN GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares.
- F4Includes 9,615 shares held by JARRETT GORLIN C/F TAYLOR GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares.
- F5The warrants were purchased as part of a private placement unit offering for $1.04 per unit, each unit consisting of one share of common stock and one-half of a warrant to purchase one share of common stock at an exercise price per share equal to $1.50 per share for a period of five (5) years.
- F6Includes 4,808 warrants to purchase shares of common stock held by JARRETT GORLIN C/F LOGAN GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares.
- F7Includes 4,808 warrants to purchase shares of common stock held by JARRETT GORLIN C/F TAYLOR GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares.