Initial Statement of Beneficial Ownership (3)
March 09 2020 - 4:06PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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STERN ADAM K |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/1/2020
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3. Issuer Name and Ticker or Trading Symbol
DarioHealth Corp. [DRIO]
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(Last)
(First)
(Middle)
8 HATOKHEN STREET |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Street)
CAESAREA, L3 3088900
(City)
(State)
(Zip)
| 5. 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
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common Stock | 2000 | I | AKS Family Foundation, Inc. |
| Common Stock | 15000 | I | AKS Family Partners |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Series A Preferred Stock | 11/27/2019 | (1) | Common Stock | 74100 | $4.05 | I | AKS Family Partners |
| Common Stock Warrant | 12/19/2019 | 12/19/2024 | Common Stock | 253911 | $4.05 | D | |
| Common Stock Warrant | 12/19/2019 | 12/19/2024 | Common Stock | 25676 | $4.28 | D | |
| Common Stock Warrant | 12/19/2019 | 12/19/2024 | Common Stock | 10086 | $4.98 | D | |
| Common Stock Warrant | 12/19/2019 | 12/19/2024 | Common Stock | 1525 | $5.90 | D | |
| Explanation of Responses: |
| (1) | Subject to beneficial ownership limitations provided for in the offering documents relating to the sale of the Series A Preferred Stock, each share of Series A Preferred Stock shall automatically convert into shares of the registrant's common stock at the conversion price upon the earlier of (i) the 36-month anniversary of the effective date of the certificate of designation (which was November 27, 2019), or (ii) the consent to conversion by holders of at least 50.1% of the outstanding shares of Series A Preferred. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
STERN ADAM K
8 HATOKHEN STREET
CAESAREA, L3 3088900 | X |
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Signatures
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| /s/ Adam Stern | | 3/9/2020 |
| **Signature of Reporting Person | Date |
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