Statement of Changes in Beneficial Ownership (4)
July 10 2020 - 4:06PM
Edgar (US Regulatory)
FORM 4
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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
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OMB APPROVAL
OMB Number:
3235-0287
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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. Issuer Name and Ticker or Trading Symbol
DarioHealth Corp.
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DRIO
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5. 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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(Last)
(First)
(Middle)
8 HATOKHEN STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/8/2020 |
(Street)
CAESAREA INDUSTRIAL PARK, L3 3088900
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | | | | | | | | 19049 | D | |
Common Stock | | | | | | | | 2500 | I | AKS Family Foundation, Inc. |
Common Stock | | | | | | | | 15500 | 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. 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 |
Common Stock Warrant | $4.05 | 7/8/2020 | | D | | | 253911 (1) | 12/19/2019 | 12/19/2024 | Common Stock | 253911 | $0 (1) | 0 | D | |
Common Stock Warrant | $4.05 | 7/8/2020 | | A | | 231383 (1) | | 12/19/2019 | 12/19/2024 | Common Stock | 231383 | $0 (1) | 231383 | D | |
Common Stock Warrant | $4.28 | 7/8/2020 | | D | | | 25676 (2) | 12/19/2019 | 12/19/2024 | Common Stock | 25676 | $0 (2) | 0 | D | |
Common Stock Warrant | $4.28 | 7/8/2020 | | A | | 22108 (2) | | 12/19/2019 | 12/19/2024 | Common Stock | 22108 | $0 (2) | 22108 | D | |
Common Stock Warrant | $4.98 | 7/8/2020 | | D | | | 10086 (3) | 12/19/2019 | 12/19/2024 | Common Stock | 10086 | $0 (3) | 0 | D | |
Common Stock Warrant | $4.98 | 7/8/2020 | | A | | 36900 (3) | | 12/19/2019 | 12/19/2024 | Common Stock | 36900 | $0 (3) | 36900 | D | |
Common Stock Warrant | $5.90 | 7/8/2020 | | D | | | 1525 (4) | 12/19/2019 | 12/19/2024 | Common Stock | 1525 | $0 (4) | 0 | D | |
Common Stock Warrant | $5.90 | 7/8/2020 | | A | | 807 (4) | | 12/19/2019 | 12/19/2024 | Common Stock | 807 | $0 (4) | 807 | D | |
Common Stock Warrant | $4.05 | 7/8/2020 | | A | | 1593 (5) | | 12/19/2019 | 12/19/2024 | Common Stock | 1593 | $0 (5) | 1593 | D | |
Common Stock Warrant | $4.28 | 7/8/2020 | | A | | 2633 (5) | | 12/19/2019 | 12/19/2024 | Common Stock | 2633 | $0 (5) | 2633 | D | |
Common Stock Warrant | $4.98 | 7/8/2020 | | A | | 1244 (5) | | 12/19/2019 | 12/19/2024 | Common Stock | 1244 | $0 (5) | 1244 | D | |
Explanation of Responses: |
(1) | The two reported transactions involved an amendment of an outstanding common stock warrant pursuant to a transfer of a portion of such warrant with Michael Siek, resulting in the deemed cancellation of the "old" warrant and the issuance of a replacement warrant. The warrant was originally issued on December 19, 2019. |
(2) | The two reported transactions involved an amendment of an outstanding common stock warrant pursuant to a transfer of a portion of the Warrant with Michael Siek, resulting in the deemed cancellation of the "old" warrant and the issuance of a replacement warrant. The warrant was originally issued on December 19, 2019. |
(3) | The two reported transactions involved an amendment of an outstanding pursuant to a transfer of a portion of the Warrant with Michael Siek common stock warrant, resulting in the deemed cancellation of the "old" warrant and the issuance of a replacement warrant. The warrant was originally issued on December 19, 2019. |
(4) | The two reported transactions involved an amendment of an outstanding common stock warrant pursuant to a transfer of a portion of the Warrant with Michael Siek, resulting in the deemed cancellation of the "old" warrant and the issuance of a replacement warrant. The warrant was originally issued on December 19, 2019. |
(5) | The reported transactions involved a transfer of an outstanding common stock warrant from Michael Siek to the reporting person. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
STERN ADAM K 8 HATOKHEN STREET CAESAREA INDUSTRIAL PARK, L3 3088900 | X |
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Signatures
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/s/ Adam Stern | | 7/10/2020 |
**Signature of Reporting Person | Date |
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