FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
OPHTHALMIC IMAGING SYSTEMS [ OISI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 05/26/2010 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 05/26/2010 | P | 3,581,089 | A | (1) | 13,338,603 | D(2)(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | $1 | 05/26/2010 | P | 1,193,696 | (4) | 06/23/2012 | Common Stock | 1,193,696 | (1) | 1,193,696 | D(2)(3) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
|
Explanation of Responses: |
1. On May 26, 2010, Ophthalmic Imaging Systems, a California corporation (the "Company"), issued and sold to U.M. AccelMed, Limited Partnership, an Israeli limited partnership ("AccelMed"), 3,581,089 shares of the Company's common stock, no par value, and a warrant to purchase up to 1,193,696 shares of common stock, for an aggregate purchase price of $1,999,967. |
2. These securities are owned directly by AccelMed and indirectly by A.M. AccelMed Management (2009) Ltd., the general partner of AccelMed (the "General Partner"), M. Arkin (1999) Ltd ("M. Arkin (1999)"), the beneficial owner of 80% of the outstanding shares of the General Partner, and Moshe Arkin, the sole director and the beneficial owner of 99.9% of the outstanding shares of M. Arkin (1999). |
3. The filing of this Form 4 shall not be construed as an admission that the General Partner, M. Arkin (1999) or Mr. Arkin is or was for the purposes of Section 16(a) of the Securities Exchange Act of 1934, as amended, the beneficial owner of any of the shares of common stock of the Company owned by AccelMed. Pursuant to Rule 16a-1, each of the General Partner, M. Arkin (1999) and Mr. Arkin disclaim beneficial ownership of the shares of the Company reported herein that are beneficially owned by AccelMed, except to the extent of their pecuniary interest therein. |
4. This warrant may be exercised beginning on the earliest of the following: (i) the date that the Company consummates a merger with and into another corporation or the date the Company consummates a sale, transfer or other disposition of all or substantially all of its assets, (ii) the date that the average closing price per share of the Company's common stock on the OTC Bulletin Board (or wherever the Company's common stock is listed or quoted for trading on the date in question) for 10 consecutive trading days exceeds $2.00, (iii) the date the Company's Board of Directors offers a transaction pursuant to which the Company will raise at least $1.5 million in a capital raising transaction with persons who are shareholders of MediVision Medical Imaging Ltd. (a large shareholder of the Company), and (iv) March 23, 2012. |
Remarks: |
/s/ U.M. AccelMed, Limited Partnership, By: A.M. Management (2009) Ltd., By: M. Arkin (1999) Ltd., By: Moshe Arkin | 06/10/2010 | |
/s/ A.M. Management (2009) Ltd., By: M. Arkin (1999) Ltd., By: Moshe Arkin | 06/10/2010 | |
/s/ M. Arkin (1999) Ltd., By Moshe Arkin | 06/10/2010 | |
/s/ Moshe Arkin | 06/10/2010 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |