0001178913-17-001121.txt : 20170414
0001178913-17-001121.hdr.sgml : 20170414
20170414162049
ACCESSION NUMBER: 0001178913-17-001121
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170413
FILED AS OF DATE: 20170414
DATE AS OF CHANGE: 20170414
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Integrity Applications, Inc.
CENTRAL INDEX KEY: 0001506983
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 980668934
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 19 HA'YAHALOMIM ST
STREET 2: P.O. BOX 12163
CITY: ASHDOD
STATE: L3
ZIP: L3 7760049
BUSINESS PHONE: 972 (8) 675-7878
MAIL ADDRESS:
STREET 1: 19 HA'YAHALOMIM ST
STREET 2: P.O. BOX 12163
CITY: ASHDOD
STATE: L3
ZIP: L3 7760049
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Malka David
CENTRAL INDEX KEY: 0001556758
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54785
FILM NUMBER: 17763005
MAIL ADDRESS:
STREET 1: C/O INTEGRITY APPLICATIONS, INC.
STREET 2: 102 HA'AVODA STREET, P.O. BOX 432
CITY: ASHKELON
STATE: L3
ZIP: L3 78100
4
1
zk1719817.xml
OWNERSHIP DOCUMENT
X0306
4
2017-04-13
0
0001506983
Integrity Applications, Inc.
IGAP
0001556758
Malka David
C/O INTEGRITY APPLICATIONS, INC.
19 HA'YAHALOMIM ST. P.O. BOX 12163
ASHDOD
L3
7760049
ISRAEL
0
1
0
0
Vice President of Operations
Option (Right to Buy)
4.50
2017-04-13
4
A
0
361875
0
A
2027-04-13
Common Stock, par value $0.001 per share
361875
361875
D
Option (Right to Buy)
7.75
2017-04-13
4
A
0
266617
0
A
2027-04-13
Common Stock, par value $0.001 per share
266617
266617
D
Option (Right to Buy)
4.50
2017-04-13
4
A
0
25000
0
A
Common Stock, par value $0.001 per share
25000
25000
D
On a fully diluted basis.
The options shall vest over a three-year period commencing on April 13, 2017.
The option shall vest 50% upon CFDA approval and 50% upon FDA approval.
Pursuant to the employment agreement entered into by the Company's wholly owned subsidiary, A.D. Integrity Applications Ltd. and the Reporting Person, the grant of the options to purchase common stock is subject to the Company reaching certain corporate development milestones.
The option shall vest over a three year period beginning on the date of grant as set forth in Note 4.
The option shall expire upon the ten (10) year anniversary of the date of grant as set forth in Note 4.
/s/ David Malka
2017-04-14