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