0001178913-17-001782.txt : 20170609 0001178913-17-001782.hdr.sgml : 20170609 20170609112100 ACCESSION NUMBER: 0001178913-17-001782 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170601 FILED AS OF DATE: 20170609 DATE AS OF CHANGE: 20170609 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: SCHWARTZ REVAN CENTRAL INDEX KEY: 0001690043 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-54785 FILM NUMBER: 17901895 MAIL ADDRESS: STREET 1: 19 HA'YAHALOMIM ST., P.O. BOX 12163 STREET 2: C/O INTEGRITY APPLICATIONS, INC. CITY: ASHDOD STATE: L3 ZIP: 7760049 4/A 1 a1720119.xml OWNERSHIP DOCUMENT X0306 4/A 2017-06-01 2017-06-06 0 0001506983 Integrity Applications, Inc. IGAP 0001690043 SCHWARTZ REVAN 19 HA'YAHALOMIM ST., P.O. BOX 12163 C/O INTEGRITY APPLICATIONS, INC. ASHDOD L3 7760049 ISRAEL 1 0 0 0 Restricted Stock Units 0 2017-06-01 4 A 0 22727 0 A 2018-06-01 Common Stock, par value $0.001 per share 22727 22727 D The restricted stock units do not have a conversion or exercise price. The reporting person's original Form 4 included a conversion price of $1.98. The restricted stock units are scheduled to vest on June 1, 2018, assuming continued service as a director through and on such date. After June 1, 2018, the common stock underlying the restricted stock units may be issued on such date as the reporting person elects or upon termination of their service with the Issuer. /s/ Revan Schwartz 2017-06-09