0001104659-23-057158.txt : 20230508 0001104659-23-057158.hdr.sgml : 20230508 20230508161205 ACCESSION NUMBER: 0001104659-23-057158 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230504 FILED AS OF DATE: 20230508 DATE AS OF CHANGE: 20230508 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KAPLAN JON H. CENTRAL INDEX KEY: 0001751699 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37704 FILM NUMBER: 23897864 MAIL ADDRESS: STREET 1: 1573 MALLORY LANE STREET 2: SUITE 100 CITY: BRENTWOOD STATE: TN ZIP: 37027 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DarioHealth Corp. CENTRAL INDEX KEY: 0001533998 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 452973162 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 18 W 18TH ST., 5TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10011 BUSINESS PHONE: 646.665.4667 MAIL ADDRESS: STREET 1: 18 W 18TH ST., 5TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10011 FORMER COMPANY: FORMER CONFORMED NAME: LabStyle Innovations Corp. DATE OF NAME CHANGE: 20111101 4 1 tm2315002-2_4seq1.xml OWNERSHIP DOCUMENT X0407 4 2023-05-04 0 0001533998 DarioHealth Corp. DRIO 0001751699 KAPLAN JON H. 18 W. 18TH ST, 5TH FLOOR NEW YORK NY 10011 1 0 0 0 0 Series B-2 Preferred Stock 3.37 2023-05-04 4 P 0 30 1000 A 2023-05-04 2026-05-04 Common Stock 30 D The Series B Preferred Stock will automatically convert into shares of common stock, subject to certain beneficial ownership limitations, including a non-waivable 19.99% ownership blocker, on the 15-month anniversary of the issuance date. The Series B Preferred Stock initially converts into shares of common stock at a conversion price of $3.37. In addition, the holders of Series B Preferred Stock will also be entitled dividends payable as follows: (i) a number of shares of Common Stock equal to five percent (5.0%) of the number of shares of Common Stock issuable upon conversion of the Series B Preferred Stock then held by such holder for each full quarter anniversary of holding for a total of four (4) quarters from the closing date, and (ii) a number of shares of common stock equal to ten percent (10%) of the number of shares of common stock issuable upon conversion of the Series B Preferred Stock then held by such holder on the fifth full quarter from the closing date. /s/ Jon Kaplan 2023-05-08