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