SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Weiss Amir

(Last) (First) (Middle)
C/O 124 DVORA HANEVI'A ST.

(Street)
TEL AVIV L3 6944020

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/24/2021
3. Issuer Name and Ticker or Trading Symbol
TEVA PHARMACEUTICAL INDUSTRIES LTD [ TEVA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Accounting Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Ordinary Shares(1) 14,391.41 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Restricted Share Units (2) (2) Ordinary Shares(1) 14,258 (3) D
Restricted Share Units (4) (4) Ordinary Shares(1) 9,657 (3) D
Restricted Share Units (5) (5) Ordinary Shares(1) 4,809 (3) D
Restricted Share Units (6) (6) Ordinary Shares(1) 981 (3) D
Stock Options (right to buy) (7) 03/02/2028 Ordinary Shares(1) 10,002 $19.16 D
Stock Options (right to buy) (8) 03/03/2027 Ordinary Shares(1) 7,755 $34.7 D
Stock Options (right to buy) (9) 03/17/2026 Ordinary Shares(1) 5,003 $53.5 D
Stock Options (right to buy) (10) 03/12/2025 Ordinary Shares(1) 3,752 $60.21 D
Stock Options (right to buy) (11) 03/11/2024 Ordinary Shares(1) 1,501 $48.76 D
Explanation of Responses:
1. The Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one Ordinary Share.
2. Restricted share units were granted on March 5, 2021, with 3,564 vesting on each of March 5, 2022, March 5, 2023, March 5, 2024 and 3,566 vesting on March 5, 2025.
3. Each restricted share unit represents a contingent right to receive, at settlement, one ordinary share or, at the option of the Human Resources and Compensation Committee, the cash value of one ordinary share.
4. Restricted share units were granted on February 28, 2020 with 3,219 vesting on each of February 28, 2022, February 28, 2023 and February 28, 2024.
5. Restricted share units were granted on March 4, 2019, with 2,403 vesting on March 4, 2022 and 2,406 vesting on March 4, 2023.
6. Restricted share units were granted on March 3, 2018 and vest on March 2, 2022.
7. Stock options were granted on March 3, 2018, with 2,500 having vested on each of March 2, 2019, March 2, 2020 and March 2, 2021 and 2,502 vesting on March 2, 2022.
8. Stock options were granted on March 3, 2017, with 1,938 having vested on each of March 3, 2018, March 3, 2019 and March 3, 2020 and 1,941 on March 3, 2021.
9. Stock options were granted on March 17, 2016, with 1,250 having vested on each of March 17, 2017, March 17, 2018 and March 17, 2019 and 1,253 on March 17, 2020.
10. Stock options were granted on March 12, 2015, with 938 having vested on each of March 12, 2016, March 12, 2017, March 12, 2018 and March 12, 2019.
11. Stock options were granted on March 12, 2014, with 500 having vested on each of March 12, 2015 and March 12, 2016 and 501 having vested on March 12, 2017.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Dov Bergwerk as attorney-in-fact for Amir Weiss 12/06/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.