0001178913-16-006960.txt : 20161115
0001178913-16-006960.hdr.sgml : 20161115
20161115175127
ACCESSION NUMBER: 0001178913-16-006960
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161115
FILED AS OF DATE: 20161115
DATE AS OF CHANGE: 20161115
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
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54785
FILM NUMBER: 162000841
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
1
zk1619216.xml
OWNERSHIP DOCUMENT
X0306
4
2016-11-15
0
0001506983
Integrity Applications, Inc.
IGAP
0001690043
SCHWARTZ REVAN
C/O INTEGRITY APPLICATIONS, INC.
19 HA'YAHALOMIM ST. P.O. BOX 12163
ASHDOD
L3
7760049
ISRAEL
1
0
0
0
Options (Right to Buy)
4.50
2016-11-15
4
A
0
26666
0
A
2026-11-15
Common Stock, par value $0.001 per share
26666
26666
D
The options will vest in 8 equal quarterly installments with the first installment vesting on February 15, 2017 subject to the continued service of the Reporting Person as of each such date.
/s/ Revan Schwartz
2016-11-15