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