0001571049-17-007924.txt : 20170915 0001571049-17-007924.hdr.sgml : 20170915 20170915165228 ACCESSION NUMBER: 0001571049-17-007924 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170614 FILED AS OF DATE: 20170915 DATE AS OF CHANGE: 20170915 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Semler Herbert J CENTRAL INDEX KEY: 0001594356 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 171088439 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 2330 NW EVERETT ST. CITY: PORTLAND STATE: OR ZIP: 97210 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Semler Shirley L. CENTRAL INDEX KEY: 0001594358 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 171088437 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 2330 NW EVERETT ST. CITY: PORTLAND STATE: OR ZIP: 97210 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Semler Scientific, Inc. CENTRAL INDEX KEY: 0001554859 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 261367393 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2330 N.W. EVERETT STREET CITY: PORTLAND STATE: OR ZIP: 97210 BUSINESS PHONE: 408-627-4557 MAIL ADDRESS: STREET 1: 2330 N.W. EVERETT STREET CITY: PORTLAND STATE: OR ZIP: 97210 4/A 1 t1702598x2_4a.xml FORM 4/A X0306 4/A 2017-06-14 2017-06-15 0 0001554859 Semler Scientific, Inc. SMLR 0001594356 Semler Herbert J C/O SEMLER SCIENTIFIC, INC. 2330 NW EVERETT ST. PORTLAND OR 97210 1 0 1 0 0001594358 Semler Shirley L. C/O SEMLER SCIENTIFIC, INC. 2330 NW EVERETT ST. PORTLAND OR 97210 0 0 1 0 Common Stock 2017-06-14 4 M 0 150000 0.52 A 150000 D Common Stock 378064 I See footnote Stock Option (right to buy) 0.52 2017-06-14 4 M 0 150000 0 A 2008-01-01 2018-01-01 Common Stock 150000 0 D This amendment is being filed to correct the previously reported number of shares reported in Column 5. The correct number is 150,000. This option was held directly by Dr. Herbert J. Semler. These securities are held in family trusts and may be deemed to be beneficially owned by the reporting persons as beneficiaries and Co-Trustees of such trusts. /s/ Daniel E. Conger, attorney-in-fact 2017-09-15 /s/ Daniel E. Conger, attorney-in-fact 2017-09-15