0001571049-18-000496.txt : 20181003 0001571049-18-000496.hdr.sgml : 20181003 20181003142050 ACCESSION NUMBER: 0001571049-18-000496 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181001 FILED AS OF DATE: 20181003 DATE AS OF CHANGE: 20181003 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006 CENTRAL INDEX KEY: 0001742975 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 181104623 BUSINESS ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN CT. CITY: SAN JOSE STATE: CA ZIP: 95112 BUSINESS PHONE: (877) 774-4211 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN CT. CITY: SAN JOSE STATE: CA ZIP: 95112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chang William H CENTRAL INDEX KEY: 0001594408 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36305 FILM NUMBER: 181104624 MAIL ADDRESS: STREET 1: C/O SEMLER SCIENTIFIC, INC. STREET 2: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 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: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 BUSINESS PHONE: 408-627-4557 MAIL ADDRESS: STREET 1: 911 BERN COURT, SUITE 110 CITY: SAN JOSE STATE: CA ZIP: 95112 4 1 tv504066_4.xml FORM 4 X0306 4 2018-10-01 0 0001554859 Semler Scientific, Inc. SMLR 0001742975 William H.C. Chang & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006 C/O SEMLER SCIENTIFIC, INC. 911 BERN COURT, SUITE 110 SAN JOSE CA 95112 0 0 1 0 0001594408 Chang William H C/O SEMLER SCIENTIFIC, INC. 911 BERN COURT, SUITE 110 SAN JOSE CA 95112 0 0 1 0 Common Stock 2018-10-01 4 X 0 134616 2.60 A 1400419 D Common Stock Warrant (Right to Buy) 2.60 2018-10-01 4 X 0 134616 0 D 2017-05-02 2022-01-21 Common Stock 134616 0 D William H.C. & Diana Shon Chang TTEE Chang Family Trust U/A DTD 10/23/2006, by /s/ William H.C. Chang, Trustee 2018-10-03 /s/ William H. Chang 2018-10-03