0001415889-16-005612.txt : 20160421 0001415889-16-005612.hdr.sgml : 20160421 20160421180541 ACCESSION NUMBER: 0001415889-16-005612 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160419 FILED AS OF DATE: 20160421 DATE AS OF CHANGE: 20160421 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Medovex Corp. CENTRAL INDEX KEY: 0001591165 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3729 HARDEE AVENUE CITY: ATLANTA STATE: GA ZIP: 30341 BUSINESS PHONE: (404) 393-6989 MAIL ADDRESS: STREET 1: 3729 HARDEE AVENUE CITY: ATLANTA STATE: GA ZIP: 30341 FORMER COMPANY: FORMER CONFORMED NAME: SpineZ DATE OF NAME CHANGE: 20131105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gorlin Jarrett S CENTRAL INDEX KEY: 0001629409 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36763 FILM NUMBER: 161584930 MAIL ADDRESS: STREET 1: 3279 HERDEE AVE CITY: ATLANTA STATE: GA ZIP: 30341 4 1 form4-04212016_030432.xml X0306 4 2016-04-19 0001591165 Medovex Corp. MDVX 0001629409 Gorlin Jarrett S 3279 HARDEE AVENUE ATLANTA GA 30341 true true false false CHIEF EXECUTIVE OFFICER Common Stock 2016-04-19 4 P 0 44081 1.225 A 561118 D Warrant to purchase shares of Common Stock 1.30 2016-04-19 4 P 0 22040 0 A 2016-10-19 2021-04-19 Common Stock 22040 62840 D Represents shares held by The Jarrett S. & Rebecca L. Gorlin Family Limited Partnership. Mr. Gorlin disclaims beneficial ownership of these shares. The Warrant is initially exercisable six months following the date of issuance (04/19/2016) for a period of five (5) years from the date of issuance /s/ Jarrett Gorlin 2016-04-21