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