SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Gorlin Jarrett S

(Last) (First) (Middle)
3279 HARDEE AVENUE

(Street)
ATLANTA GA 30341

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Medovex Corp. [ MDVX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CHIEF EXECUTIVE OFFICER
3. Date of Earliest Transaction (Month/Day/Year)
04/19/2016
4. If Amendment, Date of Original Filed (Month/Day/Year)
04/21/2016
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 04/19/2016 P 43,028(1) A $1.255 560,065(2) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant to purchase shares of Common Stock $1.3 04/19/2016 P 21,514 10/19/2016(3) 04/19/2021 Common Stock 21,514(4) $0 62,314 D
Explanation of Responses:
1. On April 21, 2016, the Reporting Person filed a Form 4 with the Commission. The previously filed Form 4 reported the purchase of shares of common stock (the "Shares") of MedoveX Corporation (the "Company"). In compliance with NASDAQ rules and regulations, the Reporting Person is hereby amending his report to accurately reflect the correct number of Shares purchased which was reduced, effectively increasing the purchase price from $1.225 to $1.255.
2. Represents shares held by The Jarrett S. & Rebecca L. Gorlin Family Limited Partnership. Mr. Gorlin disclaims beneficial ownership of these shares.
3. 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
4. On April 21, 2016, the Reporting Person filed a Form 4 with the Commission. The previously filed Form 4 reported the purchase of a warrant to purchase shares of common stock (the "Warrant") of MedoveX Corporation (the "Company"). In compliance with NASDAQ rules and regulations, the Reporting Person is hereby amending his report to accurately reflect the correct number of underlying shares that the Warrant represents, which was reduced pursuant to NASDAQ guidelines.
/s/ Jarrett Gorlin 05/13/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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