0001415889-17-000267.txt : 20170214 0001415889-17-000267.hdr.sgml : 20170214 20170214195205 ACCESSION NUMBER: 0001415889-17-000267 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170209 FILED AS OF DATE: 20170214 DATE AS OF CHANGE: 20170214 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: 17612402 MAIL ADDRESS: STREET 1: 3279 HERDEE AVE CITY: ATLANTA STATE: GA ZIP: 30341 4 1 form4-02142017_040256.xml X0306 4 2017-02-09 0001591165 Medovex Corp. MDVX 0001629409 Gorlin Jarrett S 3279 HARDEE AVENUE ATLANTA GA 30341 true true false false CHIEF EXECUTIVE OFFICER Common Stock 2017-02-09 4 P 0 67307 1.04 A 617172 D Warrant to purchase shares of Common Stock 1.50 2017-02-09 4 P 0 33654 1.04 A 2017-02-09 2022-02-09 Common Stock 33654 95968 D The shares were purchased as part of a private placement unit offering for $1.04 per unit, each unit consisting of one share of common stock and one-half of a warrant to purchase one share of common stock at an exercise price per share equal to $1.50 per share for a period of five (5) years. Includes 487,337 shares held by The Jarrett S. & Rebecca L. Gorlin Family Limited Partnership. Mr. Gorlin disclaims beneficial ownership of these shares. Includes 9,615 shares held by JARRETT GORLIN C/F LOGAN GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares. Includes 9,615 shares held by JARRETT GORLIN C/F TAYLOR GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares. The warrants were purchased as part of a private placement unit offering for $1.04 per unit, each unit consisting of one share of common stock and one-half of a warrant to purchase one share of common stock at an exercise price per share equal to $1.50 per share for a period of five (5) years. Includes 4,808 warrants to purchase shares of common stock held by JARRETT GORLIN C/F LOGAN GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares. Includes 4,808 warrants to purchase shares of common stock held by JARRETT GORLIN C/F TAYLOR GORLIN UTMA/GA. The Reporting Person claims beneficial ownership of these shares. /s/ Jarrett Gorlin 2017-02-14