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