0001615774-17-007638.txt : 20171227
0001615774-17-007638.hdr.sgml : 20171227
20171227172156
ACCESSION NUMBER: 0001615774-17-007638
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171222
FILED AS OF DATE: 20171227
DATE AS OF CHANGE: 20171227
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rafaeli Dolev
CENTRAL INDEX KEY: 0001536967
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-11635
FILM NUMBER: 171276670
MAIL ADDRESS:
STREET 1: C/O PHOTOMEDEX, INC.
STREET 2: 100 LAKESIDE DRIVE, STE. 100
CITY: HORSHAM
STATE: PA
ZIP: 19044
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FC Global Realty Inc
CENTRAL INDEX KEY: 0000711665
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 592058100
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2300 COMPUTER DRIVE
STREET 2: BUILDING G,
CITY: WILLOW GROVE
STATE: PA
ZIP: 19090
BUSINESS PHONE: 2156193600
MAIL ADDRESS:
STREET 1: 2300 COMPUTER DRIVE
STREET 2: BUILDING G,
CITY: WILLOW GROVE
STATE: PA
ZIP: 19090
FORMER COMPANY:
FORMER CONFORMED NAME: PHOTOMEDEX INC
DATE OF NAME CHANGE: 20000811
FORMER COMPANY:
FORMER CONFORMED NAME: LASER PHOTONICS INC
DATE OF NAME CHANGE: 19920703
4
1
s108553_form4.xml
4
X0306
4
2017-12-22
0
0000711665
FC Global Realty Inc
FCRE
0001536967
Rafaeli Dolev
C/O FC GLOBAL REALTY INCORPORATED
2300 COMPUTER DRIVE, BUILDING G
WILLOW GROVE
PA
19090
1
0
1
0
FC Global Common Stock
2017-12-22
4
J
0
3134876
0.9997
A
3318400
D
The transactions reported on this Form 4 were effected pursuant to a Convertible Payout Note dated May 17, 2017 and the Stock Grant Agreement dated December 22, 2017.
The price reported in Column 4 was set by the terms of the Convertible Payout Note dated May 17, 2017 and the Stock Grant Agreement dated December 22, 2017.
The total shares reflected in Column 5 includes the shares granted under the Convertible Payout Note dated May 17, 2017 and the Stock Grant Agreement dated December 22, 2017 as well as the shares previously held by Dr. Rafaeli adjustment for a 1-for-5 reverse stock split in September 2016.
/s/ Dolev Rafaeli
2017-12-27