Harold Jacob Form 3 NanoVibronix / HAROLD JACOB ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person^*

JACOB HAROLD

(Last) (First) (Middle)

C/O NANOVIBRONIX, INC.

525 EXECUTIVE BOULEVARD

(Street)

ELMSFORD NY 10523

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
04/10/2015

3. Issuer Name and Ticker or Trading Symbol
NanoVibronix, Inc. [ NONE ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
Chief Medical Officer

5. If Amendment, Date of Original Filed (Month/Day/Year)

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 Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	25,662	D
Common Stock	64,178	I	By Medical Instrument Development Inc.(1)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Option to Purchase Common Stock	(2)	12/31/2017	Common Stock	4,286	72.45	D
Option to Purchase Common Stock	12/09/2010	12/09/2020	Common Stock	10,714	1.193	D
Option to Purchase Common Stock	03/28/2013	03/28/2023	Common Stock	108,571	0.07	D
Warrants to Purchase Common Stock	05/12/2014	11/15/2018	Common Stock	12,362	1.393	I	By Medical Instrument Development Inc.(1)

Explanation of Responses:

1. Represents securities held by Medical Instrument Development Inc., an entity controlled by Dr. Jacob. In such capacity, Dr. Jacob may be deemed to beneficially own the reported securities.

2. The option was granted on December 13, 2007 and is currently fully vested and exercisable.

	/s/ Harold Jacob, M.D.	04/10/2015
	** 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 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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