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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/19/2015 | 3. Issuer Name and Ticker or Trading Symbol SteadyMed Ltd. [ STDY ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 03/19/2015 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Series A-2 Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 198,393 | 6.62 | I | See Footnote(3) |
Series B Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 286,944 | 4.07 | I | See Footnote(3) |
Series D Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 151,791 | 6.14 | I | See Footnote(3) |
Series E Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 396,974 | 8.49 | I | See Footnote(3) |
Series D Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 16,298 | 6.14 | I | See Footnote(4) |
Series E Convertible Preferred Shares | (1) | (2) | Ordinary Shares | 94,643 | 8.49 | I | See Footnote(5) |
Warrant to Purchase Series E Preferred Shares | (6) | 02/17/2021 | Ordinary Shares | 10,664 | 0.01 | I | See Footnote(5) |
Explanation of Responses: |
1. Such preferred shares will convert into that number of Issuer's ordinary shares disclosed above at the closing of a Qualified IPO (as defined in the Issuer's Ninth Amended and Restated Articles of Association dated March 1, 2015). |
2. The shares do not have an expiration date. |
3. By Samson Venture Partners I, LLC. Samson Venture Partners, LLC is the Manager and the Reporting Person is a Co-Manager of Samson Venture Partners, LLC. |
4. By Randsburg Capital, LLC. Reporting Person is a Co-Manager of Randsburg Capital, LLC. |
5. By Iron Capital I, LLC. Iron Capital, LLC is the Manager and the Reporting Person is the Sole Manager of Iron Capital, LLC. |
6. All shares subject to this warrant are fully exercisable. At the closing of a Qualified IPO (as defined in the Issuer's Ninth Amended and Restated Articles of Association dated March 1, 2015) this warrant was automatically converted into a warrant to purchase that number of Issuer's ordinary shares disclosed above. |
Remarks: |
This Form 3/A amends the Form 3 filed by the Reporting Person on March 19, 2015 to include the securities held by Iron Capital I, LLC and Randsburg Capital, LLC. |
/s/Ron Ginor | 07/20/2015 | |
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |