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) 01/01/2018 | 3. Issuer Name and Ticker or Trading Symbol TEVA PHARMACEUTICAL INDUSTRIES LTD [ TEVA ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
| Ordinary Shares(1) | 2,974.39 | D | |
| 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 | ||||
| Stock Options (right to buy) | (2) | 11/06/2021 | Ordinary Shares(1) | 6,668 | 41.72 | D | |
| Stock Options (right to buy) | (3) | 02/23/2022 | Ordinary Shares(1) | 5,335 | 44.59 | D | |
| Stock Options (right to buy) | (4) | 12/12/2022 | Ordinary Shares(1) | 6,668 | 38.84 | D | |
| Stock Options (right to buy) | (5) | 02/23/2023 | Ordinary Shares(1) | 6,668 | 38.08 | D | |
| Stock Options (right to buy) | (6) | 03/11/2024 | Ordinary Shares(1) | 15,002 | 48.76 | D | |
| Stock Options (right to buy) | (7) | 03/11/2025 | Ordinary Shares(1) | 51,308 | 60.21 | D | |
| Stock Options (right to buy) | (8) | 03/16/2026 | Ordinary Shares(1) | 50,006 | 53.5 | D | |
| Stock Options (right to buy) | (9) | 02/14/2027 | Ordinary Shares(1) | 62,364 | 34.9 | D | |
| Restricted Share Units | (10) | (10) | Ordinary Shares(1) | 4,885 | (11) | D | |
| Restricted Share Units | (12) | (12) | Ordinary Shares(1) | 7,075 | (11) | D | |
| Restricted Share Units | (13) | (13) | Ordinary Shares(1) | 11,778 | (11) | D | |
| Explanation of Responses: |
| 1. The Ordinary Shares may be represented by American Depositary Shares, each of which currently represents one Ordinary Share. |
| 2. Stock options were granted on November 7, 2011 and vested on November 7, 2015. |
| 3. Stock options were granted on February 24, 2012 and vested on February 24, 2016. |
| 4. Stock options were granted on December 13, 2012 and vested on December 13, 2015. |
| 5. Stock options were granted on February 24, 2013 and vested on February 24, 2016. |
| 6. Stock options were granted on March 12, 2014, with 7,501 having vested on each of March 12, 2016 and March 12, 2017. |
| 7. Stock options were granted on March 12, 2015, with 12,827 having vested on each of March 12, 2016 and March 12, 2017 and 12,827 vesting on each of March 12, 2018 and March 12, 2019. |
| 8. Stock options were granted on March 17, 2016, with 12,501 having vested on March 17, 2017, 12,501 vesting on each of March 17, 2018 and March 17, 2019 and 12,503 vesting on March 17, 2020. |
| 9. Stock options were granted on February 14, 2017, with 20,788 vesting on each of February 14, 2019, February 14, 2020 and February 14, 2021. |
| 10. Restricted share units were granted on March 12, 2015, with 2,441 vesting on March 12, 2018 and 2,444 vesting on March 12, 2019. |
| 11. Each restricted share unit represents a contingent right to receive, at settlement, one ordinary share or, at the option of the Human Resources and Compensation Committee, the cash value of one ordinary share. |
| 12. Restricted share units were granted on March 17, 2016, with 2,358 vesting on each of March 17, 2018 and March 17, 2019 and 2,359 vesting on March 17, 2020. |
| 13. Restricted share units were granted on February 14, 2017, with 3,926 vesting on each of February 14, 2019, February 14, 2020 and February 14, 2021. |
| Remarks: |
| The Reporting Person is filing this form in connection with the Issuer's transition from a foreign private issuer to a domestic issuer, effective January 1, 2018. Exhibit List Exhibit 24 - Power of Attorney |
| /s/ Dov Bergwerk, as attorney-in-fact for David M. Stark | 01/02/2018 | |
| ** 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. | ||