SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Stuka Paul

(Last) (First) (Middle)
C/O INSPIREMD, INC.
321 COLUMBUS AVENUE

(Street)
BOSTON MA 02116

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
InspireMD, Inc. [ NSPR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
07/07/2016
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Convertible Preferred Stock $0.33 07/07/2016 P 3,030 07/07/2016 07/07/2021 Common Stock 530,250(1) $33(2) 3,030 D
Warrants to Purchase Common Stock $0.2 07/07/2016 P 303,000 07/07/2016 07/07/2021 Common Stock 303,000 $33(2) 303,000 D
Series B Convertible Preferred Stock $0.33 07/07/2016 P 1,515 07/07/2016 07/07/2021 Common Stock 265,125(3) $33(2) 1,515 I See Note(4)
Warrants to Purchase Common Stock $0.2 07/07/2016 P 151,500 07/07/2016 07/07/2021 Common Stock 151,500 $33(2) 151,500 I See Note(4)
Explanation of Responses:
1. Consists of 303,000 shares of Common Stock issuable upon conversion of the Preferred Stock at the conversion price of $0.33 per share and the stated value of $33 and payment of all dividends accrued on the Preferred Stock in an aggregate of 227,250 shares of Common Stock upon conversion of the Preferred Stock.
2. Each share of Preferred Stock was accompanied by a Warrant to purchase 100 shares of Common Stock at an exercise price of $0.20 per share of Common Stock. Each share of Preferred Stock and accompanying Warrant to Purchase Common Stock was acquired at an aggregate price of $33.00.
3. Consists of 151,500 shares of Common Stock issuable upon conversion of the Preferred Stock at the conversion price of $0.33 per share and the stated value of $33 and payment of all dividends accrued on the Preferred Stock in an aggregate of 113,625 shares of Common Stock upon conversion of the Preferred Stock.
4. These securities are held by Osiris Investment Partners, L.P. ("Osiris"). The Reporting Person serves as the managing member of Osiris Partners, LLC, the general partner of Osiris. In such capacity, the Reporting Person may be deemed to beneficially own the reported securities. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership for purposes of Section 16 or for any other purposes.
/s/ Paul Stuka 07/11/2016
** 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 4 (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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