Sec Form 4 Filing - Rimon Gold Assets Ltd @ Wize Pharma, Inc. - 2018-03-26

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Rimon Gold Assets Ltd
2. Issuer Name and Ticker or Trading Symbol
Wize Pharma, Inc. [ WIZP]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
RAVEN RAVID & CO., 32A HABARZEL ST.
3. Date of Earliest Transaction (MM/DD/YY)
03/26/2018
(Street)
TEL AVIV, L36971047
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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
Common Stock, par value $0.001 per share 03/26/2018 C 217,442 ( 1 ) A $ 1.308 1,770,802 ( 2 ) D
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
2016 Future Investment Rights ( 3 ) $ 1.308 03/26/2018 C 217,442 03/31/2016 06/30/2019 Common Stock 217,442 $ 0 392,055 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Rimon Gold Assets Ltd
RAVEN RAVID & CO.
32A HABARZEL ST.
TEL AVIV, L36971047
X
Signatures
/s/ Abir Raveh 05/08/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The 217,442 shares of common stock of the Issuer were issued upon the exercise of a portion of the 2016 Investment Rights (as defined below).
( 2 )Represents (i) 217,442 shares of common stock, (ii) 593,925 shares of common stock issuable upon the conversion of the 2016 Convertible Notes (as defined below), (iii) 259,003 shares of common stock issuable upon the conversion of the 2017 Convertible Notes (as defined below), (iv) 392,055 shares of common stock issuable upon the exercise of Reporting Person's 2016 Investment Right (as defined below) and (v) 308,377 shares of common stock issuable upon the exercise of Reporting Person's 2017 Investment Right (as defined below). Reporting Person is an Israeli private company wholly owned by the Goldfinger Trust (the "Trust"), whose trustee is Abir Raveh (the "Trustee") and whose beneficiary is Yair Goldfinger. The Trust directs the management of Reporting Person, its investment and voting decisions and the Trustee directs the management of the Trust, its investment and voting decisions.
( 3 )Reporting Person's outstanding loan in the principal amount of $531,067, which bears interest at an annual rate of 4% (the "2016 Convertible Notes"), is convertible (including accrued interest), into 593,925 shares of common stock based on a conversion price per share of $0.9768. Reporting Person has the right, until June 30, 2019, to invest up to $796,601, in the aggregate, at an agreed price per share of $1.308 (the "2016 Investment Right"). Reporting Person 's outstanding loan to the Issuer in the principal amount of $274,048, which bears interest at an annual rate of 4% (the "2017 Convertible Notes") is currently convertible (including accrued interest), into 259,003 shares of common stock based on a loan conversion price per share of $1.1112. The maturity date of the 2016 Convertible Notes and the 2017 Convertible Notes is December 31, 2018. Reporting Person has the right (the "2017 Investment Right") until June 30, 2019, to invest up to $512,187, at a price per share of $1.332.

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).

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