Statement of Changes in Beneficial Ownership (4)
2017年9月7日 - 5:49AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Ibex Israel Fund 1 LLLP
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2. Issuer Name
and
Ticker or Trading Symbol
BLUE SPHERE CORP.
[
BLSP
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
3200 CHERRY CREEK SOUTH DRIVE, SUITE 670
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/1/2017
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(Street)
DENVER, CO 80209
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/1/2017
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J
(1)
(2)
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324754
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D
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(1)
(2)
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0
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Warrant (right to buy)
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$13.00
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9/1/2017
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J
(1)
(2)
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96154
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2/15/2016
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2/15/2021
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Common Stock
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96154
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(1)
(2)
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0
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D
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Explanation of Responses:
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(1)
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On September 1, 2017, in connection with the creation of a master-feeder fund structure, Ibex Israel Fund 1 LLLP ("Ibex Israel 1"), formerly known as Lazarus Israel Opportunities Fund LLLP, transferred all of its existing investments, including the common stock and warrants of the Issuer, into Ibex Israel Fund LLLP ("Ibex Israel"), formerly known as Lazarus Israel Opportunities Fund II LLLP, in exchange for partnership interests in Ibex Israel. Ibex Investors LLC ("Ibex Investors"), formerly known as Lazarus Management Company LLC, is the investment adviser of Ibex Israel 1 and Ibex Israel (the "Funds"), and Justin Borus is its manager. Ibex GP LLC ("Ibex GP"), formerly known as Lazarus GP LLC, is the general partner of each of the Funds and Mr. Borus is its manager.
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(2)
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The pecuniary interest of Ibex Investors and Mr. Borus in the securities of the Issuer did not change as a result of the transfer and each of Ibex Investors and Mr. Borus expressly disclaims beneficial ownership of the securities held by the Funds except to the extent of his or its pecuniary interest therein. Each of the Funds expressly disclaims beneficial ownership of the shares held by the other Funds.
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Remarks:
All numbers have been adjusted for a 130-for-1 reverse stock split of the Issuer's common stock on or about March 24, 2017.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Ibex Israel Fund 1 LLLP
3200 CHERRY CREEK SOUTH DRIVE, SUITE 670
DENVER, CO 80209
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X
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Signatures
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Ibex Israel Fund 1 LLLP By: Ibex GP LLC, its general partner By: /s/ Justin B. Borus, manager
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9/6/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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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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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 control number.
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