<SEC-DOCUMENT>0001178913-17-000765.txt : 20170314
<SEC-HEADER>0001178913-17-000765.hdr.sgml : 20170314
<ACCEPTANCE-DATETIME>20170314160037
ACCESSION NUMBER:		0001178913-17-000765
CONFORMED SUBMISSION TYPE:	4
PUBLIC DOCUMENT COUNT:		2
CONFORMED PERIOD OF REPORT:	20170308
FILED AS OF DATE:		20170314
DATE AS OF CHANGE:		20170314

ISSUER:		

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			Integrity Applications, Inc.
		CENTRAL INDEX KEY:			0001506983
		STANDARD INDUSTRIAL CLASSIFICATION:	SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
		IRS NUMBER:				980668934
		STATE OF INCORPORATION:			DE
		FISCAL YEAR END:			1231

	BUSINESS ADDRESS:	
		STREET 1:		19 HA'YAHALOMIM ST
		STREET 2:		P.O. BOX 12163
		CITY:			ASHDOD
		STATE:			L3
		ZIP:			L3 7760049
		BUSINESS PHONE:		972 (8) 675-7878

	MAIL ADDRESS:	
		STREET 1:		19 HA'YAHALOMIM ST
		STREET 2:		P.O. BOX 12163
		CITY:			ASHDOD
		STATE:			L3
		ZIP:			L3 7760049

REPORTING-OWNER:	

	OWNER DATA:	
		COMPANY CONFORMED NAME:			Darivoff Philip
		CENTRAL INDEX KEY:			0001690551

	FILING VALUES:
		FORM TYPE:		4
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	000-54785
		FILM NUMBER:		17688035

	MAIL ADDRESS:	
		STREET 1:		1 FARMSTEAD ROAD
		CITY:			SHORT HILLS
		STATE:			NJ
		ZIP:			07078
</SEC-HEADER>
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<DESCRIPTION>OWNERSHIP DOCUMENT
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    <documentType>4</documentType>

    <periodOfReport>2017-03-08</periodOfReport>

    <notSubjectToSection16>0</notSubjectToSection16>

    <issuer>
        <issuerCik>0001506983</issuerCik>
        <issuerName>Integrity Applications, Inc.</issuerName>
        <issuerTradingSymbol>IGAP</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001690551</rptOwnerCik>
            <rptOwnerName>Darivoff Philip</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O INTEGRITY APPLICATIONS, INC.</rptOwnerStreet1>
            <rptOwnerStreet2>19 HA'YAHALOMIM ST P.O. BOX 12163</rptOwnerStreet2>
            <rptOwnerCity>ASHDOD</rptOwnerCity>
            <rptOwnerState>L3</rptOwnerState>
            <rptOwnerZipCode>7760049</rptOwnerZipCode>
            <rptOwnerStateDescription>ISRAEL</rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>1</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>0</isTenPercentOwner>
            <isOther>0</isOther>
            <officerTitle></officerTitle>
            <otherText></otherText>
        </reportingOwnerRelationship>
    </reportingOwner>

    <derivativeTable>
        <derivativeTransaction>
            <securityTitle>
                <value>Series C 5.5% Convertible Preferred Stock</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <value>4.50</value>
                <footnoteId id="F1"/>
            </conversionOrExercisePrice>
            <transactionDate>
                <value>2017-03-08</value>
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                <transactionCode>P</transactionCode>
                <equitySwapInvolved>0</equitySwapInvolved>
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            <transactionAmounts>
                <transactionShares>
                    <value>1000</value>
                </transactionShares>
                <transactionPricePerShare>
                    <footnoteId id="F4"/>
                </transactionPricePerShare>
                <transactionAcquiredDisposedCode>
                    <value>A</value>
                </transactionAcquiredDisposedCode>
            </transactionAmounts>
            <exerciseDate>
                <value>2017-03-08</value>
            </exerciseDate>
            <expirationDate>
                <footnoteId id="F2"/>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Common Stock, par value $0.001 per share</value>
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                <underlyingSecurityShares>
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            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>I</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value>By Vayikra Capital, LLC</value>
                    <footnoteId id="F5"/>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeTransaction>
        <derivativeTransaction>
            <securityTitle>
                <value>Series C-1 Warrants</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <value>4.50</value>
                <footnoteId id="F6"/>
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            <transactionDate>
                <value>2017-03-08</value>
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                    <value>A</value>
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            <exerciseDate>
                <value>2016-11-30</value>
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            <expirationDate>
                <value>2022-03-08</value>
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            <underlyingSecurity>
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                    <value>Common Stock, par value $0.001 per share</value>
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            <ownershipNature>
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                    <value>I</value>
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                <natureOfOwnership>
                    <value>By Vayikra Capital, LLC</value>
                    <footnoteId id="F5"/>
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        </derivativeTransaction>
        <derivativeTransaction>
            <securityTitle>
                <value>Series C-2 Warrants</value>
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            <conversionOrExercisePrice>
                <value>7.75</value>
                <footnoteId id="F6"/>
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                <value>2017-03-08</value>
            </exerciseDate>
            <expirationDate>
                <value>2022-03-08</value>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Common Stock, par value $0.001 per share</value>
                </underlyingSecurityTitle>
                <underlyingSecurityShares>
                    <value>222223</value>
                    <footnoteId id="F3"/>
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                <directOrIndirectOwnership>
                    <value>I</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value>By Vayikra Capital, LLC</value>
                    <footnoteId id="F5"/>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeTransaction>
    </derivativeTable>

    <footnotes>
        <footnote id="F1">Footnote 1 is attached hereto as Exhibit 99.1.</footnote>
        <footnote id="F2">The Series C 5.5% Convertible Preferred Stock has no expiration date.</footnote>
        <footnote id="F3">The Reporting Person has acquired Units consisting of: (a) 1,000 shares of Series C 5.5% Convertible Preferred Stock, convertible into 66,667 shares of Common Stock; (b) Series C-1 Warrants, exercisable into 222,223 shares of Common Stock; and (c) Series C-2 Warrants, exercisable into 222,223 shares of Common Stock. The conversion of such Series C 5.5% Convertible Preferred Stock, Series C-1 Warrants and Series C-2 Warrants is subject to a beneficial ownership limitation which provides that Vayikra Capital, LLC is not permitted to convert such securities if such conversion would cause the Reporting Person to beneficially own more than 9.99% of the shares of Common Stock outstanding after giving effect to such conversion. The amount of shares of Common Stock of which such Series C 5.5% Convertible Preferred Stock, Series C-1 Warrants and Series C-2 Warrants are convertible into or exercisable for was calculated without giving effect to any ownership limitation of the Reporting Person.</footnote>
        <footnote id="F4">The reported securities are included within 1,000 Units purchased by the reporting person for $1,000 per Unit. Each Unit consists of (a) one share of Series C 5.5% Convertible Preferred Stock; (b) one warrant to purchase up to a number of shares of common stock equal to 100% of the number of shares of common stock issuable upon conversion of one share of Series C 5.5% Convertible Preferred Stock, at an initial exercise price of $4.50 per share; and (c) one warrant to purchase up to a number of shares of common stock equal to 100% of the number of shares of common stock issuable upon conversion of one share of Series C 5.5% Preferred Stock, at an initial exercise price of $7.75 per share.</footnote>
        <footnote id="F5">The securities are held by Vayikra Capital, LLC, of which the Reporting Person is the sole member. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of any pecuniary interest therein and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose.</footnote>
        <footnote id="F6">The exercise price of the Series C-1 Warrants and the Series C-2 Warrants will be subject to adjustment upon the occurrence of those items listed in footnote 1 (with the exception of subsection (b) thereof).</footnote>
    </footnotes>

    <remarks>Exhibit List

Exhibit 99.1 - Footnote 1</remarks>

    <ownerSignature>
        <signatureName>/s/ Philip Darivoff</signatureName>
        <signatureDate>2017-03-14</signatureDate>
    </ownerSignature>
</ownershipDocument>
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<DESCRIPTION>FOOTNOTE 1:
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<div style="MARGIN-LEFT: 0pt; DISPLAY: block; MARGIN-RIGHT: 0pt; TEXT-INDENT: 0pt" align="left"><font style="FONT-SIZE: 10pt; FONT-FAMILY: Times New Roman; DISPLAY: inline">(1)
The Series C 5.5% Convertible Preferred Stock is initially convertible into common stock at a conversion price of $4.50 per
share. The initial conversion price may be subject to downward adjustment upon (a) dilution of the Common Stock by stock
split or dividend distribution, (b) subsequent equity sales with a conversion price lower than the conversion price of the
Series C 5.5% Convertible Preferred Stock, (c)&#160;&#160;distribution to all Common Stock holders, and not to holders of
Series C 5.5% Convertible Preferred Stock, of evidence of the Issuer&#8217;s indebtedness or assets or rights or warrants to
subscribe for or purchase any security other than the Common Stock, (d) consummation of a purchase offer, tender offer or
exchange offer for more than 50% of the outstanding Common Stock, (e) reclassification, reorganization or recapitalization of
the Common Stock or any compulsory share exchange pursuant to which the Common Stock is effectively converted into or
exchanged for other securities, cash or property, or (f) consummation of a merger, consolidation, reclassification or
disposition of all or substantially all of the Issuer&#8217;s assets.</font></div>

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