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Delaware
|
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6411
|
| |
86-1916231
|
|
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(State or Other Jurisdiction of
Incorporation or Organization) |
| |
(Primary Standard Industrial
Classification Code Number) |
| |
(I.R.S. Employer
Identification Number) |
|
|
Mitchell Nussbaum, Esq.
Angela Dowd, Esq. Jane Tam, Esq. Loeb & Loeb LLP 345 Park Avenue New York, New York 10154 Phone: (212) 407-4000 Fax: (212) 407-4990 |
| |
Brad L. Shiffman, Esq.
Blank Rome LLP The Chrysler Building 405 Lexington Ave, New York, NY 10174 Phone: (212) 885-5000 Fax: (212) 885-5001 |
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Large accelerated filer
☐
|
| |
Accelerated filer
☐
|
|
|
Non-accelerated filer
☒
|
| |
Smaller reporting company
☒
|
|
| | | |
Emerging growth company
☒
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| | ||||||||||||||
Title of Each Class of Security
Being Registered |
| | |
Proposed
Maximum Aggregate offering Price(1)(2) |
| | |
Amount of
Registration Fee(3) (6) |
| ||||||
Class A common stock, $0.0001 par value (2)
|
| | | | $ | 28,750,000 | | | | | | $ | 3,136.63 | | |
Representative’s Warrants(4)
|
| | | | | | | | | | | | | | |
Common stock issuable upon exercise of Representative’s Warrants(5)
|
| | | | | 1,796,875 | | | | | | | 196.04 | | |
Total
|
| | | | $ | 30,546,875 | | | | | | $ | 3,332.67 | | |
| | |
Amount to be
paid |
| |||
SEC registration fee
|
| | | $ | 3,333 | | |
FINRA filing fee
|
| | | $ | 5,082 | | |
NASDAQ Capital Market listing fee
|
| | | $ | 55,000 | | |
Printing and engraving expenses
|
| | | $ | 60,000 | | |
Legal fees and expenses
|
| | | $ | 1,000,000 | | |
Accounting fees and expenses
|
| | | $ | 100,000 | | |
Transfer agent and registrar fees and expenses
|
| | | $ | 12,300 | | |
Miscellaneous expenses
|
| | | $ | 300,000 | | |
Total
|
| | | $ | 1,535,715 | | |
Exhibit No.
|
| |
Description
|
|
4.37* | | | | |
4.38* | | | | |
4.39* | | | | |
4.40* | | | | |
4.41* | | | Convertible Promissory Note dated April 1, 2021, between Marpai Health, Inc. and Yuri Kokush | |
4.42* | | | | |
4.43* | | | | |
4.44* | | | | |
4.45* | | | | |
4.46* | | | | |
4.47* | | | | |
4.48* | | | Convertible Promissory Note dated April 1, 2021, between Marpai Health, Inc. and The Kadosh Family Irrevocable Trust — 2020 | |
4.49* | | | | |
4.50* | | | | |
4.51* | | | | |
4.52* | | | | |
4.53* | | | | |
4.54* | | | | |
4.55* | | | | |
4.56* | | | | |
4.57* | | | | |
4.58* | | | | |
4.59* | | | | |
4.60* | | | | |
4.61* | | | | |
4.62* | | | |
Exhibit No.
|
| |
Description
|
|
10.22* | | | | |
10.23* | | | | |
10.24* | | | | |
10.25* | | | | |
10.26* | | | | |
10.27* | | | | |
10.28* | | | | |
10.29* | | | | |
14.1* | | | | |
14.2* | | | | |
21.1* | | | | |
23.1* | | | | |
23.2* | | | | |
23.3* | | | | |
23.4 | | | | |
23.5 | | | | |
23.6 | | | | |
24.1* | | | | |
99.1* | | | | |
99.2* | | | | |
99.3* | | | | |
99.4* | | | | |
99.5* | | | | |
99.6* | | | | |
99.7* | | | |
|
Signature
|
| |
Title
|
| |
Date
|
|
|
/s/ Edmundo Gonzalez
Edmundo Gonzalez
|
| | Chief Executive Officer, Secretary and Director (Principal Executive Officer) | | |
October 14, 2021
|
|
|
*
Yoram Bibring
|
| | Principal Financial and Accounting Officer | | |
October 14, 2021
|
|
|
*
Damien Lamendola
|
| | Director | | |
October 14, 2021
|
|
|
*
Yaron Eitan
|
| | Director | | |
October 14, 2021
|
|
|
*/s/ By: Edmundo Gonzalez
Attorney-in-Fact
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| | | |