XWELL, Inc. — Director's Dealing 2017

Jan 20, 2017

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: FORM Holdings Corp. (FH)
CIK: 0001410428
Period of Report: 2017-01-17

Reporting Person: Nyrkovskaya Anastasia (Chief Financial Officer)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2017-01-17	Common Stock	A	58962	—	Acquired	60562	Direct

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2017-01-17	Stock Option	$2.12	A	250000	Acquired	2027-01-17	Common Stock (250000)	Direct

Footnotes

F1: Represents 58,962 shares of restricted stock units which vest on the first year anniversary of the grant date.

F2: Includes 58,962 shares of unvested restricted stock units.

F3: These options to purchase shares of common stock of the Issuer vest quarterly over 12 quarters starting March 31, 2017.