XWELL, Inc. — Director's Dealing 2017

Jan 20, 2017

SEC Form 3 — Initial Statement of Beneficial Ownership

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

Reporting Person: Charkow Jason (VP Legal & Business Affairs)

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Stock Option	$32.40	2023-01-13	Common Stock (10000)		Direct
Stock Option	$27.70	2023-10-17	Common Stock (10000)		Direct
Stock Option	$5.10	2025-01-15	Common Stock (15000)		Direct
Stock Option	$1.55	2026-04-04	Common Stock (150000)		Direct

Footnotes

F1: These options to purchase shares of common stock of the Issuer vest quarterly over 12 quarters starting January 31, 2013.

F2: These options to purchase shares of common stock of the Issuer vest quarterly over 12 quarters starting October 17, 2013.

F3: These options to purchase shares of common stock of the Issuer vest quarterly over 12 quarters starting January 15, 2015.

F4: These options to purchase shares of common stock of the Issuer vest quarterly over 12 quarters starting April 4, 2016.