| Nano-X Imaging Ltd. |
| (Name of Issuer) |
| Ordinary Shares |
| (Title of Class of Securities) |
| M70700105 |
| (CUSIP Number) |
| November 22, 2021 |
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(Date of Event Which Requires Filing of this Statement)
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CUSIP No. M70700105
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Page 2 of 5 Pages
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1
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NAMES OF REPORTING PERSONS
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Moshe Moalem
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a)☐
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(b)☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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Israel
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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2,126,473
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6
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SHARED VOTING POWER
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0
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7
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SOLE DISPOSITIVE POWER
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2,126,473
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8
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SHARED DISPOSITIVE POWER
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0
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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2,126,473
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10
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CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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4.4%
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12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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IN
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CUSIP No. M70700105
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Page 3 of 5 Pages
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| ITEM 1(a). |
NAME OF ISSUER
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| ITEM 1(b). |
ADDRESS OF ISSUER’S PRINCIPAL EXECUTIVE OFFICES
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| ITEM 2(a). |
NAME OF PERSONS FILING
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| ITEM 2(b). |
ADDRESS OF PRINCIPAL BUSINESS OFFICE
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| ITEM 2(c). |
CITIZENSHIP
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| ITEM 2(d). |
TITLE OF CLASS OF SECURITIES
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| ITEM 2(e). |
CUSIP NUMBER
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| ITEM 3. |
If this statement is filed pursuant to §§ 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:
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| (a) | ☐ |
Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o); |
| (b) | ☐ |
Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c); |
| (c) | ☐ |
Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c); |
| (d) | ☐ | Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8); |
| (e) | ☐ | An investment adviser in accordance with § 240.13d-1(b)(1)(ii)(E); |
| (f) | ☐ | An employee benefit plan or endowment fund in accordance with § 240.13d-1(b)(1)(ii)(F); |
| (g) | ☐ | A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G); |
| (h) | ☐ | A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); |
| (i) | ☐ | A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3); |
| (j) | ☐ | A non-U.S. institution in accordance with § 240.13d-1(b)(1)(ii)(J); |
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CUSIP No. M70700105
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Page 4 of 5 Pages
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| (k) | ☐ | Group, in accordance with § 240.13d-1(b)(1)(ii)(K). |
| ITEM 4. |
OWNERSHIP
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| (a) |
Amount beneficially owned: 2,126,473 ordinary shares
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| (b) |
Percent of class: 4.4%
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| (i) |
Sole power to vote or direct the vote: 2,126,473 ordinary shares
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| (ii) | Shared power to vote or direct the vote: 0 |
| (iii) | Sole power to dispose or to direct the disposition of: 2,126,473 ordinary shares |
| (iv) | Shared power to dispose or to direct the disposition of: 0 |
| ITEM 5. |
OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS
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| ITEM 6. |
OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON
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| ITEM 7. |
IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY OR CONTROL PERSON
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| ITEM 8. |
IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP
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| ITEM 9. |
NOTICE OF DISSOLUTION OF GROUP
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| ITEM 10. |
CERTIFICATION
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CUSIP No. M70700105
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Page 5 of 5 Pages
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DATE:
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December 21, 2021
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MOSHE MOALEM
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| /s/ Moshe Moalem | ||