Form 3 TEVA PHARMACEUTICAL INDU For: Nov 24 Filed by: Weiss Amir
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| FORM
3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF
SECURITIES
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act
of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person
*
| C/O 124 DVORA HANEVI'A ST. |
|
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
11/24/2021
|
3. Issuer Name
and
Ticker or Trading Symbol
TEVA PHARMACEUTICAL INDUSTRIES LTD
[
TEVA
]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Chief Accounting Officer |
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check
Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting
Person |
|
| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
|
3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
|
Ordinary Shares
(1)
|
14,391.41
|
D
|
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
|
2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
|
4. Conversion or Exercise Price of Derivative Security
|
5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Restricted Share Units
|
|
|
Ordinary Shares
(1)
|
14,258
|
(3)
|
D
|
|
|
Restricted Share Units
|
|
|
Ordinary Shares
(1)
|
9,657
|
(3)
|
D
|
|
|
Restricted Share Units
|
|
|
Ordinary Shares
(1)
|
4,809
|
(3)
|
D
|
|
|
Restricted Share Units
|
|
|
Ordinary Shares
(1)
|
981
|
(3)
|
D
|
|
|
Stock Options (right to buy)
|
|
03/02/2028 |
Ordinary Shares
(1)
|
10,002
|
19.16
|
D
|
|
|
Stock Options (right to buy)
|
|
03/03/2027 |
Ordinary Shares
(1)
|
7,755
|
34.7
|
D
|
|
|
Stock Options (right to buy)
|
|
03/17/2026 |
Ordinary Shares
(1)
|
5,003
|
53.5
|
D
|
|
|
Stock Options (right to buy)
|
|
03/12/2025 |
Ordinary Shares
(1)
|
3,752
|
60.21
|
D
|
|
|
Stock Options (right to buy)
|
|
03/11/2024 |
Ordinary Shares
(1)
|
1,501
|
48.76
|
D
|
|
| Explanation of Responses: |
|
|
|
|
|
|
|
|
|
|
|
| Remarks: |
| Exhibit 24 - Power of Attorney |
|
/s/ Dov Bergwerk as attorney-in-fact for Amir Weiss |
12/06/2021 |
|
** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
4
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
FOR SECTION 16 REPORTING OBLIGATIONS
KNOW ALL BY THESE PRESENTS, that the undersigned hereby makes, constitutes and
appoints Dov Bergwerk, Dikla Tadmor, Netanel Derovan and Shira Aran-Porat
signing singly, as the undersigneds true and lawful attorney-in-fact, with full
power and authority as hereinafter described on behalf of and in the name, place
and stead of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including
any amendments thereto) with respect to the securities of Teva Pharmaceutical
Industries Limited, a company incorporated under the law of Israel, or any
successor thereto (the "Company"), with the U.S. Securities and Exchange
Commission, any national securities exchanges and the Company, as considered
necessary or advisable under Section 16(a) of the Securities Exchange Act of
1934 and the rules and regulations promulgated thereunder, as amended from time
to time (the "Exchange Act");
(2) seek or obtain, as the undersigneds representative and on the undersigneds
behalf, information of transactions in the Companys securities from any
third-party, including brokers, employee benefit plan administrators and
trustees, and the undersigned hereby authorizes any such person to release any
such information to the undersigned and approves and ratifies any such release
of information; and
(3) perform any and all other acts which in the discretion of such
attorney-in-fact is necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in his or her discretion on information provided to such
attorney-in-fact without independent verification of such information;
(2) any documents prepared, executed, acknowledged and/or delivered by such
attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney
will be in such form and will contain such information and disclosure as such
attorney-in-fact, in his or her discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the undersigneds responsibility to comply with the requirement of the Exchange
Act, (ii) any liability of the undersigned for any failure to comply with such
requirements or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigneds obligations under the Exchange Act,
including without limitation the reporting requirements under Section 16 of the
Exchange Act.
The undersigned hereby gives and grants the foregoing attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the foregoing
matters as fully to all intents and purposes as the undersigned might or could
do if present, hereby ratifying all that such attorney-in-fact of, for and on
behalf of the undersigned, shall lawfully do or cause to be done by virtue of
this Power of Attorney.
This Power of Attorney shall remain in full force and effect until revoked by
the undersigned in a signed writing delivered to such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 29th day of November, 2021.
By: /s/ Amir Weiss
Name: Amir Weiss
Title: Chief Accounting Officer
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