SEC Form 4
FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION | ||
Washington, D.C. 20549 | OMB APPROVAL | |
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP | ||
OMB Number: | 3235-0287 | |
Estimated average burden | ||
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 | hours per response: | 0.5 |
or Section 30(h) of the Investment Company Act of 1940 |
1. Name and Address of Reporting Person* | 2. Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer | |||||||||||||||||||||||||||||||||||||
Wenderow Tal Baruch | Microbot Medical Inc.[ MBOT ] | (Check all applicable) | |||||||||||||||||||||||||||||||||||||
X | Director | 10% Owner | |||||||||||||||||||||||||||||||||||||
Officer (give title | Other (specify | ||||||||||||||||||||||||||||||||||||||
3. Date of Earliest Transaction (Month/Day/Year) | |||||||||||||||||||||||||||||||||||||||
(Last) | (First) | (Middle) | below) | below) | |||||||||||||||||||||||||||||||||||
C/O MICROBOT MEDICAL INC. | 08/14/2020 | ||||||||||||||||||||||||||||||||||||||
25 RECREATION PARK DRIVE, UNIT 108 | |||||||||||||||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable | ||||||||||||||||||||||||||||||||||||||
Line) | |||||||||||||||||||||||||||||||||||||||
(Street) | |||||||||||||||||||||||||||||||||||||||
X Form filed by One Reporting Person | |||||||||||||||||||||||||||||||||||||||
HINGHAM | MA | 02043 | Form filed by More than One Reporting | ||||||||||||||||||||||||||||||||||||
Person | |||||||||||||||||||||||||||||||||||||||
(City) | (State) | (Zip) | |||||||||||||||||||||||||||||||||||||
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||||||||||||||||||
1. Title of Security (Instr. 3) | 2. Transaction | 2A. Deemed | 3. | 4. Securities Acquired (A) or | 5. Amount of | 6. Ownership | 7. Nature | ||||||||||||||||||||||||||||||||
Date | Execution Date, | Transaction | Disposed Of (D) (Instr. 3, 4 and | Securities | Form: Direct | of Indirect | |||||||||||||||||||||||||||||||||
(Month/Day/Year) | if any | Code (Instr. | 5) | Beneficially | (D) or Indirect | Beneficial | |||||||||||||||||||||||||||||||||
(Month/Day/Year) | 8) | Owned Following | (I) (Instr. 4) | Ownership | |||||||||||||||||||||||||||||||||||
Reported | (Instr. 4) | ||||||||||||||||||||||||||||||||||||||
Code | V | Amount | (A) or | Price | Transaction(s) | ||||||||||||||||||||||||||||||||||
(D) | (Instr. 3 and 4) | ||||||||||||||||||||||||||||||||||||||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||||||||||||||||||
(e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||||||||||||||||||||||||||
1. Title of | 2. | 3. Transaction | 3A. Deemed | 4. | 5. Number | 6. Date Exercisable and | 7. Title and | 8. Price of | 9. Number of | 10. | 11. Nature | ||||||||||||||||||||||||||||
Derivative | Conversion | Date | Execution Date, | Transaction | of | Expiration Date | Amount of | Derivative | derivative | Ownership | of Indirect | ||||||||||||||||||||||||||||
Security | or Exercise | (Month/Day/Year) | if any | Code (Instr. | Derivative | (Month/Day/Year) | Securities | Security | Securities | Form: | Beneficial | ||||||||||||||||||||||||||||
(Instr. 3) | Price of | (Month/Day/Year) | 8) | Securities | Underlying | (Instr. 5) | Beneficially | Direct (D) | Ownership | ||||||||||||||||||||||||||||||
Derivative | Acquired | Derivative Security | Owned | or Indirect | (Instr. 4) | ||||||||||||||||||||||||||||||||||
Security | (A) or | (Instr. 3 and 4) | Following | (I) (Instr. 4) | |||||||||||||||||||||||||||||||||||
Disposed | Reported | ||||||||||||||||||||||||||||||||||||||
of (D) | Transaction(s) | ||||||||||||||||||||||||||||||||||||||
(Instr. 3, 4 | (Instr. 4) | ||||||||||||||||||||||||||||||||||||||
and 5) | |||||||||||||||||||||||||||||||||||||||
Amount | |||||||||||||||||||||||||||||||||||||||
or | |||||||||||||||||||||||||||||||||||||||
Date | Expiration | Number | |||||||||||||||||||||||||||||||||||||
Code | V | (A) | (D) | Title | of | ||||||||||||||||||||||||||||||||||
Exercisable | Date | Shares | |||||||||||||||||||||||||||||||||||||
Stock | Common | ||||||||||||||||||||||||||||||||||||||
Stock, | |||||||||||||||||||||||||||||||||||||||
Option | (1) | 4,902 | |||||||||||||||||||||||||||||||||||||
$8.16 | 08/14/2020 | A | 4,902 | 08/14/2030 | par value | $0 | 4,902 | D | |||||||||||||||||||||||||||||||
(Right to | |||||||||||||||||||||||||||||||||||||||
$0.01 per | |||||||||||||||||||||||||||||||||||||||
Buy) | |||||||||||||||||||||||||||||||||||||||
share | |||||||||||||||||||||||||||||||||||||||
Explanation of Responses:
1. The options vest as follows and in accordance with the terms of the Issuer's 2017 Equity Incentive Plan (the "Plan"): (a) on February 14, 2021, the option shall vest and shall become exercisable with respect to 25% of the common stock; and (b) on a quarterly basis over the next 30 months, the option shall equally vest and become exercisable with respect to the remaining 75% of the common stock, subject to acceleration pursuant to the terms of the Plan.
/s/ Tal Wenderow | 09/08/2020 | ||
** 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.
This is an excerpt of the original content. To continue reading it, access the original document here.
Attachments
- Original document
- Permalink
Disclaimer
Microbot Medical Inc. published this content on 09 September 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 10 September 2020 07:54:02 UTC