Microbot Medical : Form-4

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

Bornstein Yoseph

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.

08/17/2020

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 of

Date

Execution Date,

Transaction

Disposed Of (D) (Instr. 3, 4 and 5)

Securities

Form: Direct

Indirect

(Month/Day/Year)

if any

Code (Instr.

Beneficially

(D) or

Beneficial

(Month/Day/Year)

8)

Owned

Indirect (I)

Ownership

Following

(Instr. 4)

(Instr. 4)

(A) or

Reported

Code

V

Amount

Price

Transaction(s)

(D)

(Instr. 3 and 4)

By LSA-

Common Stock

08/17/2020

S

15,000

D

$10.1784

287,028(1)

I

LifeScience

Accelerator

Ltd.(2)

By LSA-

Common Stock

08/17/2020

S

119

D

$11.9113

286,909(1)

I

LifeScience

Accelerator

Ltd.(2)

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

Owned

or Indirect

(Instr. 4)

Security

(A) or

Security (Instr.

Following

(I) (Instr. 4)

Disposed

3 and 4)

Reported

of (D)

Transaction(s)

(Instr. 3, 4

(Instr. 4)

and 5)

Amount

or

Number

Date

Expiration

of

Code

V

(A)

(D)

Exercisable

Date

Title

Shares

Explanation of Responses:

1. Reporting Person, through his Rule 10b5-1 trading plan, sold an aggregate of 15,119 shares of Issuer common stock on August 17, 2020. Accordingly, Reporting Person beneficially owned 286,909 shares of Issuer common stock following the reported transactions.
2. Mr. Bornstein is the CEO and Director of LSA- Life Science Accelerator Ltd. ("LSA") and of Shizim Ltd. ("Shizim"), and Mr. Bornstein is the majority equity owner of Shizim. Shizim is the majority equity owner of LSA. Accordingly, Mr. Bornstein may be deemed to share voting and investment power over the shares beneficially owned by these entities.

/s/ Yossi Bornstein		08/19/2020
** 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.