SEC Form 3 · accession 0001140361-16-088268
Microbot Medical Inc. · MBOT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Harel Gadot
Officer — Chairman and CEO · Director · 10% Owner
Period of report
Nov 28, 2016
Accepted (ET)
Nov 30, 2016 · 5:01 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000883975
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, par value $0.01 per shareF1 | holding | — | — | — | 2,652,704 | I | By MEDX Ventures Group, LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F2,F3 | — | holding | — | — | — | Nov 28, 2016 | Sep 1, 2024 | Common Stock, par value $0.01 per share | 1,167,960 | — | I |
Explanation of responses
- F1Mr. Gadot is the Chief Executive Officer, Company Group Chairman and majority equity owner of MEDX Venture Group and thus may be deemed to share voting and investment power over the shares beneficially owned by this entity.
- F2The exercise price of such options were to be determined pursuant to an independent valuation of the underlying shares on the date of grant, which valuation has not yet been obtained. The options were originally granted by Microbot Medical Ltd., a wholly-owned subsidiary of the Issuer ("Microbot"), to the Reporting Person in September 2014 and the underlying securities were the ordinary shares of Microbot. (Footnote continues in footnote (3)).
- F3On November 28, 2016, the Issuer assumed such options as part of its acquisition of Microbot. Upon the determination of the exercise price, the Reporting Person will amend this Form 3 accordingly.