SEC Form 4 · accession 0001209191-15-003514

Microbot Medical Inc. · MBOT

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Other

Period of report

Jan 8, 2015

Accepted (ET)

Jan 9, 2015 · 6:01 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^F1,F2	Jan 8, 2015	A	195,000	$0.00	A	333,588	D
Common Stock^F3,F4	Jan 8, 2015	A	65,500	$0.00	A	399,088	D
Common Stock^F5	holding	—	—		—	24,926	I	By 401(k) Plan

No Table II lines on this filing.

F1Restricted stock units, with 1/3 vesting on each of January 8, 2016, January 8, 2017, and January 8, 2018.
F2Includes (1) 75,000 restricted stock units, with 25,000 of this vesting on each of May 24, 2015, May 24, 2016, and May 24, 2017; (2) 20,000 restricted stock units, with 10,000 of this vesting on each of January 27, 2015 and January 27, 2016; and (3) 195,000 restricted stock units, with 65,000 of these vesting on each of January 8, 2016, January 8, 2017, and January 8, 2018.
F3Restricted stock units, with performance based vesting set by the issuer's Board of Directors and tied to the timely and successful conduct and completion of the issuer's Phase II clinical studies in dry AMD and spinal cord injury.
F4Includes (1) 75,000 restricted stock units, with 25,000 of this vesting on each of May 24, 2015, May 24, 2016, and May 24, 2017; (2) 20,000 restricted stock units, with 10,000 of this vesting on each of January 27, 2015 and January 27, 2016; (3) 195,000 restricted stock units, with 65,000 of these vesting on each of January 8, 2016, January 8, 2017, and January 8, 2018; and (4) 65,500 restricted stock units with performance based vesting.
F5Shares held in 401(k) account, in accordance with issuer's employer-match policies.