SEC Form 4 · accession 0001209191-15-003523
Microbot Medical Inc. · MBOT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ann Tsukamoto
Officer — EVP, Research and Development
Period of report
Jan 27, 2012
Accepted (ET)
Jan 9, 2015 · 6:09 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 StockF1,F2 | Jan 8, 2015 | A | 250,000 | $0.00 | A | 627,506 | D | |
| Common StockF3,F4 | Jan 8, 2015 | A | 100,000 | $0.00 | A | 727,506 | D | |
| Common StockF5 | holding | — | — | — | 3,643 | I | family trust | |
| Common StockF6 | holding | — | — | — | 26,490 | I | By 401(k) Plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Restricted stock units, with 1/3 vesting on each of January 8, 2016, January 8, 2017, and January 8, 2018.
- F2Includes (1) 210,000 restricted stock units, with 70,000 of these vesting on each of June 6, 2015, June 6, 2026, and June 6, 2017; (2) 43,333 restricted stock units vesting on January 27, 2015; and (3) 250,000 restricted stock units, with 83,333 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) 210,000 restricted stock units, with 70,000 of these vesting on each of June 6, 2015, June 6, 2026, and June 6, 2017; (2) 43,333 restricted stock units vesting on January 27, 2015; (3) 250,000 restricted stock units, with 83,333 of these vesting on each of January 8, 2016, January 8, 2017, and January 8, 2018; and (4) 100,000 restricted stock units with performance based vesting.
- F52,284 shares held in trust as to which Dr. Tsukamoto disclaims beneficial ownership.
- F6Shares held in 401(k) account in accordance with issuer's employer-match policies.