SEC Form 4 · accession 0001209191-15-007186
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, 2015
Accepted (ET)
Jan 28, 2015 · 7:34 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 StockF2 | Jan 27, 2015 | F | 20,995 | $1.07 | D | 706,511 | D | |
| Common StockF3 | holding | — | — | — | 3,643 | I | family trust | |
| Common StockF4 | holding | — | — | — | 26,369 | I | By 401(k) Plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1This is recorded as a Code F disposition because the shares were used by the reporting person to pay a tax liability incurred by her from the delivery of shares incident to the vesting of restricted stock units.
- 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) 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 (3) 100,000 restricted stock units with performance based vesting.
- F32,284 shares held in trust as to which Dr. Tsukamoto disclaims beneficial ownership.
- F4Shares held in 401(k) account in accordance with issuer's employer-match policies.