SEC Form 4/A · accession 0001209191-16-114635
Microbot Medical Inc. · MBOT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Gregory T Schiffman
Officer — Chief Financial Officer
Period of report
Mar 14, 2016
Accepted (ET)
Apr 18, 2016 · 8:53 pm EDT
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 | Mar 14, 2016 | P | 166,000 | $0.30 | A | 1,599,717 | D | |
| Common StockF3 | holding | — | — | — | 21,597 | I | By 401(k) plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Warrants (right to buy)F4 | $0.30 | Mar 14, 2016 | P | 83,000 | A | Mar 14, 2016 | Mar 14, 2018 | Common Stock | 83,000 | 83,000 | D |
| Series B Warrants (right to buy)F4,F5 | $0.42 | Mar 14, 2016 | P | 124,500 | A | Mar 14, 2017 | Mar 14, 2022 | Common Stock | 124,500 | 207,500 | D |
Explanation of responses
- F1Represents common shares purchased by the reporting person in an underwritten public offering by the issuer, in which investors acquired a fixed ratio of common stock at a purchase price of $0.2999998 per share, Series A common stock warrants at a purchase price of $0.0000001 per Series A warrant, and Series B common stock warrants at a purchase price of $0.0000001 per Series B warrant.
- F2Includes (1) 175,000 restricted stock units, with 87,500 of these vesting on each of January 1, 2017 and January 1, 2018; and (2) 118,666 restricted stock units, with 59,333 of these vesting on each of January 8, 2017 and January 8, 2018; and (3) 970,000 restricted stock units with performance based vesting.
- F3Shares held in 401(k) account in accordance with issuer's employer-match policies.
- F4Represents warrants purchased by the reporting person in an underwritten public offering by the issuer, in which investors acquired a fixed ratio of common stock at a purchase price of $0.2999998 per share, Series A common stock warrants at a purchase price of $0.0000001 per Series A warrant, and Series B common stock warrants at a purchase price of $0.0000001 per Series B warrant.
- F5The Series B Warrants issued in the issuer's underwritten public offering on March 14, 2016 will become exercisable upon the later of (i) issuer's receipt of stockholder approval to effect a reverse stock split so as to permit the exercise in full of the outstanding Series B Warrants and (ii) 12 months from the date of issuance, and will expire five years from the date on which such Series B Warrants become exercisable.