0001213900-21-063551.txt : 20211206 0001213900-21-063551.hdr.sgml : 20211206 20211206122257 ACCESSION NUMBER: 0001213900-21-063551 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211202 FILED AS OF DATE: 20211206 DATE AS OF CHANGE: 20211206 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cohen Assaf CENTRAL INDEX KEY: 0001733131 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-49877 FILM NUMBER: 211472556 MAIL ADDRESS: STREET 1: ZHR INDUSTRIAL ZONE, P.O. BOX 32 CITY: ROSH PINA STATE: L3 ZIP: 1200001 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ON TRACK INNOVATIONS LTD CENTRAL INDEX KEY: 0001021604 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 000000000 STATE OF INCORPORATION: L3 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: HATNUFA 5 STREET 2: YOKNEAM INDUSTRIAL ZONE CITY: YOKNEAM STATE: L3 ZIP: 2069200 BUSINESS PHONE: 972 4 686-8021 MAIL ADDRESS: STREET 1: HATNUFA 5 STREET 2: YOKNEAM INDUSTRIAL ZONE CITY: YOKNEAM STATE: L3 ZIP: 2069200 4 1 ownership.xml X0306 4 2021-12-02 0 0001021604 ON TRACK INNOVATIONS LTD OTIVF 0001733131 Cohen Assaf HATNUFA 5, YOKNEAM INDUSTRIAL ZONE BOX 372 YOKNEAM L3 2069200 ISRAEL 0 1 0 0 Chief Financial Officer Ordinary Shares 2021-12-02 4 A 0 400000 A 400000 D Stock Option (right to buy) 1.21 2021-12-02 4 D 0 15000 0 D Ordinary Shares 15000 0 D Stock Option (right to buy) 0.84 2021-12-02 4 D 0 20000 0 D Ordinary Shares 20000 0 D Stock Option (right to buy) 0.38 2021-12-02 4 D 0 100000 0 D Ordinary Shares 100000 0 D Stock Option (right to buy) 0.22 2021-12-02 4 D 0 50000 0 D Ordinary Shares 50000 0 D Upon vesting of such ordinary shares, as described in Note 2 below, the Reporting Person shall be required to pay the par value of the shares no longer subject to restriction of NIS 0.1. The ordinary shares vest as follows: (i) 50,000 shares will vest in two equal instalments on each of 12/02/2022 and 12/02/2023; and (ii) 350,000 shares will vest in three equal instalments on each of 12/02/2022, 12/02/2023 and 12/02/2024, all subject to the terms and provisions of the Issuer's 2021 equity incentive plan. The options were disposed of to the Issuer according to the Reporting Person's consent to the cancellation thereof in connection with the grant of the ordinary shares listed in Table I. /s/ Assaf Cohen 2021-12-06