0001213900-22-056956.txt : 20220919 0001213900-22-056956.hdr.sgml : 20220919 20220919161050 ACCESSION NUMBER: 0001213900-22-056956 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220915 FILED AS OF DATE: 20220919 DATE AS OF CHANGE: 20220919 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ruderman Jan CENTRAL INDEX KEY: 0001927476 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41375 FILM NUMBER: 221250724 MAIL ADDRESS: STREET 1: C/O ACTELIS NETWORKS, INC. STREET 2: 47800 WESTINGHOUSE DRIVE CITY: FREMONT STATE: CA ZIP: 94539 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ACTELIS NETWORKS INC CENTRAL INDEX KEY: 0001141284 STANDARD INDUSTRIAL CLASSIFICATION: COMMUNICATIONS EQUIPMENT, NEC [3669] IRS NUMBER: 522160309 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4039 CLIPPER COURT CITY: FREMONT STATE: CA ZIP: 94538 BUSINESS PHONE: 510-545-1040 MAIL ADDRESS: STREET 1: 4039 CLIPPER COURT CITY: FREMONT STATE: CA ZIP: 94538 4 1 ownership.xml X0306 4 2022-09-15 0 0001141284 ACTELIS NETWORKS INC ASNS 0001927476 Ruderman Jan 4039 CLIPPER COURT FREMONT CA 94538 0 1 0 0 CRO-Americas Stock Option (Right to Buy) 4.00 2022-09-15 4 A 0 21739 0 A 2032-09-15 Common Stock, $0.0001 par value 21739 21739 D The first quarter of the options will vest on December 21, 2022 ("Vesting Date"), with the remaining three-fourths of the options vesting over the next 36 months on each monthly anniversary date of the Vesting Date, subject to the Reporting Person remaining continuously employed through the final Vesting Date. /s/ Jan Ruderman 2022-09-18