0001213900-22-056966.txt : 20220919
0001213900-22-056966.hdr.sgml : 20220919
20220919161655
ACCESSION NUMBER: 0001213900-22-056966
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: Barlev Tuvia
CENTRAL INDEX KEY: 0001927656
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41375
FILM NUMBER: 221250805
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
0001927656
Barlev Tuvia
4039 CLIPPER COURT
FREMONT
CA
94538
1
1
0
0
CEO and Chairman of the Board
Restricted Stock Units
2022-09-15
4
A
0
125000
0
A
Common Stock, $0.0001 par value
125000
125000
D
The Restricted Stock Units (the "RSUs") were granted to the Reporting Person as compensation for serving as CEO and Chaiman of the Board. The RSUs vest yearly in three equal tranches, with the first tranche vesting on May 17, 2023, the second tranche vesting on May 17, 2024, and the last tranche vesting on May 17, 2025, subject to the Reporting Person's continued engagement with the Issuer through each date that the options shall vest, unless the Reporting Person's engagement with the Issuer as both CEO and board member is terminated, in which case the unvested RSUs will vest at the termination date, based on the upcoming annual anniversary amount, pro-rated to the date of termination. Each RSU represents a contingent right to receive one share of the Issuer's common stock or the cash value thereof. The Board, in its sole discretion, will determine in accordance with the terms and conditions of the Issuer's 2015 Equity Incentive Plan, as amended, the form of payout of the RSUs (cash and/or stock).
/s/ Tuvia Barlev
2022-09-18