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