0001213900-22-080901.txt : 20221219 0001213900-22-080901.hdr.sgml : 20221219 20221219161146 ACCESSION NUMBER: 0001213900-22-080901 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221215 FILED AS OF DATE: 20221219 DATE AS OF CHANGE: 20221219 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: 221471197 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 2022-12-15 0 0001141284 ACTELIS NETWORKS INC ASNS 0001927476 Ruderman Jan 4039 CLIPPER COURT FREMONT CA 94538 0 1 0 0 CRO-Americas Restricted Stock Unit 2022-12-15 4 A 0 68000 0 A Common Stock, $0.0001 par value 68000 68000 D The first third of the Restricted Stock Units ("RSUs") will vest on September 29, 2023 ("Vesting Date"), with the remaining two-thirds of the RSUs vesting in equal increments over the next two years on each annual anniversary date following the Vesting Date, until September 29, 2025, at which point the RSU grants shall be fully vested, subject to the Reporting Person remaining continuously employed through the final Vesting Date, unless the Reporting Person's engagement with the Issuer 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 of directors of the Issuer, 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/ Jan Ruderman 2022-12-19