0000899243-15-005068.txt : 20150921 0000899243-15-005068.hdr.sgml : 20150921 20150921143215 ACCESSION NUMBER: 0000899243-15-005068 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150918 FILED AS OF DATE: 20150921 DATE AS OF CHANGE: 20150921 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: GI DYNAMICS, INC. CENTRAL INDEX KEY: 0001245791 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE MAGUIRE ROAD CITY: LEXINGTON STATE: MA ZIP: 02421 BUSINESS PHONE: 781-357-3310 MAIL ADDRESS: STREET 1: ONE MAGUIRE ROAD CITY: LEXINGTON STATE: MA ZIP: 02421 FORMER COMPANY: FORMER CONFORMED NAME: GI DYNAMICS INC DATE OF NAME CHANGE: 20030623 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DALE MICHAEL D CENTRAL INDEX KEY: 0001172346 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55195 FILM NUMBER: 151117120 MAIL ADDRESS: STREET 1: 1350 ENERGY LANE SUITE 110 CITY: ST PAUL STATE: MN ZIP: 55108 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-09-18 0 0001245791 GI DYNAMICS, INC. GID 0001172346 DALE MICHAEL D 25 HARTWELL AVENUE LEXINGTON MA 02421 1 1 0 0 President and CEO Common Stock 2015-09-18 4 M 0 20886 A 20886 D Restricted Stock Unit (RSU) 2015-09-18 4 M 0 20886 0.00 D 2024-09-18 Common Stock 20886 62658 D Restricted stock units convert into common stock on a one-for-one basis. There is no exercise price associated with the RSU. The RSU vests as to twenty-five percent (25%) of the shares on each of the first four anniversaries of the date of grant: September 18 in 2015, 2016, 2017 and 2018. In the event of a change of control of the Issuer, the RSU shall become vested in full. /s/ Robert Solomon, attorney-in-fact 2015-09-21