0001213900-19-007570.txt : 20190501
0001213900-19-007570.hdr.sgml : 20190501
20190501160619
ACCESSION NUMBER: 0001213900-19-007570
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190423
FILED AS OF DATE: 20190501
DATE AS OF CHANGE: 20190501
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SIECZKAREK MARK M
CENTRAL INDEX KEY: 0001188738
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-52545
FILM NUMBER: 19787455
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Wize Pharma, Inc.
CENTRAL INDEX KEY: 0001218683
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 880445167
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5B HANAGAR STREET
CITY: HOD HASHARON
STATE: L3
ZIP: 4527708
BUSINESS PHONE: 972 472 260 0536
MAIL ADDRESS:
STREET 1: 5B HANAGAR STREET
CITY: HOD HASHARON
STATE: L3
ZIP: 4527708
FORMER COMPANY:
FORMER CONFORMED NAME: OphthaliX, Inc.
DATE OF NAME CHANGE: 20120207
FORMER COMPANY:
FORMER CONFORMED NAME: DENALI CONCRETE MANAGEMENT INC
DATE OF NAME CHANGE: 20030213
3
1
ownership.xml
X0206
3
2019-04-23
0
0001218683
Wize Pharma, Inc.
WIZP
0001188738
SIECZKAREK MARK M
24 HANAGAR STREET
HOD HASHARON
L3
4527708
ISRAEL
1
1
0
0
Chairman
Restricted Stock Units
Common stock
202399
D
Stock Option (right to buy)
2.00
2029-04-22
Common stock
102222
D
Includes 202,399 restricted stock units ("RSUs") which represent a continent right to receive one share of common stock for each RSU. The RSUs vest 1/8 on April 23, 2019 and subsequently in seven equal quarterly installments beginning July 1, 2019. Upon a change of control, the RSUs shall automatically vest in full as of the date of the change of control.
Includes 102,222 options ("Options") to purchase one share of common stock for each option. The Options vest 1/8 on April 23, 2019 and subsequently in seven equal quarterly installments beginning July 1, 2019. Upon a change of control, the Options shall automatically vest in full as of the date of the change of control.
/s/ Mark Sierczkarek
2019-05-01