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