0000899243-16-016490.txt : 20160324
0000899243-16-016490.hdr.sgml : 20160324
20160324095124
ACCESSION NUMBER: 0000899243-16-016490
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160322
FILED AS OF DATE: 20160324
DATE AS OF CHANGE: 20160324
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: Keating Anne
CENTRAL INDEX KEY: 0001502902
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55195
FILM NUMBER: 161525865
MAIL ADDRESS:
STREET 1: 5751 COPLEY DRIVE
CITY: SAN DIEGO
STATE: CA
ZIP: 92111
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-03-22
0
0001245791
GI DYNAMICS, INC.
GID
0001502902
Keating Anne
25 HARTWELL AVENUE
LEXINGTON
MA
02421
1
0
0
0
Restricted Stock Unit (RSU)
2016-03-22
4
D
0
1000
0.00
D
2025-03-23
Common Stock
1000
0
D
There is no exercise price associated with the RSU.
The RSU was approved by GI Dynamics, Inc.'s board of directors on March 23, 2015, subject to shareholder approval. Such shareholder approval was received on June 9, 2015. By mutual agreement on March 22, 2016, the Reporting Person forfeited the RSU to the Issuer before the RSU was scheduled to vest in full on March 23, 2016.
/s/ Robert Solomon, attorney-in-fact
2016-03-24