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