0000899243-17-001471.txt : 20170118 0000899243-17-001471.hdr.sgml : 20170118 20170118170209 ACCESSION NUMBER: 0000899243-17-001471 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170112 FILED AS OF DATE: 20170118 DATE AS OF CHANGE: 20170118 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: Schorer Scott CENTRAL INDEX KEY: 0001670397 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55195 FILM NUMBER: 17534011 MAIL ADDRESS: STREET 1: 25 HARTWELL AVENUE STREET 2: C/O GI DYNAMICS, INC. CITY: LEXINGTON STATE: MA ZIP: 02421 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-01-12 0 0001245791 GI DYNAMICS, INC. GID 0001670397 Schorer Scott 355 CONGRESS STREET BOSTON MA 02110 0 1 0 0 President and CEO Stock Option (right to buy) 0.78 2017-01-12 4 A 0 170600 0.00 A 2027-01-12 Common Stock 170600 420600 D The option vests in equal amounts on a quarterly basis over four (4) years until January 12, 2021. In the event of a change of control of the Issuer, the option shall become vested in full. /s/ Adam Davey, Attorney-in-fact 2017-01-18