0000899243-19-024042.txt : 20190923 0000899243-19-024042.hdr.sgml : 20190923 20190923154307 ACCESSION NUMBER: 0000899243-19-024042 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190919 FILED AS OF DATE: 20190923 DATE AS OF CHANGE: 20190923 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Carter Charles Ross CENTRAL INDEX KEY: 0001779359 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55195 FILM NUMBER: 191107970 MAIL ADDRESS: STREET 1: C/O GI DYNAMICS, INC. STREET 2: 745 ATLANTIC AVENUE CITY: BOSTON STATE: MA ZIP: 02111 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: 745 ATLANTIC AVE STREET 2: OFFICE NO. 708 CITY: BOSTON STATE: MA ZIP: 02111 BUSINESS PHONE: 781-357-3310 MAIL ADDRESS: STREET 1: 745 ATLANTIC AVE STREET 2: OFFICE NO. 708 CITY: BOSTON STATE: MA ZIP: 02111 FORMER COMPANY: FORMER CONFORMED NAME: GI DYNAMICS INC DATE OF NAME CHANGE: 20030623 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-09-19 0 0001245791 GI DYNAMICS, INC. ASX:GID 0001779359 Carter Charles Ross 320 CONGRESS STREET, FLOOR 3 BOSTON MA 02210 0 1 0 0 CFO and Secretary Stock Option (right to buy) 1.1204 2019-09-19 4 A 0 385226 0.00 A 2029-09-19 Common Stock 385226 385226 D The option will vest over a four (4) year period, with one quarter (1/4) of the shares subject to the Option vesting on the one (1) year anniversary of the transaction date, and the remaining shares vesting on a quarterly basis over the following three (3) years of continuous service, provided that you are providing services to the Company as an employee or consultant on such vesting dates (no vesting will occur following the termination of employment or consulting services). /s/ Charles R. Carter 2019-09-23