0001213900-19-026408.txt : 20191218 0001213900-19-026408.hdr.sgml : 20191218 20191218100522 ACCESSION NUMBER: 0001213900-19-026408 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191216 FILED AS OF DATE: 20191218 DATE AS OF CHANGE: 20191218 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Thompson Juliet CENTRAL INDEX KEY: 0001715258 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55195 FILM NUMBER: 191291530 MAIL ADDRESS: STREET 1: 355 CONGRESS STREET, 4TH FLOOR STREET 2: C/O GI DYNAMICS, INC. CITY: BOSTON STATE: MA ZIP: 02210 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: 320 CONGRESS STREET STREET 2: 3RD FLOOR CITY: BOSTON STATE: MA ZIP: 02210 BUSINESS PHONE: 781-357-3310 MAIL ADDRESS: STREET 1: 320 CONGRESS STREET STREET 2: 3RD FLOOR CITY: BOSTON STATE: MA ZIP: 02210 FORMER COMPANY: FORMER CONFORMED NAME: GI DYNAMICS INC DATE OF NAME CHANGE: 20030623 4 1 ownership.xml OWNERSHIP DOCUMENT X0306 4 2019-12-16 0 0001245791 GI DYNAMICS, INC. GID 0001715258 Thompson Juliet 320 CONGRESS STREET, FLOOR 3 BOSTON MA 02210 1 0 0 0 Stock Option (right to buy) 1.34 2019-12-16 4 A 0 30000 0.00 A 2029-12-16 Common Stock 30000 30000 D The stock option grant was approved by the Issuer's board of directors on October 29, 2019, subject to stockholder approval, and by the stockholders of the Issuer on December 16, 2019. The stock options will fully vest on October 29, 2020. In the event of a change of control of the Issuer prior to October 29, 2020, the stock options will become vested in full. /s/ Juliet Thompson 2019-12-16