0001213900-21-006789.txt : 20210204 0001213900-21-006789.hdr.sgml : 20210204 20210204163633 ACCESSION NUMBER: 0001213900-21-006789 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210128 FILED AS OF DATE: 20210204 DATE AS OF CHANGE: 20210204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VIRGILIO JOSEPH III CENTRAL INDEX KEY: 0001832913 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55195 FILM NUMBER: 21591701 MAIL ADDRESS: STREET 1: 320 CONGRESS ST STREET 2: 3RD FLOOR 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 X0306 4 2021-01-28 0 0001245791 GI DYNAMICS, INC. NONE 0001832913 VIRGILIO JOSEPH III 320 CONGRESS STREET, FLOOR 3 BOSTON MA 02210 1 1 0 0 President & CEO Stock Option (right to buy) 0.06 2021-01-28 4 A 0 11075869 0.00 A 2031-01-28 Common Stock 11075869 11075869 D The stock option grant was approved by the Issuer's board of directors on January 28, 2021. The stock options will vest over four years, with 25% vesting on January 28, 2022 and the remainder vesting in 12 quarterly installments thereafter, subject to such individual's continued service through each such date. In the event of a change of control of the Issuer prior to vesting, any unvested shares will become vested in full. /s/ Joseph Virgilio 2021-02-04