0001493152-21-024674.txt : 20211005
0001493152-21-024674.hdr.sgml : 20211005
20211005182006
ACCESSION NUMBER: 0001493152-21-024674
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210929
FILED AS OF DATE: 20211005
DATE AS OF CHANGE: 20211005
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Burell Scott R
CENTRAL INDEX KEY: 0001399318
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-19871
FILM NUMBER: 211308123
MAIL ADDRESS:
STREET 1: 6500 HARBOUR HEIGHTS PKWY #303
CITY: MUKILTEO
STATE: WA
ZIP: 98275
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Microbot Medical Inc.
CENTRAL INDEX KEY: 0000883975
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 943078125
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 25 RECREATION PARK DR SUITE 108
CITY: HINGHAM
STATE: MA
ZIP: 02043
BUSINESS PHONE: 908-938-5561
MAIL ADDRESS:
STREET 1: 25 RECREATION PARK DR SUITE 108
CITY: HINGHAM
STATE: MA
ZIP: 02043
FORMER COMPANY:
FORMER CONFORMED NAME: STEMCELLS INC
DATE OF NAME CHANGE: 20000524
FORMER COMPANY:
FORMER CONFORMED NAME: CYTOTHERAPEUTICS INC/DE
DATE OF NAME CHANGE: 19930328
4
1
ownership.xml
X0306
4
2021-09-29
0
0000883975
Microbot Medical Inc.
MBOT
0001399318
Burell Scott R
C/O MICROBOT MEDICAL INC.
25 RECREATION PARK DRIVE, UNIT 108
HINGHAM
MA
02043
1
0
0
0
Stock Option (Right to Buy)
7.00
2021-09-29
4
A
0
13571
0
A
2031-09-29
Common Stock, par value $0.01 per share
13571
13571
D
The options vest as follows and in accordance with the terms of the Issuer's 2020 Omnibus Performance Award Plan: (a) on March 29, 2022, the option shall vest and shall become exercisable with respect to 25% of the common stock; and (b) on a quarterly basis over the next 30 months, the option shall equally vest and become exercisable with respect to the remaining 75% of the common stock.
/s/ Scott Burell
2021-10-05