SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Jasinski Lawrence J

(Last) (First) (Middle)
C/O REWALK ROBOTICS LTD.
3 HATNUFA ST. P.O. BOX 161

(Street)
YOKNEAM ILIT L3 20692203

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/31/2015
3. Issuer Name and Ticker or Trading Symbol
ReWalk Robotics Ltd. [ RWLK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Ordinary Shares, par value NIS 0.01 per share 30,175(1) I ESOP
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Option (Right to buy) (2) 05/01/2022 Ordinary Shares 248,220 $1.32 D
Option (Right to buy) (3) 12/24/2023 Ordinary Shares 141,030 $1.49 D
Option (Right to buy) (4) 12/15/2024 Ordinary Shares 62,864 $20.77 D
Option (Right to buy) (5) 12/03/2025 Ordinary Shares 130,000 $7.3 D
Explanation of Responses:
1. Represents 30,175 Ordinary Shares issuable upon the vesting of restricted stock units ("RSUs") granted under the ReWalk 2014 Equity Incentive Plan on December 15, 2014. One-fourth, or 7,544 Ordinary Shares, of the RSUs vested on the first anniversary of the date of grant and remaining RSUs vest in 16 equal quarterly installments starting one quarter after the first anniversary of the date of grant.
2. Represents stock options granted under the ReWalk 2012 Equity Incentive Plan on May 1, 2012. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant.
3. Represents stock options granted under the ReWalk 2012 Equity Incentive Plan on January 1, 2014. The options become vested and exercisable in 48 equal monthly installments starting one month following the date of grant.
4. Represents stock options granted under the ReWalk 2014 Equity Incentive Plan on December 15, 2014. The options become vested and exercisable in 48 equal monthly installments starting one month following the date of grant.
5. Represents stock options granted under the ReWalk 2014 Equity Incentive Plan on December 3, 2015. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant.
Remarks:
Exhibit 24.1 - Power of Attorney
/s/ Kevin Hershberger as attorney-in-fact 12/31/2015
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.