0001493152-20-020492.txt : 20201104
0001493152-20-020492.hdr.sgml : 20201104
20201104175437
ACCESSION NUMBER: 0001493152-20-020492
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201102
FILED AS OF DATE: 20201104
DATE AS OF CHANGE: 20201104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MIKA THOMAS
CENTRAL INDEX KEY: 0001263576
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36445
FILM NUMBER: 201287984
MAIL ADDRESS:
STREET 1: TEGAL CORP
STREET 2: 2201 SOUTH MCDOWELL BLVD
CITY: PETALUMA
STATE: CA
ZIP: 94954
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: NanoVibronix, Inc.
CENTRAL INDEX KEY: 0001326706
STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 525 EXECUTIVE BLVD
CITY: ELMSFORD
STATE: NY
ZIP: 10523
BUSINESS PHONE: (914) 233-3004
MAIL ADDRESS:
STREET 1: 525 EXECUTIVE BLVD
CITY: ELMSFORD
STATE: NY
ZIP: 10523
FORMER COMPANY:
FORMER CONFORMED NAME: Nano Vibronix, Inc.
DATE OF NAME CHANGE: 20111206
FORMER COMPANY:
FORMER CONFORMED NAME: Nano Vibronix Inc
DATE OF NAME CHANGE: 20050510
4
1
ownership.xml
X0306
4
2020-11-02
0
0001326706
NanoVibronix, Inc.
NAOV
0001263576
MIKA THOMAS
C/O NANOVIBRONIX, INC.
525 EXECUTIVE BOULEVARD
ELMSFORD
NY
10523
1
0
0
0
Option to Purchase Common Stock
2.57
2020-11-02
4
D
0
20000
0.00
D
2016-04-27
2025-04-27
Common Stock
20000
0
D
Option to Purchase Common Stock
5.35
2020-11-02
4
D
0
20000
0.00
D
2017-07-18
2026-07-18
Common Stock
20000
0
D
Option to Purchase Common Stock
4.75
2020-11-02
4
D
0
22083
0.00
D
2018-08-14
2028-08-14
Common Stock
22083
0
D
Option to Purchase Common Stock
4.75
2020-11-02
4
D
0
32500
0.00
D
2018-12-31
2028-08-14
Common Stock
32500
0
D
Option to Purchase Common Stock
2.83
2020-11-02
4
D
0
30000
0.00
D
2019-12-04
2029-12-04
Common Stock
30000
0
D
The options were canceled by mutual agreement of the reporting person and NanoVibronix, Inc. The reporting person received $1.00 as the aggregate consideration for the cancellations.
/s/ Thomas Mika
2020-11-04