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