0001493152-17-010330.txt : 20170907 0001493152-17-010330.hdr.sgml : 20170907 20170907191713 ACCESSION NUMBER: 0001493152-17-010330 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170824 FILED AS OF DATE: 20170907 DATE AS OF CHANGE: 20170907 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bornstein Yoseph CENTRAL INDEX KEY: 0001690100 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19871 FILM NUMBER: 171074888 MAIL ADDRESS: STREET 1: 16 IRUS STREET CITY: ROSH HA'AYIN STATE: L3 ZIP: 4858022 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: 175 DERBY ST. 27/1 STREET 2: . CITY: HINGHAM STATE: MA ZIP: 02043 BUSINESS PHONE: 908-938-5561 MAIL ADDRESS: STREET 1: 175 DERBY ST. 27/1 STREET 2: . 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 form4.xml X0306 4 2017-08-24 0 0000883975 Microbot Medical Inc. MBOT 0001690100 Bornstein Yoseph C/O MICROBOT MEDICAL INC. 25 RECREATION PARK DRIVE, UNIT 108 HINGHAM MA 02043 1 0 1 0 Common Stock 2017-08-24 4 S 0 10000 1.0311 D 5295409 I By LSA- LifeScience Accelerator Ltd. Common Stock 2017-08-25 4 S 0 15000 1.0808 D 5280409 I By LSA- LifeScience Accelerator Ltd. Mr. Bornstein is the CEO and Director of LSA- Life Science Accelerator Ltd. ("LSA") and of Shizim Ltd. ("Shizim"), and Mr. Bornstein is the majority equity owner of Shizim. Shizim is the majority equity owner of LSA. Accordingly, Mr. Bornstein may be deemed to share voting and investment power over the shares beneficially owned by these entities. /s/ Yoseph Bornstein 2017-09-07