0001493152-17-010331.txt : 20170907
0001493152-17-010331.hdr.sgml : 20170907
20170907192030
ACCESSION NUMBER: 0001493152-17-010331
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170830
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: 171074893
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
2017-08-30
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
2017-08-30
4
S
0
5000
1.07
D
5275409
I
By LSA- LifeScience Accelerator Ltd.
Common Stock
2017-08-30
4
S
0
5000
1.0605
D
5270409
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