|4Nov 30, 5:34 PM ET

Microbot Medical Inc. 4

4 · Microbot Medical Inc. · Filed Nov 30, 2016

Insider Transaction Report

Form 4
Period: 2016-11-28
Transactions
  • Other

    Common Stock

    2016-11-287,977,0921,776,457 total
  • Other

    Convertible Debenture

    2016-11-28+1,776,4571,776,457 total
    Exercise: $0.64Common Stock
  • Other

    Common Stock

    2016-11-28+9,753,5499,753,549 total
Footnotes (3)
  • [F1]Pursuant to a merger agreement effective as of November 28, 2016 reported in a Form 8-K filed by the Issuer on November 29, 2016, Alpha Capital Anstalt ("Alpha") was issued 9,753,549 shares of common stock, which immediately following the merger were surrendered by Alpha to the Issuer pursuant to the terms of a Right to Shares Agreement. The Right to Shares Agreement contains a 4.99% "blocker" provision designed to prevent Alpha from being a beneficial owner of more than 4.99% of the Issuer's Common Stock. Therefore, Alpha is no longer an affiliate of the Issuer.
  • [F2]In connection with the merger on November 28, 2016, Alpha exchanged a non-convertible note for a convertible debenture containing a 4.99% "blocker" provision.
  • [F3]The number of shares owned by Alpha does not include any shares issued to Lane Ventures, Inc., a consultant of the Issuer. Alpha disclaims beneficial ownership of any of the shares issued to Lane Ventures, Inc.

Documents

1 file
  • 4
    f4112816alpha_microbotmed.xmlPrimary

    OWNERSHIP DOCUMENT