SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 12/31/2015 | 3. Issuer Name and Ticker or Trading Symbol ReWalk Robotics Ltd. [ RWLK ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Ordinary Shares, par value NIS 0.01 per share | 2,715(1) | I | ESOP |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Option (Right to buy) | (2) | 07/17/2023 | Ordinary Shares | 8,530 | 1.32 | D | |
Option (Right to buy) | (3) | 12/24/2023 | Ordinary Shares | 15,498 | 1.49 | D | |
Option (Right to buy) | (4) | 12/15/2024 | Ordinary Shares | 5,657 | 20.77 | D | |
Option (Right to buy) | (5) | 09/25/2025 | Ordinary Shares | 25,000 | 8 | D |
Explanation of Responses: |
1. Represents 2,715 ordinary shares issuable upon the vesting of restricted stock units ("RSUs") granted under the ReWalk 2014 Equity Incentive Plan on January 9, 2015. The RSUs vest in four equal annual installments starting on the first anniversary of the date of grant. |
2. Represents stock options granted under the ReWalk 2012 Equity Incentive Plan on August 1, 2013. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant. Original option grant was for 13,320 ordinary shares of which 4,790 have been exercised, leaving 8,530 shares underlying options outstanding. |
3. Represents stock options granted under the ReWalk 2012 Equity Incentive Plan on August 1, 2013. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant. Original option grant was for 21,708 ordinary shares of which 6,210 have been exercised, leaving 15,498 shares underlying options outstanding. |
4. Represents stock options granted under the ReWalk 2014 Equity Incentive Plan on December 15, 2014. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant. |
5. Represents stock options granted under the ReWalk 2014 Equity Incentive Plan on September 25, 2015. The options become vested and exercisable in 12 equal quarterly installments starting on the first anniversary of the date of grant. |
Remarks: |
Exhibit 24.1 - Power of Attorney |
/s/ Kevin Hershberger as attorney-in-fact | 12/31/2015 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |