Amended Statement of Beneficial Ownership (sc 13d/a)
June 20 2017 - 4:55PM
Edgar (US Regulatory)
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
SCHEDULE
13D
Under
the Securities Exchange Act of 1934
(Amendment
No. 2)*
MICROBOT
MEDICAL INC.
(Name
of Issuer)
Common
Stock, par value $0.01 per Share
(Title
of Class of Securities)
59503A
105
(CUSIP
Number)
Yoseph
Bornstein
16
Irus Street
Rosh-Ha’Ayin,
Israel 4858022
(+972)
544553007
(Name,
Address and Telephone Number of Person Authorized to
Receive
Notices and Communications)
June
8, 2017
(Date
of Event which Requires Filing of this Statement)
If
the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule
13D, and is filing this schedule because of §§240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box. [
]
NOTE
:
Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See Rule
13d-7 for other parties to whom copies are to be sent.
*The
remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the
subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in
a prior cover page.
The
information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section
18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the Notes).
1.
|
Names
of Reporting Person:
Yoseph
Bornstein
|
|
2.
|
Check
the Appropriate Box if a Member of a Group (See Instructions)
(a)
[ ]
(b)
[ ]
|
|
3.
|
SEC
Use Only
|
|
4.
|
Source
of Funds (See Instructions):
OO
(1)
|
|
5.
|
Check
if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
|
[ ]
|
6.
|
Citizenship
or Place of Organization:
Israel
|
|
NUMBER
OF
SHARES
BENEFICIALLY
OWNED
BY
EACH
REPORTING
PERSON
WITH
|
7.
|
Sole
Voting Power:
None
|
8.
|
Shared
Voting Power:
5,305,409
(see Item 5)
|
9.
|
Sole
Dispositive Power:
None
|
10.
|
Shared
Dispositive Power:
5,305,409
(see Item 5)
|
11.
|
Aggregate
Amount Beneficially Owned by Each Reporting Person:
5,305,409
|
|
12.
|
Check
if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
|
[ ]
|
13.
|
Percent
of Class Represented by Amount in Row (11):
15.94%
|
|
14.
|
Type
of Reporting Person (See Instructions):
IN
|
|
(1)
No change in beneficial ownership of Reporting Person. See Item 3.
1.
|
Names
of Reporting Person:
LSA-
Life Science Accelerator Ltd.
|
|
2.
|
Check
the Appropriate Box if a Member of a Group (See Instructions)
(a)
[ ]
(b)
[ ]
|
|
3.
|
SEC
Use Only
|
|
4.
|
Source
of Funds (See Instructions):
OO
(1)
|
|
5.
|
Check
if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
|
[ ]
|
6.
|
Citizenship
or Place of Organization:
Israel
|
|
NUMBER
OF
SHARES
BENEFICIALLY
OWNED
BY
EACH
REPsORTING
PERSON
WITH
|
7.
|
Sole
Voting Power:
None
|
8.
|
Shared
Voting Power:
5,305,409
(see Item 5)
|
9.
|
Sole
Dispositive Power:
None
|
10.
|
Shared
Dispositive Power:
5,305,409
(see Item 5)
|
11.
|
Aggregate
Amount Beneficially Owned by Each Reporting Person:
5,305,409
|
|
12.
|
Check
if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
|
[ ]
|
13.
|
Percent
of Class Represented by Amount in Row (11):
15.94%
|
|
14.
|
Type
of Reporting Person (See Instructions):
OO
|
|
(1)
No change in beneficial ownership of Reporting Person. See Item 3.
Item
1. Security and Issuer
This
statement on Schedule 13D (this “Statement”) relates to the issued and outstanding shares of common stock, par value
$0.01 per share (the “Company Common Stock”), of Microbot Medical Inc., a Delaware corporation (the “Company”).
The principal executive offices of the Company are located at 25 Recreation Park Drive, Unit 108, Hingham, MA 02043.
Item
2. Identity and Background
This
statement is filed pursuant to Rule 13d-1 under the Securities Exchange Act of 1934, as amended, by Yoseph Bornstein. Mr. Bornstein
is a natural person, and is a director on the Board of Directors of the Company, with an address of 16 Irus Street, Rosh-Ha’Ayin,
Israel 4858022.
Mr.
Bornstein has not, during the past five years, (i) been convicted in a criminal proceeding (excluding traffic violations or similar
misdemeanors); or (ii) been a party to a civil proceeding of a judicial or administrative body of competent jurisdiction where
as a result of such proceeding was or is subject to a judgment, decree or final order enjoining future violations of, or prohibiting
or mandating activities subject to federal or state securities laws or finding any violation with respect to such laws.
Mr.
Bornstein is an Israeli citizen.
Item
3. Source and Amount of Funds or Other Consideration
On
June 8, 2017, the Company closed on a securities purchase agreement with certain institutional investors for the purchase and
sale of an aggregate of 3,750,000 shares of the Company’s Common Stock (the “Stock Sale”). As a result of the
Stock Sale and other unregistered sales of the Company’s Common Stock as disclosed in the Company’s filings with the
Securities and Exchange Commission (collectively, the “Stock Issuances”), the number of outstanding shares of Common
Stock of the Company increased to approximately 33,276,333 as of June 12, 2017.
Item
4. Purpose of Transaction
As
a result of the Stock Sale and Stock Issuances, Mr. Bornstein’s beneficial ownership in the Company decreased to 15.94%
Mr.
Bornstein acquired beneficial ownership of the securities of the Company for investment purposes only and with no view to their
resale or other distribution of any kind and with no current plans or proposals with respect to the Company or any securities
of the Company which relate to or would result in:
(a)
The acquisition by any person of additional securities of the Issuer, or the disposition of securities of the Issuer;
(b)
An extraordinary corporate transaction, such as a merger, reorganization or liquidation, involving the Issuer or any of its subsidiaries;
(c)
A sale or transfer of a material amount of assets of the Issuer or any of its subsidiaries;
(d)
Any change in the present board of directors or management of the Issuer, including any plans or proposals to change the number
or term of directors or to fill any existing vacancies on the board;
(e)
Any material change in the present capitalization or dividend policy of the Issuer;
(f)
Any other material change in the issuer’s business or corporate structure including but not limited to, if the Issuer is
a registered closed-end investment company, any plans or proposals to make any changes in its investment policy for which a vote
is required by section 13 of the Investment Company Act of 1940;
(g)
Changes in the Issuer’s charter, bylaws or instruments corresponding thereto or other actions which may impede the acquisition
of control of the issuer by any person;
(h)
Causing a class of securities of the issuer to be delisted from a national securities exchange or to cease to be authorized to
be quoted in an inter-dealer quotation system of a registered national securities association;
(i)
A class of equity securities of the issuer becoming eligible for termination of registration pursuant to Section 12(g)(4) of the
Act; or
(j)
Any action similar to any of those enumerated above.
Reference
is made to Item 3 herein and hereby is incorporated by reference.
Item
5. Interest in Securities of the Issuer
(a)
|
As
of the date of this report, LSA - Life Science Accelerator Ltd. (“LSA”) beneficially
owns 5,305,409 shares of the Company Common Stock, which number of shares represents
approximately 15.94% of the outstanding Common Stock based on 33,276,333 shares of outstanding
Company Common Stock. Mr. Bornstein is the CEO and Director of 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.
The
percentage of ownership reported in this Item 5 was calculated in accordance with Rule 13d-3(d)(1)(i) promulgated under
the Securities Exchange Act of 1934, as amended.
|
|
|
(b)
|
Mr.
Bornstein has shared power with LSA to vote or direct the vote, and to dispose or direct the disposition, of 5,305,409 shares
of Company Common Stock.
|
|
|
(c)
|
Except
as described herein, the Reporting Person has not effected any transaction in Company Common Stock in the past 60 days.
|
|
|
(d)
and (e)
|
Not
applicable
|
Item
6. Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer
Reference
is made to Items 3 and 4 herein and hereby is incorporated by reference.
Item
7. Material to be Filed as Exhibits
Not
Applicable.
SIGNATURES
After
reasonable inquiry and to the best of my knowledge and belief, the undersigned certify that the information set forth in this
statement is true, complete and correct.
Date:
June 15, 2017
|
By:
|
/s/
Yoseph Bornstein
|
|
Name:
|
Yoseph
Bornstein
|
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