Initial Statement of Beneficial Ownership (3)
November 07 2019 - 6:17PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
*
Bassan Merav |
2. Date of Event Requiring Statement (MM/DD/YYYY)
10/28/2019
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3. Issuer Name and Ticker or Trading Symbol
BiomX Inc. [PHGE]
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(Last)
(First)
(Middle)
C/O BIOMX LTD., 7 PINHAS SAPIR ST., FLOOR 2 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Development Officer / |
(Street)
NESS ZIONA, L3 7414002
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Common Stock Options - Right to Buy | (1) | 10/10/2029 | Common Stock Options | 189997 | $10.00 | D | |
Explanation of Responses: |
(1) | 25% of these options shall vest on October 10, 2020. Thereafter, the remaining options shall vest in 12 equal quarterly installments over three years. As of the reporting date, options to purchase 189,997 shares of common stock were unvested. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Bassan Merav C/O BIOMX LTD. 7 PINHAS SAPIR ST., FLOOR 2 NESS ZIONA, L3 7414002 |
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| Chief Development Officer |
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Signatures
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/s/ Merav Bassan | | 11/5/2019 |
**Signature of Reporting Person | Date |
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