Initial Statement of Beneficial Ownership (3)
November 07 2019 - 6:19PM
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
*
Puttagunta Sailaja |
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 Medical 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) | 12/5/2028 | Common Stock Options | 183946 | $2.03 | I | By SPB Consulting LLC (4) |
Common Stock Options-Right to Buy | (2) | 12/5/2028 | Common Stock Options | 73579 | $2.03 | I | By SPB Consulting LLC (4) |
Common Stock Options-Right to Buy | (3) | 3/29/2029 | Common Stock Options | 6051 | $2.03 | I | By SPB Consulting LLC (4) |
Explanation of Responses: |
(1) | 25% of these options shall vest on December 5, 2019 . Thereafter, the remaining options shall vest in 12 equal quarterly installments over three years. As of the reporting date, options to purchase 183,946 shares of common stock were unvested. |
(2) | These options shall vest upon the achievement of specific performance-based milestones, as defined in the option grant. As of the reporting date, options to purchase 73,579 shares of common stock were unvested. |
(3) | 25% of these options shall vest on March 29, 2020. Thereafter, the remaining options shall vest in 12 equal quarterly installments over three years. As of the reporting date, options to purchase 6,051 shares of common stock were unvested. |
(4) | Options are held by SPB Consulting LLC. The reporting person is the sole member of SPB Consulting LLC and may be deemed the indirect beneficial owner of the securities held by SPB Consulting LLC. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Puttagunta Sailaja C/O BIOMX LTD. 7 PINHAS SAPIR ST., FLOOR 2 NESS ZIONA, L3 7414002 |
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| Chief Medical Officer |
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Signatures
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/s/ Sailaja Puttagunta | | 11/6/2019 |
**Signature of Reporting Person | Date |
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