o NoneEntity Type
0000883975
STEMCELLS INC
CYTOTHERAPEUTICS INC/DE
 
x Corporation
o Limited Partnership
o Limited Liability Company
o General Partnership
o Business Trust
o Other
Name of Issuer
 Microbot Medical Inc.
Jurisdiction of Incorporation/OrganizationDELAWARE 
Year of Incorporation/Organization
  x Over Five Years Ago
  o Within Last Five Years (Specify Year)  
  o Yet to Be Formed 



2. Principal Place of Business and Contact Information
Name of Issuer 
 Microbot Medical Inc. 
Street Address 1Street Address 2
 25 Recreation Park Drive, Unit 108 
CityState/Province/CountryZIP/Postal CodePhone No. of Issuer
 HINGHAM MASSACHUSETTS 02043 781-875-3605 



3. Related Persons
Last NameFirst NameMiddle Name
GadotHarel
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: x Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
Ben NaimDavid
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
 Chief Financial Officer

Last NameFirst NameMiddle Name
WaizerYoav
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
BornsteinYoseph
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

 
Last NameFirst NameMiddle Name
LaxminarainPratipatti
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
BurellScott
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
MaddenMartin
Street Address 1Street Address 2
25 Recreation Park Drive, Unit 108
CityState/Province/CountryZIP/Postal Code
HINGHAMMASSACHUSETTS02043
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

 


4. Industry Group
o Agriculture Health Care o Retailing
 Banking & Financial Services   x Biotechnology o Restaurants
  o Commercial Banking   o Health Insurance Technology
  o Insurance  o Hospitals & Physicians  o Computers
  o Investing  o Pharmaceuticals  o Telecommunications
  o Investment Banking  o Other Health Care  o Other Technology
  o Pooled Investment Fund

    Travel
  o Other Banking & Financial Services o Manufacturing  o Airlines & Airports
 Real Estate  o Lodging & Conventions
  o Commercial  o Tourism & Travel Services
  o Construction  o Other Travel
  o REITS & Finance o Other
  o Residential 
  o Other Real Estate 
o Business Services 
 Energy 
  o Coal Mining 
  o Electric Utilities 
  o Energy Conservation 
  o Environmental Services 
  o Oil & Gas 
  o Other Energy 


5. Issuer Size
Revenue RangeAggregate Net Asset Value Range
x No Revenues o No Aggregate Net Asset Value
o $1 - $1,000,000 o $1 - $5,000,000
o $1,000,001 - $5,000,000 o $5,000,001 - $25,000,000
o $5,000,001 - $25,000,000 o $25,000,001 - $50,000,000
o $25,000,001 - $100,000,000 o $50,000,001 - $100,000,000
o Over $100,000,000 o Over $100,000,000
o Decline to Disclose o Decline to Disclose
o Not Applicable o Not Applicable


6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
o Rule 504(b)(1) (not (i), (ii) or (iii)) o Rule 505
o Rule 504 (b)(1)(i) x Rule 506(b)
o Rule 504 (b)(1)(ii) o Rule 506(c)
o Rule 504 (b)(1)(iii) o Securities Act Section 4(a)(5)
  o Investment Company Act Section 3(c)

7. Type of Filing
x New Notice Date of First Sale 2019-12-27 o First Sale Yet to Occur
o Amendment

8. Duration of Offering
Does the Issuer intend this offering to last more than one year? o Yes x No

9. Type(s) of Securities Offered (select all that apply)
o Pooled Investment Fund Interests o Equity
o Tenant-in-Common Securities o Debt
o Mineral Property Securities x Option, Warrant or Other Right to Acquire Another Security
x Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security o Other (describe)
  


10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? o Yes x No
 
Clarification of Response (if Necessary) 
  

11. Minimum Investment
Minimum investment accepted from any outside investor$ 0 USD

12. Sales Compensation
RecipientRecipient CRD Number o None
 H.C. Wainwright & Co., LLC 375
(Associated) Broker or Dealer x None(Associated) Broker or Dealer CRD Number x None
    
Street Address 1Street Address 2
 430 Park Avenue 3rd Floor
City State/Province/CountryZIP/Postal Code
 New York NEW YORK 10022
State(s) of Solicitation o All States o Foreign/Non-US
 NEW YORK
 

 



13. Offering and Sales Amounts
Total Offering Amount $   USD x Indefinite
Total Amount Sold $ 0 USD 
Total Remaining to be Sold $   USD x Indefinite
 
Clarification of Response (if Necessary)
 This Form D is being filed in connection with warrants issued to H.C. Wainwright & Co., LLC as partial compensation in connection with a registered direct offering by the Issuer.


14. Investors
o Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
 
  Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: 1


15. Sales Commissions & Finders’ Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions$ 0 USD o Estimate
Finders' Fees$ 0 USD o Estimate
 
Clarification of Response (if Necessary)
 H.C. Wainright & Co., LLC received warrants to purchase 45,045 shares of common stock in connection with a registered direct offering by the Company on December 31, 2019 among other compensation.


16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
 $ 0 USD o
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