| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
| Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10. | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
NanoVibronix, Inc. [ NAOV ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/15/2023 | ||||||||||||||||||||||||||
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4. 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 Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Option to Purchase Common Stock | $1.24 | 11/15/2023 | A | 3,334 | (1) | 11/15/2033 | Common Stock | 3,334 | $0 | 3,334 | D | ||||
| Option to Purchase Common Stock | $32 | 11/29/2023 | D | 1,500 | 07/13/2020 | 07/13/2030 | Common Stock | 1,500 | $0(5) | 0 | D | ||||
| Option to Purchase Common Stock | $8.94 | 11/29/2023 | D | 3,000 | (2) | 09/13/2032 | Common Stock | 3,000 | $0(5) | 0 | D | ||||
| Option to Purchase Common Stock | $14.4 | 11/29/2023 | D | 2,000 | 10/01/2020 | 10/01/2030 | Common Stock | 2,000 | $0(5) | 0 | D | ||||
| Option to Purchase Common Stock | $16.8 | 11/29/2023 | D | 4,500 | (3) | 12/22/2030 | Common Stock | 4,500 | $0(5) | 0 | D | ||||
| Option to Purchase Common Stock | $20.2 | 11/29/2023 | D | 3,000 | (4) | 12/29/2031 | Common Stock | 3,000 | $0(5) | 0 | D | ||||
| Explanation of Responses: |
| 1. 100% of the option vested on November 15, 2023, in accordance with that certain option agreement entered into by and between the Issuer and the reporting person and the NanoVibronix, Inc. 2014 Long-Term Incentive Plan. |
| 2. 25% of the option vested on September 13, 2022 (the "2022 Date of Grant"), with an additional 25% to vest on the three-month anniversary of the 2022 Date of Grant, a further 25% to vest on the six-month anniversary of the 2022 Date of Grant, and the final 25% to vest on the nine-month anniversary of the 2022 Date of Grant, in accordance with that certain option agreement entered into by and between the Issuer and the reporting person and the NanoVibronix, Inc. 2014 Long-Term Incentive Plan. |
| 3. 20% of the option vested on December 22, 2020 (the "2020 Date of Grant"), with an additional 20% vested on the three month anniversary of the 2020 Date of Grant, a further 20% vested on the six month anniversary of the 2020 Date of Grant, a further 20% vested on the nine month anniversary of the 2020 Date of Grant, and the final 20% vested on the year anniversary of the 2020 Date of Grant, in accordance with that certain option agreement entered into by and between the Issuer and the reporting person and the NanoVibronix, Inc. 2014 Long-Term Incentive Plan. |
| 4. 25% of the option vested on December 29, 2021 (the " 2021 Date of Grant"), with an additional 25% vested on the three-month anniversary of the 2021 Date of Grant, a further 25% vested on the six-month anniversary of the 2021 Date of Grant, and the final 25% vested on the nine-month anniversary of the 2021 Date of Grant, in accordance with that certain option agreement entered into by and between the Issuer and the reporting person and the NanoVibronix, Inc. 2014 Long-Term Incentive Plan. |
| 5. The options were canceled by mutual agreement of the reporting person and NanoVibronix, Inc. The reporting person received $1.00 as the aggregate consideration for the cancellations. |
| /s/ Thomas Mika | 12/04/2023 | |
| ** 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 4 (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. | ||