UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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SCHEDULE 13D
Under the Securities Exchange Act of 1934
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MICROBOT MEDICAL INC.
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(Name of Issuer)
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Common Stock, par value $0.01 per Share
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(Title of Class of Securities)
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59503A 105
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(CUSIP Number)
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Yoseph Bornstein
16 Iris Street
Rosh-Ha’Ayin, Israel 4858022
(+972) 544553007
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(Name, Address and Telephone Number of Person Authorized to
Receive Notices and Communications)
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November 28, 2016
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(Date of Event which Requires Filing of this Statement)
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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. o
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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.
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*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.
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CUSIP No.
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59503A 105
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1.
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Names of Reporting Person:
Yoseph Bornstein
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions)
(a) o
(b) o
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions):
SC
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
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o
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6.
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Citizenship or Place of Organization:
Israel
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON WITH
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7.
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Sole Voting Power:
None
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8.
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Shared Voting Power:
5,305,409 (see Item 5)
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9.
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Sole Dispositive Power:
None
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10.
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Shared Dispositive Power:
5,305,409 (see Item 5)
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person:
5,305,409
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
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o
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13.
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Percent of Class Represented by Amount in Row (11):
14.63%
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14.
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Type of Reporting Person (See Instructions):
IN
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CUSIP No.
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59503A 105
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1.
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Names of Reporting Person:
LSA- Life Science Accelerator Ltd.
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2.
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Check the Appropriate Box if a Member of a Group (See Instructions)
(a) o
(b) o
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3.
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SEC Use Only
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4.
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Source of Funds (See Instructions):
SC
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5.
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Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e)
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o
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6.
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Citizenship or Place of Organization:
Israel
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON WITH
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7.
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Sole Voting Power:
None
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8.
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Shared Voting Power:
5,305,409 (see Item 5)
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9.
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Sole Dispositive Power:
None
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10.
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Shared Dispositive Power:
5,305,409 (see Item 5)
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11.
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Aggregate Amount Beneficially Owned by Each Reporting Person:
5,305,409
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12.
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Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions):
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o
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13.
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Percent of Class Represented by Amount in Row (11):
14.63%
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14.
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Type of Reporting Person (See Instructions):
OO
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(a)
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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 14.63% of the outstanding Common Stock based on 36,254,240 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.
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(b)
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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.
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(c)
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Except as described herein, the Reporting Person has not effected any transaction in Company Common Stock in the past 60 days.
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(d) and (e)
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Not applicable
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Exhibit 1: Agreement and Plan of Merger and Reorganization (1)
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(1)
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Incorporated by reference to the Company’s Proxy Statement on Schedule 14A filed with the SEC on September 27, 2016.
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By:
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/s/ Yoseph Bornstein
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Name:
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Yoseph Bornstein
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