Initial Statement of Beneficial Ownership (3)
March 25 2021 - 10:11AM
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
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Mor George Adi |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/16/2021
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3. Issuer Name and Ticker or Trading Symbol
Chemomab Therapeutics Ltd. [CMMB]
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(Last)
(First)
(Middle)
15 KAFRISIN ST. |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director ___X___ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Executive Officer / |
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(Street)
TEL AVIV, L3 6901658
(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) |
| American Depositary Shares (1) | 649550 | D | |
| American Depositary Shares (1) | 514495 | I | By Kobi George, the Reporting Person's spouse |
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 |
| Option to purchase American Depositary Shares | (2) | 3/15/2028 | American Depositary Shares (1) | 131698 | $1.49 | D | |
| Option to purchase American Depositary Shares | (3) | 10/27/2026 | American Depositary Shares (1) | 33725 | $0.80 | I | By Kobi George, the Reporting Person's spouse |
| Explanation of Responses: |
| (1) | Each American Depositary Share (ADS) represents twenty (20) ordinary shares, no par value, of the Issuer. |
| (2) | 98,770 of these options have vested and are exercisable as of the date hereof. An additional 32,928 options will become exercisable in four equal installments, at each three month anniversary of the grant date, commencing on June 15, 2021, subject to the Reporting Person's continued service. |
| (3) | These options have vested and are exercisable as of the date hereof, subject to the Reporting Person's continued service. |
Remarks:
Exhibit 24.1: Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Mor George Adi
15 KAFRISIN ST.
TEL AVIV, L3 6901658 | X | X | Chief Executive Officer |
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Signatures
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| /s/ Matthew Rudolph, Esq., Attorney-in-Fact for Adi Mor George | | 3/25/2021 |
| **Signature of Reporting Person | Date |
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