Statement of Changes in Beneficial Ownership (4)

Date : 08/08/2019 @ 3:11PM
Source : Edgar (US Regulatory)
Stock : Obalon Therapeutics Inc (OBLN)
Quote : 1.6699  -0.0201 (-1.19%) @ 6:04PM

Statement of Changes in Beneficial Ownership (4)

FORM 4
[ X ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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
                      

1. Name and Address of Reporting Person *

INTERWEST PARTNERS X LP
2. Issuer Name and Ticker or Trading Symbol

OBALON THERAPEUTICS INC [ OBLN ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                      __ X __ 10% Owner
_____ Officer (give title below)      _____ Other (specify below)
(Last)          (First)          (Middle)

2710 SAND HILL ROAD, SUITE 200
3. Date of Earliest Transaction (MM/DD/YYYY)

8/6/2019
(Street)

MENLO PARK, CA 94025
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/Group Filing (Check Applicable Line)

___ Form filed by One Reporting Person
_ X _ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. 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
Common Stock   8/6/2019     P    25000   (1) A $4.00   (1) 380224   (2) D    

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Trans. Date 3A. Deemed Execution Date, if any 4. Trans. 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 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 of Derivative Security: 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
Warrants (Right to buy)   $4.40   8/6/2019     P      18750   (1)      8/6/2019   8/5/2024   COMMON   18750   $0.00   (1) 18750   (2) D    

Explanation of Responses:
(1)  The reporting persons purchased these shares directly from the underwriter in the Issuer's registered offering of Common Stock with 75% warrant coverage at a price of $4.00 per unit. There was no additional consideration paid for the warrants.
(2)  These securities are held of record by InterWest Partners X, L.P. ("IW10"). InterWest Management Partners X, LLC ("IMP10") is the general partner of IW10 and has sole voting and investment control over the shares owned by IW10. Gilbert H. Kliman, and Arnold L. Oronsky are Managing Directors of IMP10 and, Keval Desai and Khaled A. Nasr, and are Venture Members of IMP10. Douglas Fisher, a Member of IMP10 is also a Director of the Issuer, and when required, files a separate Form 4 in his own name. All Reporting Persons disclaim beneficial ownership of shares of Obalon Therapeutics, Inc. stock held by IW10, except to the extent of their respective pecuniary interest therein. The filing of this statement shall not be deemed an admission that, for purposes of Section 16 of the Securities Exchange Act of 1944, or otherwise, any of the Reporting Persons are the beneficial owner of all of the equity securities covered by this statement.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
INTERWEST PARTNERS X LP
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X

InterWest Management Partners X, LLC
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X

Kliman Gilbert H
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X

ORONSKY ARNOLD L
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X

Desai Keval
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X

NASR KHALED
2710 SAND HILL ROAD, SUITE 200
MENLO PARK, CA 94025

X


Signatures
/s/ Karen A. Wilson, Attorney-in-Fact for InterWest Partners X, LP 8/8/2019
** Signature of Reporting Person Date

/s/ Karen A. Wilson, Attorney-in-Fact for InterWest Management Partners X, L.L.C. 8/8/2019
** Signature of Reporting Person Date

/s/ Karen A. Wilson, Attorney-in-Fact for Gilbert Kliman 8/8/2019
** Signature of Reporting Person Date

/s/ Karen A. Wilson, Attorney-in-Fact for Arnold L. Oronsky 8/8/2019
** Signature of Reporting Person Date

/s/ Karen A. Wilson, Attorney-in-Fact for Keval Desai 8/8/2019
** Signature of Reporting Person Date

/s/ Karen A. Wilson, Attorney-in-Fact for Khaled A. Nasr 8/8/2019
** 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 control number.

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