Statement of Changes in Beneficial Ownership (4)
June 25 2020 - 6:56PM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Rasdal Andrew P |
2. Issuer Name and Ticker or Trading Symbol
OBALON THERAPEUTICS INC
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OBLN
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) President, CEO & Exec Chairman |
(Last)
(First)
(Middle)
C/O OBALON THERAPEUTICS, INC., 5421 AVENIDA ENCINAS, SUITE F |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/23/2020 |
(Street)
CARLSBAD, CA 92008
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 |
Stock Option | (1) | 6/23/2020 | | A | | 52865 | | (2) | 6/23/2030 | Common Stock | 52865 | $0 | 52865 | D | |
Stock Option (Right to Buy) | $0.73 | 6/23/2020 | | A | | 165135 | | (2) | 6/23/2030 | Common Stock | 165135 | $0 | 165135 | D | |
Explanation of Responses: |
(1) | Each share of Common Stock underlying the cash-settled Option represents the right to a cash payment equal to the excess, if any, of (i) the Fair Market Value of each such share on the date of exercise over (ii) the exercise price per share set forth in the Notice of Stock Option Grant ($0.73), and such Option shall vest as to 1/36th of the shares of Common Stock underlying the Option on each monthly anniversary of the grant date, subject to the Grantee's continued service with the Company through the applicable vesting date. This Option may not be exercised for Shares of the Company's Common Stock. |
(2) | The Option shall vest as to 1/36th of the shares of Common Stock underlying the Option on each monthly anniversary of the grant date, subject to the Grantee's continued service with the Company through the applicable vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Rasdal Andrew P C/O OBALON THERAPEUTICS, INC. 5421 AVENIDA ENCINAS, SUITE F CARLSBAD, CA 92008 | X |
| President, CEO & Exec Chairman |
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Signatures
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/s/ Nooshin Hussainy as attorney-in-fact for Andrew Rasdal | | 6/25/2020 |
**Signature of Reporting Person | Date |
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