0001790300-21-000008.txt : 20210917 0001790300-21-000008.hdr.sgml : 20210917 20210917182554 ACCESSION NUMBER: 0001790300-21-000008 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210722 FILED AS OF DATE: 20210917 DATE AS OF CHANGE: 20210917 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BLACKFORD GARY CENTRAL INDEX KEY: 0001156320 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093] STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 211261626 MAIL ADDRESS: STREET 1: 7700 FRANCE AVENUE SOUTH CITY: EDINA STATE: MN ZIP: 55435 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ReShape Lifesciences Inc. CENTRAL INDEX KEY: 0001427570 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1001 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 BUSINESS PHONE: 949-429-6680 MAIL ADDRESS: STREET 1: 1001 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 FORMER COMPANY: FORMER CONFORMED NAME: OBALON THERAPEUTICS INC DATE OF NAME CHANGE: 20080220 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2021-07-22 0 0001427570 ReShape Lifesciences Inc. RSLS 0001156320 BLACKFORD GARY 1001 CALLE AMANECER SAN CLEMENTE CA 92673 1 0 0 0 Common Stock, $0.001 par value per share 2021-07-22 4 A 0 253429 0 A 253429 D These shares will vest and be issued with respect to 241,961 shares on each of July 22, 2021 and July 22, 2022 pursuant to a restricted stock unit granted under the ReShape Lifesciences Inc. Second Amended and Restated 2003 Stock Incentive Plan. /s/Gary D. Blackford 2021-09-17