0001209191-16-149810.txt : 20161114 0001209191-16-149810.hdr.sgml : 20161111 20161114174036 ACCESSION NUMBER: 0001209191-16-149810 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161109 FILED AS OF DATE: 20161114 DATE AS OF CHANGE: 20161114 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OBALON THERAPEUTICS 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: 5421 AVENIDA ENCINAS STREET 2: SUITE F CITY: San Diego STATE: CA ZIP: 92008 BUSINESS PHONE: 858-480-2400 MAIL ADDRESS: STREET 1: 5421 AVENIDA ENCINAS STREET 2: SUITE F CITY: San Diego STATE: CA ZIP: 92008 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hussainy Nooshin CENTRAL INDEX KEY: 0001685634 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 161996506 MAIL ADDRESS: STREET 1: C/O OBALON THERAPEUTICS, INC. STREET 2: 5421 AVENIDA ENCINAS, SUITE F CITY: CARLSBAD STATE: CA ZIP: 92008 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-11-09 0 0001427570 OBALON THERAPEUTICS INC OBLN 0001685634 Hussainy Nooshin C/O OBALON THERAPEUTICS, INC. 5421 AVENIDA ENCINAS, SUITE F CARLSBAD, CA 92008 CA 92008 0 1 0 0 VP of Finance Stock Option (right to buy) 8.74 2016-11-09 4 A 0 40000 0.00 A 2026-11-09 Common Stock 40000 40000 D The option vests as to 2.0833% of the total shares monthly, commencing on December 9, 2016, with 100% of the total shares vested on November 9, 2020, subject to the reporting person's provision of service to the issuer on each vesting date. /s/ Nooshin Hussainy 2016-11-14