0001209191-16-149825.txt : 20161114 0001209191-16-149825.hdr.sgml : 20161111 20161114174221 ACCESSION NUMBER: 0001209191-16-149825 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: Plovanic William J. CENTRAL INDEX KEY: 0001685640 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 161996574 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 0001685640 Plovanic William J. C/O OBALON THERAPEUTICS, INC. 5421 AVENIDA ENCINAS, SUITE F CARLSBAD CA 92008 0 1 0 0 Chief Financial Officer Stock Option (right to buy) 8.74 2016-11-09 4 A 0 55000 0.00 A 2026-11-09 Common Stock 55000 55000 D The option vests as to 25% of the total shares on March 7, 2017, and then 2.0833% of the total shares monthly thereafter, with 100% of the total shares vested on March 7, 2020, subject to the reporting person's provision of service to the issuer on each vesting date. /s/ Nooshin Hussainy as attorney-in-fact for William Plovanic 2016-11-14