0001214659-18-000188.txt : 20180104 0001214659-18-000188.hdr.sgml : 20180104 20180104161347 ACCESSION NUMBER: 0001214659-18-000188 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180102 FILED AS OF DATE: 20180104 DATE AS OF CHANGE: 20180104 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: 18510261 MAIL ADDRESS: STREET 1: C/O OBALON THERAPEUTICS, INC. STREET 2: 5421 AVENIDA ENCINAS, SUITE F CITY: CARLSBAD STATE: CA ZIP: 92008 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 4 1 marketforms-40646.xml PRIMARY DOCUMENT X0306 4 2018-01-02 0001427570 OBALON THERAPEUTICS INC OBLN 0001685640 Plovanic William J. C/O OBALON THERAPEUTICS, INC. 5421 AVENIDA ENCINAS, SUITE F CARLSBAD CA 92008 false true false false Chief Financial Officer Stock Option (Right to Buy) 7.15 2018-01-02 4 A false 100000 0.00 A 2028-01-02 Common Stock 100000 100000 D The Option shall vest as to 1/48th of the Shares underlying the Option on each monthly anniversary of the Grant Date, subject to the grantee's continued status as a Service Provider with the Company through the applicable vesting date. In addition, any portion of the Option that vests will not be exercisable until Mr. Plovanic relocates his primary residence to within 35 miles of the Company's headquarters (at the time of the relocation), provided that such relocation must occur no later than the second anniversary of the Grant Date. The Option will automatically expire if Mr. Plovanic does not satisfy this requirement prior to or on the second anniversary of the Grant Date. /s/ Nooshin Hussainy as attorney-in-fact for William J. Plovanic 2018-01-04