0001214659-19-004753.txt : 20190725 0001214659-19-004753.hdr.sgml : 20190725 20190725163018 ACCESSION NUMBER: 0001214659-19-004753 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190723 FILED AS OF DATE: 20190725 DATE AS OF CHANGE: 20190725 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: 19974774 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-45370.xml PRIMARY DOCUMENT X0306 4 2019-07-23 0001427570 OBALON THERAPEUTICS INC OBLN 0001685640 Plovanic William J. C/O OBALON THERAPEUTICS, INC. 5421 AVENIDA ENCINAS, SUITE F CARLSBAD CA 92008 true true false false President & CFO Stock Option (Right to Buy) .96 2019-07-23 4 A false 300000 0 A 2029-07-23 Common Stock 300000 300000 D The option shall vest as to 1/48th of the shares underlying the option on each monthly anniversary of May 20, 2019, subject to Mr. Plovanic's continued status as a service provider with the Issuer through the applicable vesting date. Share amounts do not reflect the impact of a 1-for-10 reverse stock split that became effective after the grant date for the options referenced herein. /s/ Nooshin Hussainy as attorney-in-fact for William J. Plovanic 2019-07-25