0001628280-18-001667.txt : 20180214 0001628280-18-001667.hdr.sgml : 20180214 20180214155831 ACCESSION NUMBER: 0001628280-18-001667 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20180214 DATE AS OF CHANGE: 20180214 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-89741 FILM NUMBER: 18612077 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Rasdal Andrew P CENTRAL INDEX KEY: 0001323238 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: C/O DEXCOM, INC. STREET 2: 5555 OBERLIN DRIVE CITY: SAN DIEGO STATE: CA ZIP: 92121 SC 13G 1 obalon-2018rasdal13g.htm SC 13G Document
 
 
 


Securities and Exchange Commission
Washington, D.C. 20549
Schedule 13G
(Rule 13d-102)
Information to be Included in Statements Filed Pursuant
to § 240.13d-1(b), (c) and (d) and Amendments Thereto Filed
Pursuant to § 240.13d-2

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No.)*

Obalon Therapeutics, Inc.
(Name of Issuer)

Common Stock
(Title of Class of Securities)
 
67424L100
(CUSIP Number)
December 31, 2017
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
[        ]    Rule 13d-1(b)
[        ]    Rule 13d-1(c)
[ X]    Rule 13d-1(d)
* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).






1

Names of Reporting Persons
Andrew P. Rasdal
2

Check the Appropriate Box if a Member of a Group (a) [ ] (b) [ ]
3

SEC Use Only
 
4

Citizen or Place of Organization
United States
Number of Shares Beneficially Owned by Each Reporting Person With

5
Sole Voting Power
   481,988
 
6
Shared Voting Power
   450,495
 
7
Sole Dispositive Power
   347,150
 
8
Shared Dispositive Power
   450,495
 
9

Aggregate Amount Beneficially Owned by Each Reporting Person
932,483
10

Check if the Aggregate Amount in Row (9) Excludes Certain Shares  
Not Applicable 
11

Percent of Class Represented by Amount in Row 9  
5.2% 
12

Type of Reporting Person  
IN

ITEM 1.

(a) Name of Issuer:
Obalon Therapeutics, Inc. (the “Issuer”).    
(b) Address of Issuer’s Principal Executive Offices:
5421 Avenida Encinas, Suite F, Carlsbad, California 92008.
ITEM 2.
(a) Name of Person Filing:
Andrew P. Rasdal is hereinafter individually referred to as the “Reporting Person.”
(b) Address or Principal Business Office:
The business address of the Reporting Person is C/O Obalon Therapeutics, Inc., 5421 Avenida Encinas, Suite F, Carlsbad, California 92008.
(c) Citizenship of each Reporting Person is:
The Reporting Person is a citizen of the United States.
(d) Title of Class of Securities:
Common stock, par value $0.001 per share (“Common Stock”).





(e) CUSIP Number:
67424L100
ITEM 3.    
Not applicable.
ITEM 4.
Ownership.
The ownership information below represents beneficial ownership of Common Stock of the Issuer as of December 31, 2017, based upon 17,500,604 shares of Common Stock outstanding as of December 31, 2017.
(a)-(c)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Reporting Person
 
Amount
beneficially
owned
 
 
Percent
of class:
 
 
Sole
power
to vote
or to
direct
the vote:
 
 
Shared
power to
vote or to
direct the
vote:
 
 
Sole
power to
dispose or
to direct
the
disposition
of:
 
 
Shared
power to
dispose or
to direct
the
disposition
of:
 
Andrew P. Rasdal
 
 
932,483
 
 
 
5.2
%
 
 
481,988
 
 
 
450,495
 
 
 
347,150
 
 
 
450,495
 

Andrew P. Rasdal has the sole power to vote 481,988 shares of Common Stock, including 478,412 shares that Mr. Rasdal has the right to acquire within 60 days of December 31, 2017, of which 134,838 shares are subject to a right of repurchase upon the cessation of Mr. Rasdal’s service to Obalon Therapeutics, Inc. prior to vesting.
Mr. Rasdal has the sole power to dispose of 347,150 shares of Common Stock, including 343,574 shares that Mr. Rasdal has the right to acquire within 60 days of December 31, 2017.
In addition, Mr. Rasdal shares beneficial ownership of 450,495 shares of Common Stock held in The Rasdal Family Trust dated December 10, 1996 of which Mr. Rasdal is a co-trustee.

ITEM 5.
Ownership of Five Percent or Less of a Class.
Not applicable.
ITEM 6.
Ownership of More than Five Percent on Behalf of Another Person.
Not applicable.
ITEM 7.
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company.
Not applicable.
ITEM 8.
Identification and Classification of Members of the Group.
Not applicable.
ITEM 9.
Notice of Dissolution of Group.
Not applicable.
ITEM 10.
Certification.
Not applicable.





SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Date:    February 14, 2018



/s/ Andrew P. Rasdal        
Andrew P. Rasdal