Sec Form 4 Filing - Cavanaugh Stefanie L. @ Apollo Endosurgery, Inc. - 2021-01-06

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Cavanaugh Stefanie L.
2. Issuer Name and Ticker or Trading Symbol
Apollo Endosurgery, Inc. [ APEN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
CFO, Treasurer, Secretary
(Last) (First) (Middle)
1120 SOUTH CAPITAL OF TEXAS HIGHWAY, BUILDING ONE, STE 300
3. Date of Earliest Transaction (MM/DD/YY)
01/06/2021
(Street)
AUSTIN, TX78746
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/06/2021 J( 1 ) 218 A $ 0 81,879 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Cavana ugh Stefanie L.
1120 SOUTH CAPITAL OF TEXAS HIGHWAY
BUILDING ONE, STE 300
AUSTIN, TX78746
CFO, Treasurer, Secretary
Signatures
/s/ Brian Szymczak - Attorney-in-Fact 01/07/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents shares of the Issuer's common stock paid as interest on $25,750 aggregate principal amount of the Reporting Person's 6.0% Convertible Debentures, or the Notes, previously reported, for the interest payment period from and including July 1, 2020, the issue date of the Notes, to, but excluding, January 1, 2021. Interest on the Notes is payable semi-annually in shares of the Issuer's common stock on January 1 and July 1 of each year at a rate of 6.00% per year and based on the volume-weighted average price of the Issuer's common stock for the 10 consecutive trading days immediately preceding the applicable interest payment date.

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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