Sec Form 4 Filing - DITTAMORE RAYMOND V @ OBALON THERAPEUTICS INC - 2020-09-16

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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
DITTAMORE RAYMOND V
2. Issuer Name and Ticker or Trading Symbol
OBALON THERAPEUTICS INC [ OBLN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O OBALON THERAPEUTICS, INC., 5421 AVENIDA ENCINAS, SUITE F
3. Date of Earliest Transaction (MM/DD/YY)
09/16/2020
(Street)
CARLSBAD, CA92008
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
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
Stock Option ( 1 ) 09/16/2020 A 27,250 ( 2 ) 09/16/2030 Common Stock 27,250 $ 0 27,250 D
Stock Option (Right to Buy) $ 0.77 09/16/2020 A 27,250 ( 2 ) 09/16/2030 Common Stock 27,250 $ 0 27,250 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DITTAMORE RAYMOND V
C/O OBALON THERAPEUTICS, INC.
5421 AVENIDA ENCINAS, SUITE F
CARLSBAD, CA92008
X
Signatures
/s/ Nooshin Hussainy as attorney-in-fact for Raymond V. Dittamore 09/18/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Each share of Common Stock underlying the cash-settled Option represents the right to a cash payment equal to the excess, if any, of (i) the Fair Market Value of each such share on the date of exercise over (ii) the exercise price per share set forth in the Notice of Stock Option Grant ($0.77), and such Option shall vest as to 1/36th of the shares of Common Stock underlying the Option on each monthly anniversary of the grant date, subject to the Grantee's continued service with the Company through the applicable vesting date. This Option may not be exercised for shares of the Company's Common Stock.
( 2 )The Option shall vest as to 1/36th of the shares of Common Stock underlying the Option on each monthly anniversary of the grant date, subject to the Grantee's continued service with the Company through the applicable vesting date.

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