0000904454-19-000600.txt : 20190808 0000904454-19-000600.hdr.sgml : 20190808 20190808162315 ACCESSION NUMBER: 0000904454-19-000600 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190806 FILED AS OF DATE: 20190808 DATE AS OF CHANGE: 20190808 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DOMAIN PARTERS VII L P CENTRAL INDEX KEY: 0001374150 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009891 BUSINESS ADDRESS: STREET 1: ONE PALMER SQUARE SUITE 515 CITY: PRINCETON STATE: NJ ZIP: 08542 BUSINESS PHONE: 609-683-5656 MAIL ADDRESS: STREET 1: ONE PALMER SQUARE SUITE 515 CITY: PRINCETON STATE: NJ ZIP: 08542 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BLAIR JAMES C CENTRAL INDEX KEY: 0001024000 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009892 MAIL ADDRESS: STREET 1: 5880 PACIFIC CENTER BLVD CITY: SAN DIEGO STATE: CA ZIP: 92121-4204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DOVEY BRIAN H CENTRAL INDEX KEY: 0001207786 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009893 MAIL ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TREU JESSE I CENTRAL INDEX KEY: 0001013425 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009894 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VITULLO NICOLE CENTRAL INDEX KEY: 0001196863 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009895 MAIL ADDRESS: STREET 1: 3030 SCIENCE PARK ROAD CITY: SAN DIEGO STATE: CA ZIP: 92121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Halak Brian K CENTRAL INDEX KEY: 0001354718 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37897 FILM NUMBER: 191009896 MAIL ADDRESS: STREET 1: C/O DOMAIN ASSOCIATES STREET 2: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 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 edgar.xml PRIMARY DOCUMENT X0306 4 2019-08-06 0001427570 OBALON THERAPEUTICS INC OBLN 0001374150 DOMAIN PARTERS VII L P C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 0001024000 BLAIR JAMES C C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 0001207786 DOVEY BRIAN H C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 0001013425 TREU JESSE I C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 0001196863 VITULLO NICOLE C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 0001354718 Halak Brian K C/O DOMAIN ASSOCIATES, LLC 202 CARNEGIE CENTER, SUITE 104 PRINCETON NJ 08540 0 0 1 0 Common Stock 2019-08-06 4 P 0 250000 4.00 A 813433 D Warrants to Purchase Common Stock 4.40 2019-08-06 4 P 0 187500 4.00 A 2019-08-06 2024-08-06 Common Stock 187500 187500 D The reported securities were purchased as Units, each Unit consisting of one share of Common Stock and a Warrant to purchase 0.75 of one share of Common Stock, at a purchase price of $4.00 per Unit. The reported ownership reflects the one-for-ten reverse split of the Common Stock effected on July 24, 2019. The securities reported as directly beneficially owned by the designated Reporting Person may be deemed to be indirectly beneficially owned by each of the Reporting Owners listed below, each of whom is a managing member of One Palmer Square Associates VII, LLC, the sole general partner of the designated Reporting Person. Pursuant to Instruction 4(b)(iv) of Form 4, each such individual has elected to report as indirectly beneficially owned the entire number of securities owned by the designated Reporting Person, however each of them disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his or her pecuniary interest therein and/or that are not actually distributed to him or her. As managing members of One Palmer Square Associates VII, LLC, which is also the sole general partner of DP VII Associates, L.P., each Reporting Owner listed below may also be deemed to indirectly beneficially own 4,957 shares of Common Stock held by DP VII Associates, L.P. /s/ Lisa A. Kraeutler, as Attorney-in-Fact for Domain Partners VII, L.P., J. Blair, B. Dovey, J. Treu, N. Vitullo and B. Halak 2019-08-08