0001251769-21-000103.txt : 20210811
0001251769-21-000103.hdr.sgml : 20210811
20210811202518
ACCESSION NUMBER: 0001251769-21-000103
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210809
FILED AS OF DATE: 20210811
DATE AS OF CHANGE: 20210811
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Black Jeffrey G.
CENTRAL INDEX KEY: 0001449439
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35706
FILM NUMBER: 211165236
MAIL ADDRESS:
STREET 1: 4955 DIRECTORS PLACE
CITY: SAN DIEGO
STATE: CA
ZIP: 92121
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Apollo Endosurgery, Inc.
CENTRAL INDEX KEY: 0001251769
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 161630142
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1120 SOUTH CAPITAL OF TX HWY
STREET 2: BUILDING 1 SUITE 300
CITY: AUSTIN
STATE: TX
ZIP: 78746
BUSINESS PHONE: 512-279-5100
MAIL ADDRESS:
STREET 1: 1120 SOUTH CAPITAL OF TX HWY
STREET 2: BUILDING 1 SUITE 300
CITY: AUSTIN
STATE: TX
ZIP: 78746
FORMER COMPANY:
FORMER CONFORMED NAME: LPATH, INC
DATE OF NAME CHANGE: 20060316
FORMER COMPANY:
FORMER CONFORMED NAME: LPATH INC
DATE OF NAME CHANGE: 20051202
FORMER COMPANY:
FORMER CONFORMED NAME: NEIGHBORHOOD CONNECTIONS INC
DATE OF NAME CHANGE: 20040323
4
1
wf-form4_162872789954355.xml
FORM 4
X0306
4
2021-08-09
0
0001251769
Apollo Endosurgery, Inc.
APEN
0001449439
Black Jeffrey G.
1120 S. CAPITAL OF TEXAS HIGHWAY
BUILDING ONE, SUITE 300
AUSTIN
TX
78746
0
1
0
0
Chief Financial Officer
Common Stock
2021-08-11
4
P
0
25000
8.75
A
25000
D
Common Stock
2021-08-09
4
A
0
120000
0
A
145000
D
Common Stock
2021-08-09
4
A
0
80000
0
A
225000
D
Stock Option (Right to Buy)
8.69
2021-08-09
4
A
0
150000
8.69
A
2031-08-09
Common Stock
150000.0
150000
D
Represents weighted average price of shares purchased. Prices ranged between $8.40 - $9.00, inclusive. The holder undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon written request, full information regarding the number of shares purchase at each separate price within the range set forth in this footnote.
Represents the grant of Restricted Stock Units ("RSU"). Each RSU provides the Reporting Person with a contingent right to receive one share of the Issuer's common stock. One third of the RSU grant will vest upon the achievement of revenue for the trailing four quarters equal to each of $70 million, $90 million and $110 million, subject to the Reporting Person providing continuous service to the Issuer through each such date. Accelerated vesting may occur in the event of a Change in Control, as that term is defined in the Apollo Endosurgery, Inc. 2017 Equity Incentive Plan. The RSU grant will be governed by the terms of the 2017 Equity Incentive Plan.
Represents the grant of RSUs. Each RSU provides the Reporting Person with a contingent right to receive one share of the Issuer's common stock. One quarter of the RSU grant will vest on the first anniversary of the effective date (August 3, 2021) and the remainder will vest in equal annual installments over the following three years, subject to the Reporting Person providing continuous service to the Issuer through each such date. Accelerated vesting may occur in the event of a Change in Control, as that term is defined in the Apollo Endosurgery, Inc. 2017 Equity Incentive Plan. The RSU grant will be governed by the terms of the 2017 Equity Incentive Plan.
The shares underlying the option shall vest as to 25% on the first anniversary of the effective date (August 3, 2021) and the remainder will vest in equal monthly installments over the following three years, subject to the Reporting Person providing continuous service to the Issuer through each such date. Accelerated vesting may occur in the event of a Change in Control, as that term is defined in the Apollo Endosurgery, Inc. 2017 Equity Incentive Plan.
/s/ Brian Szymczak - Attorney-in-Fact
2021-08-11