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