Statement of Changes in Beneficial Ownership (4)
08 July 2021 - 6:28AM
Edgar (US Regulatory)
FORM 4
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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 OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 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.
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APEN
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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/YYYY)
7/7/2021 |
(Street)
AUSTIN, TX 78746
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 7/7/2021 | | J(1) | | 91 | A | $0 | 95998 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security (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 |
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 January 1, 2021, to, but excluding, July 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. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Cavanaugh Stefanie L. 1120 SOUTH CAPITAL OF TEXAS HIGHWAY BUILDING ONE, STE 300 AUSTIN, TX 78746 |
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| CFO, Treasurer, Secretary |
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Signatures
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/s/ Brian Szymczak - Attorney-in-Fact | | 7/7/2021 |
**Signature of Reporting Person | Date |
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