Initial Statement of Beneficial Ownership (3)
02 March 2022 - 10:16AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP
OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response... 0.5 |
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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 *
Gutteridge Mike |
2. Date of Event Requiring Statement
(MM/DD/YYYY)
2/15/2022
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3. Issuer Name and Ticker or Trading
Symbol Apollo Endosurgery, Inc. [APEN] |
(Last)
(First)
(Middle)
1120 SOUTH CAPITAL OF TEXAS HIGHWAY, BUILDING ONE, SUITE
300 |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
___X___ Officer (give title
below) _____
Other (specify below)
VP, Int'l Sales and Marketing / |
(Street)
AUSTIN, TX 78746
(City)
(State)
(Zip)
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5. If Amendment, Date Original
Filed(MM/DD/YYYY)
|
6. Individual or Joint/Group
Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Beneficially
Owned
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1.Title of Security
(Instr. 4) |
2. Amount of Securities Beneficially Owned
(Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) |
4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Common Stock |
22838 |
D |
|
Common Stock |
41199 (1) |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 4) |
2. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
3. Title and Amount of Securities Underlying
Derivative Security
(Instr. 4) |
4. Conversion or Exercise Price of Derivative
Security |
5. Ownership Form of Derivative Security: Direct (D)
or Indirect (I)
(Instr. 5) |
6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Stock Option (Right to Buy) |
(2) |
5/25/2027 |
Common Stock |
14000.0 |
$6.5 |
D |
|
Stock Option (Right to Buy) |
(2) |
12/7/2027 |
Common Stock |
25500.0 |
$4.37 |
D |
|
Stock Option (Right to Buy) |
(2) |
5/7/2029 |
Common Stock |
22655.0 |
$3.49 |
D |
|
Stock Option (Right to Buy) |
(2) |
5/7/2030 |
Common Stock |
22171.0 |
$2.08 |
D |
|
Stock Option (Right to Buy) |
(2) |
3/10/2031 |
Common Stock |
14846.0 |
$5.95 |
D |
|
Explanation of
Responses: |
(1) |
Represents grants of
Restricted Stock Units (the "RSU Awards") payable solely in common
stock of the Issuer. The shares subject to the RSU Awards shall
vest over a four-year period at the rate of 25% per
year. |
(2) |
The shares underlying the
option shall vest as to 25% on the first anniversary of the grant
date and the remainder will vest in equal monthly installments over
the following three years. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Gutteridge Mike
1120 SOUTH CAPITAL OF TEXAS HIGHWAY
BUILDING ONE, SUITE 300
AUSTIN, TX 78746 |
|
|
VP, Int'l Sales and Marketing |
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Signatures
|
/s/ Brian Szymczak -
Attorney-in-Fact |
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3/1/2022 |
**Signature of
Reporting Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
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