| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 02/15/2022 | 3. Issuer Name and Ticker or Trading Symbol Apollo Endosurgery, Inc. [ APEN ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 03/01/2022 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| 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 | 22,838 | D | |
| Common Stock | 21,403(1) | D | |
| Common Stock | 19,796(2) | D | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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) | (3) | 05/25/2027 | Common Stock | 14,000 | 6.5 | D | |
| Stock Option (Right to Buy) | (4) | 12/07/2027 | Common Stock | 25,500 | 4.37 | D | |
| Stock Option (Right to Buy) | (4) | 05/07/2029 | Common Stock | 22,655 | 3.49 | D | |
| Stock Option (Right to Buy) | (5) | 05/07/2030 | Common Stock | 22,171 | 2.08 | D | |
| Stock Option (Right to Buy) | (4) | 03/10/2031 | Common Stock | 14,846 | 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. Represents grants of "RSU Awards" payable solely in common stock of the Issuer. The shares subject to the RSU Awards shall vest over a three-year period at the rate of 33% per year. |
| 3. The shares underlying the performance based option vested 25% on 1/2/2018 and the remainder will vest in equal monthly installments over the following three years. |
| 4. 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. |
| 5. The shares underlying the option shall vest as to 33% on the first anniversary of the grant date and the remainder will vest in equal monthly installments over the following two years. |
| Remarks: |
| Corrected Table I breakout and footnotes, and corrected Table II footnotes. |
| /s/ Brian Szymczak - Attorney-in-Fact | 03/10/2022 | |
| ** 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 Number. | ||
