SEC Form 4 · accession 0000899243-17-027684

Apollo Endosurgery, Inc. · APEN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Rick D Anderson

Director · 10% Owner

Period of report

Nov 15, 2017

Accepted (ET)

Nov 30, 2017 · 4:55 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001251769

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Nov 15, 2017	J	1,266,909	—	D	0	I	By PTV Evergreen Fund, L.P.
Common Stock^F1,F3	Nov 15, 2017	J	12,669	—	A	12,669	I	By PTV GP Evergreen, L.P.
Common Stock^F4,F3	Nov 15, 2017	J	12,669	—	D	0	I	By PTV GP Evergreen, L.P.
Common Stock^F4	Nov 15, 2017	J	4,223	—	A	49,677	D
Common Stock^F5	holding	—	—		—	2,199,186	I	By PTV Sciences II, L.P.
Common Stock^F6	holding	—	—		—	1,347,565	I	By PTV IV, L.P.
Common Stock^F7	holding	—	—		—	605,712	I	By PTV Special Opportunities I, L.P.

Table II — derivative securities

No Table II lines on this filing.

Explanation of responses

F1Represents in-kind distribution by PTV Evergreen Fund, L.P. to its partners (including PTV GP Evergreen, L.P.) without consideration.
F2These securities are owned by PTV Evergreen Fund, L.P. ("PTV EG"). PTV GP III Management, LLC ("PTV GPM") is the sole general partner of PTV GP Evergreen, L.P. ("PTV GP EG"), which is the sole general partner of PTV EG. The managers of PTV GPM are Matthew S. Crawford and Rick D. Anderson, who may be deemed to share voting and investment control over the shares owned by PTV EG. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.
F3These securities are owned by PTV GP EG. PTV GPM is the sole general partner of PTV GP EG. Accordingly, PTV GPM may be deemed to have voting and investment control over the shares owned by PTV GP EG. The managers of PTV GPM are Matthew S. Crawford and Rick D. Anderson, who may be deemed to share voting and investment control over the shares owned by PTV GP EG. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.
F4Represents in-kind distribution by PTV GP EG to its partners (including the Reporting Person) without consideration.
F5These securities are owned by PTV Sciences II, L.P. ("PTV II"). Pinto TV GP Company LLC ("PTV GPC") is the sole general partner of Pinto Technology Ventures GP II, L.P. ("PTV GP II"), which is the sole general partner of PTV II. The managers of PTV GPC are Matthew S. Crawford and Rick D. Anderson, who may be deemed to share voting and investment control over the shares owned by PTV II. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.
F6These securities are owned by PTV IV, L.P. ("PTV IV"). PTV GP III Management, LLC ("PTV GPM") is the sole general partner of PTV GP IV, L.P. ("PTV GP IV"), which is the sole general partner of PTV IV. The managers of PTV GPM are Matthew S. Crawford and Rick D. Anderson, who may be deemed to share voting and investment control over the shares owned by PTV IV. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.
F7These securities are owned by PTV Special Opportunities I, L.P. ("PTV SO"). PTV GP III Management, LLC ("PTV GPM") is the sole general partner of PTV GP SO I, L.P. ("PTV GP SO"), which is the sole general partner of PTV SO. The managers of PTV GPM are Matthew S. Crawford and Rick D. Anderson, who may be deemed to share voting and investment control over the shares owned by PTV SO. The Reporting Person disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.