SEC Form 4 · accession 0001179110-16-033600

Apollo Endosurgery, Inc. · APEN

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

Table I — non-derivative securities

Table II — derivative securities

Explanation of responses

• F1Shares of common stock of the corporation then known as Apollo Endosurgery, Inc. ("Old Apollo") were converted into shares of the Issuer pursuant to that certain Agreement and Plan of Merger and Reorganization, dated as of September 8, 2016, by and among the Issuer, Merger Sub, Inc. and Old Apollo (the "Merger Agreement"). Pursuant to the terms of the Merger Agreement, each share of common stock was converted into 0.3163 shares of the Issuer's common stock. Following the merger, the Issuer effected a reverse stock split at a ratio of one new share for every five and one half shares of common stock outstanding.
• F2These securities are held in the name of H.I.G. Ventures - Endosurgery, LLC. H.I.G. Capital, LLC has sole voting and investment control over the shares owned by H.I.G. Ventures - Endosurgery, LLC. The Managing Directors of H.I.G. Capital, LLC have shared voting and investment control over the shares owned by H.I.G. Ventures - Endosurgery, LLC. The Reporting Person is a Managing Director of H.I.G. Capital, LLC and may be deemed to be the beneficial owner of the securities held by H.I.G. Ventures - Endosurgery, LLC.

Remarks

Exhibit Index: Exhibit 24 - Power of Attorney (incorporated by reference to the Power of Attorney filed as Exhibit 24 to the Form 3 filed by the Reporting Person on December 29, 2016)