SEC Form 4 · accession 0001209191-15-024182

ReShape Lifesciences Inc. · RSLS

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

Reporting owner

Director

Period of report

Nov 14, 2014

Accepted (ET)

Mar 9, 2015 · 5:37 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001371217

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	holding	—	—		—	25,000	I	Family Trust
Common Stock^F2	holding	—	—		—	150,000	I	Pibrac Property Holdings PTY

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Performance Option (right to buy)^F7	$1.14	Nov 14, 2014	A	25,000	A	Nov 14, 2014	Oct 6, 2018	Common Stock	25,000	25,000	D
Director Option (right to buy)^F3	$2.63	holding	—	—	—	May 5, 2011	May 5, 2021	Common Stock	25,000	25,000	D
Stock Option (right to buy)^F4	$2.76	holding	—	—	—	Jul 1, 2011	Jul 1, 2015	Common Stock	50,000	50,000	D
Director Option (right to buy)^F3	$2.77	holding	—	—	—	May 9, 2012	May 9, 2022	Common Stock	10,000	10,000	D
Stock Option (right to buy)^F5	$2.65	holding	—	—	—	Jan 22, 2013	Jan 22, 2017	Common Stock	50,000	50,000	D
Warrants^F2	$1.14	holding	—	—	—	Feb 27, 2013	Feb 27, 2018	Common Stock	60,000	60,000	I
Director Option (right to buy)^F3	$0.88	holding	—	—	—	May 8, 2013	May 8, 2023	Common Stock	10,000	10,000	D
Option (right to buy)^F6	$1.31	holding	—	—	—	May 31, 2013	May 31, 2017	Common Stock	50,000	50,000	D
Director Option (right to buy)^F3	$1.84	holding	—	—	—	May 7, 2014	May 7, 2024	Common Stock	25,000	25,000	D

F1The reporting person disclaims beneficial interest in the shares held by the Trust.
F2The reporting person disclaims beneficial interest in the shares, except to the extent of his pecuniary interest in such shares.
F3Vests immediately as to 25% on date noted and thereafter in cumulative installments of 1/36th per month.
F4Vests in increments of 1/48th per month, beginning the date shown.
F5Vests immediately as to 16,667 shares on the date noted; 16,667 shares on 1/22/2014 and 16,666 shares on 1/22/2015.
F6Vests immediately as to 16,667 shares on the date noted; 16,667 shares on 5/31/2014 and 16,666 shares on 5/31/2015.
F7On October 6, 2014, the reporting person was granted an option to purchase 25,000 shares of common stock upon the satisfaction of certain performance criteria prior to March 31, 2015. The performance criteria were met, resulting in vesting of the option in full.