SEC Form 3

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* INTERWEST PARTNERS X LP (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)	2. Date of Event Requiring Statement (Month/Day/Year) 10/05/2016	3. Issuer Name and Ticker or Trading Symbol OBALON THERAPEUTICS INC [ OBLN ]
		4. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner Officer (give title below) Other (specify below)	5. If Amendment, Date of Original Filed (Month/Day/Year)
			6. Individual or Joint/Group Filing (Check Applicable Line) Form filed by One Reporting Person X Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
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)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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
Series C Preferred Stock	(1)	(1)	Common Stock	1,615,041	(1)	D(2)
Series D Preferred Stock	(3)	(3)	Common Stock	464,494	(3)	D(2)
Series E Preferred Stock	(4)	(4)	Common Stock	373,803	(4)	D(2)

1. Name and Address of Reporting Person* INTERWEST PARTNERS X LP (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* InterWest Management Partners X, LLC (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* GIANOS PHILIP T (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* Holmes W Stephen (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* Kliman Gilbert H (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* ORONSKY ARNOLD L (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* Desai Keval (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* NASR KHALED (Last) (First) (Middle) 2710 SAND HILL ROAD, SUITE 200 (Street) MENLO PARK CA 94025 (City) (State) (Zip)

Explanation of Responses:

1. Each share of the issuer's Series C Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's initial public offering ("IPO") and has no expiration date.

2. These securities are held of record by InterWest Partners X, L.P. ("IW10"). InterWest Management Partners X, LLC ("IMP10") is the general partner of IW10. Philip T. Gianos, W. Stephen Holmes, Gilbert H. Kliman and Arnold L. Oronsky are the managing directors of IMP10, and Keval Desai and Khalad A. Nasr are venture members of IMP10. Each of the reporting persons disclaims beneficial ownership of the securities reported herein for purposes of Rule 16a-1(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of its or his pecuniary interest therein, if any. The reporting persons have designated a representative, currently Doug Fisher, a consultant of InterWest Venture Management Co., to serve on the issuer's board of directors. This report shall not be deemed an admission that any of the reporting persons is a beneficial owner of such securities for the purposes of Section 16 of the Exchange Act, or for any other purposes.

3. Each share of the issuer's Series D Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date.

4. Each share of the issuer's Series E Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the issuer's IPO and has no expiration date.

Remarks:

	/s/ Karen A. Wilson, Attorney-in-Fact for InterWest Partners X, LP	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for InterWest Management Partners X, LLC	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for Philip T. Gianos	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for W. Stephen Holmes	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for Gilbert Kliman	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for Arnold L. Oronsky	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for Keval Desai	10/05/2016
	/s/ Karen A. Wilson, Attorney-in-Fact for Khaled A. Nasr	10/05/2016
	** 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.
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FORM 3 JOINT FILER INFORMATION

Name of
"Reporting Persons":	InterWest Partners X, L.P. ("IW10")
			InterWest Management Partners X, LLC ("IMP10")

			Philip T. Gianos
			W. Stephen Holmes
			Gilbert H. Kliman
			Arnold L. Oronsky
			Keval Desai
			Khaled Nasr

Address:		2710 Sand Hill Road, Suite 200
			Menlo Park, CA  94025

Designated Filer:	InterWest Partners X, L.P.

Issuer and Ticker Symbol: Obalon Therapeutics, Inc. ("OBLN")

Date of Event:		October 5, 2016

Each of the following is a Joint Filer with InterWest Partners X L.P. ("IW10")
and may be deemed to share indirect beneficial ownership in the securities set
forth on the attached Form 3:

InterWest Management Partners X, LLC ("IMP10") is the general partner of IW10
and has sole voting and investment control over the shares owned by IW10. Philip
T. Gianos, W. Stephen Holmes, Gilbert H. Kliman, and Arnold L. Oronsky are
Managing Directors of IMP10 and, Keval Desai and Khaled A. Nasr, and are Venture
Members of IMP10. Douglas Fisher, a Member of IMP10 is also a Director of the
Issuer, and has filed a separate Form 3 in his own name.

All Reporting Persons disclaim beneficial ownership of shares of Obalon
Therapeutics, Inc. stock held by IW10, except to the extent of their respective
pecuniary interest therein. The filing of this statement shall not be deemed an
admission that, for purposes of Section 16 of the Securities Exchange Act of
1934, or otherwise, any of the Reporting Persons are the beneficial owner of all
of the equity securities covered by this statement.


Each of the Reporting Persons listed above has designated InterWest Partners X,
L.P. as its designated filer of Forms 3, 4 and 5 in accordance with Section
16(a) of the Securities Exchange Act of 1934 and the rules thereunder.  Each
Reporting Person has appointed InterWest Management Partners X, LLC as its
attorney in fact for the purpose of making reports relating to transaction in
Obalon Therapeutics, Inc. Common Stock.

INTERWEST MANAGEMENT PARTNERS X, L.L.C.

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney


INTERWEST PARTNERS X, LP

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney


Philip T. Gianos, an individual

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney



Keval Desai, an individual

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney



Gilbert H. Kliman, an individual

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney



Arnold L. Oronsky, an individual

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney



W. Stephen Holmes, an individual

By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney


Khaled A. Nasr, an individual


By:	/s/ Karen A. Wilson
	Karen A. Wilson, Power of Attorney







POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, InterWest Partners X, LP, hereby constitutes and appoints Karen
A. Wilson as its true and lawful Attorney-in-Fact, with full power in its name
and on its behalf, to take all actions and do all things necessary with respect
to all matters arising in connection with the ownership reporting requirements
of the securities laws of the United States, including the execution and
delivery of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
26th day of September, 2016.


INTERWEST PARTNERS X, LP



/s/ Gilbert H. Kliman
By:  Gilbert H. Kliman, Managing Director of InterWest Management Partners X,
LLC, its General Partner






POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, InterWest Management Partners X, LLC, hereby constitutes and
appoints Karen A. Wilson as its true and lawful Attorney-in-Fact, with full
power in its name and on its behalf, to take all actions and do all things
necessary with respect to all matters arising in connection with the ownership
reporting requirements of the securities laws of the United States, including
the execution and delivery of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
26th day of September, 2016.


INTERWEST MANAGEMENT PARTNERS X, LLC



/s/ Gilbert H. Kliman
By:  Gilbert H. Kliman, Managing Director







POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, Philip T. Gianos, hereby constitutes and appoints Karen A.
Wilson as his true and lawful Attorney-in-Fact, with full power in his name and
on his behalf, to take all actions and do all things necessary with respect to
all matters arising in connection with the ownership reporting requirements of
the securities laws of the United States, including the execution and delivery
of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
28th day of May, 1996.


PHILIP T. GIANOS



/s/ Philip T. Gianos






POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, W. Stephen Holmes, hereby constitutes and appoints Karen A.
Wilson as his true and lawful Attorney-in-Fact, with full power in his name and
on his behalf, to take all actions and do all things necessary with respect to
all matters arising in connection with the ownership reporting requirements of
the securities laws of the United States, including the execution and delivery
of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
28th day of May, 1996.


W. STEPHEN HOLMES



/s/ W. Stephen Holmes





POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, Gilbert H. Kliman, hereby constitutes and appoints Karen A.
Wilson as his true and lawful Attorney-in-Fact, with full power in his name and
on his behalf, to take all actions and do all things necessary with respect to
all matters arising in connection with the ownership reporting requirements of
the securities laws of the United States, including the execution and delivery
of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this 8th
day of September, 2000.


GILBERT H. KLIMAN



/s/ Gilbert H. Kliman





POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, Arnold L. Oronsky, hereby constitutes and appoints Karen A.
Wilson as his true and lawful Attorney-in-Fact, with full power in his name and
on his behalf, to take all actions and do all things necessary with respect to
all matters arising in connection with the ownership reporting requirements of
the securities laws of the United States, including the execution and delivery
of all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
28th day of May, 1996.


ARNOLD L. ORONSKY



/s/ Arnold L. Oronsky






POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, Keval Desai, hereby constitutes and appoints Karen A. Wilson as
his true and lawful Attorney-in-Fact, with full power in his name and on his
behalf, to take all actions and do all things necessary with respect to all
matters arising in connection with the ownership reporting requirements of the
securities laws of the United States, including the execution and delivery of
all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
25th day of June, 2012.


KEVAL DESAI



/s/ Keval Desai






POWER OF ATTORNEY



KNOW ALL BY THESE PRESENTS:

The undersigned, Khaled A. Nasr, hereby constitutes and appoints Karen A. Wilson
as his true and lawful Attorney-in-Fact, with full power in his name and on his
behalf, to take all actions and do all things necessary with respect to all
matters arising in connection with the ownership reporting requirements of the
securities laws of the United States, including the execution and delivery of
all documents in connection therewith.

The undersigned agrees to indemnify said Attorney-in-Fact against, and hold her
free and harmless from, and all loss, cost, expense, damage or liability which
she may incur or sustain as a result of any action taken by her in good faith
pursuant to this Power of Attorney.

This Power of Attorney shall remain in full force and effect until revoked in
writing by the undersigned and the authority granted herein may be relied upon
by any person until such person has actually received written notice of
revocation.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this
31st day of May, 2007.


KHALED A. NASR



/s/ Khaled A. Nasr