SEC Form 4 · accession 0000899243-18-029481

VAPOTHERM INC · VAPO

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

Reporting owner

Gilde Healthcare Holding B.V.

10% Owner

Period of report

Nov 16, 2018

Accepted (ET)

Nov 20, 2018 · 5:12 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001253176

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F3	Nov 16, 2018	C	1,028,079	—	A	1,028,079	I	See Footnote
Common Stock^F2,F3	Nov 16, 2018	C	68,447	—	A	1,096,526	I	See Footnote
Common Stock^F3	Nov 16, 2018	P	92,500	$14.00	A	1,189,026	I	See Footnote

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series B Convertible Preferred Stock^F3,F1	—	Nov 16, 2018	C	482,142	D	—	—	Common Stock	482,142	I
Series C Convertible Preferred Stock^F3,F1	—	Nov 16, 2018	C	401,527	D	—	—	Common Stock	401,527	I
Series D Convertible Preferred Stock^F3,F1	—	Nov 16, 2018	C	144,410	D	—	—	Common Stock	144,410	I
Series D-1 Convertible Preferred Stock^F3,F2	—	Nov 16, 2018	C	68,447	D	—	—	Common Stock	68,447	I

Explanation of responses

F1Upon closing of the Issuer's initial public offering, each share of Series B Convertible Preferred Stock, Series C Convertible Preferred Stock and Series D Convertible Preferred Stock automatically converted into one share of Common Stock without payment or further consideration. There was no expiration date for the Series B Convertible Preferred Stock, the Series C Convertible Preferred Stock or the Series D Convertible Preferred Stock.
F2Upon closing of the Issuer's initial public offering, each share of Series D-1 Convertible Preferred Stock automatically converted into 1.137 shares of Common Stock without payment or further consideration. There was no expiration date for the Series D-1 Convertible Preferred Stock.
F3The shares are held directly by Cooperatieve Gilde Healthcare III Sub-Holding U.A. ("Gilde"). Geoff Pardo ("Pardo"), who is a member of the Issuer's board of directors, is a partner of Gilde. Gilde is managed by Gilde Healthcare III Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of Pardo, Management and Holding may be deemed to have voting, investment and dispositive power with respect to these securities. Each of Pardo, Management and Holding disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein