SEC Form 4 · accession 0001104659-17-062947
OptiNose, Inc. · OPTN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ramy A Mahmoud
Officer — President and COO
Period of report
Oct 17, 2017
Accepted (ET)
Oct 19, 2017 · 4:02 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001494650
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Oct 17, 2017 | C | 52,490 | — | A | 52,490 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series C-1 Convertible Preferred StockF2 | — | Oct 17, 2017 | C | 16,564 | D | — | — | Common Stock | 47,835 | 0 | D |
| Series C-2 Convertible Preferred StockF2 | — | Oct 17, 2017 | C | 1,612 | D | — | — | Common Stock | 4,655 | 0 | D |
Explanation of responses
- F1Represents the total number of shares of Common Stock received by the Reporting Person upon conversion of Series C-1 and Series C-2 Preferred Stock in connection with the closing of the Issuer's initial public offering.
- F2The Series C-1 and Series C-2 Preferred Stock converted into Common Stock on a 2.8879-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series C-1 and Series C-2 Preferred Stock were convertible at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Preferred Stock had no expiration date.