SEC Form 4 · accession 0001104659-17-062950

OptiNose, Inc. · OPTN

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

Reporting owner

Director

Period of report

Oct 17, 2017

Accepted (ET)

Oct 19, 2017 · 4:03 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 Stock^F1,F2	Oct 17, 2017	C	327,757	—	A	327,757	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series C Convertible Preferred Stock^F2	—	Oct 17, 2017	C	82,713	D	—	—	Common Stock	238,866	D
Series C-1 Convertible Preferred Stock^F2	—	Oct 17, 2017	C	20,715	D	—	—	Common Stock	59,822	D
Series C-2 Convertible Preferred Stock^F2	—	Oct 17, 2017	C	10,066	D	—	—	Common Stock	29,069	D

F1Represents the total number of shares of Common Stock received by the Reporting Person upon conversion of Series C, Series C-1 and Series C-2 Preferred Stock in connection with the closing of the Issuer's initial public offering.
F2The Series C, 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, 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.