0001209191-21-029136.txt : 20210429
0001209191-21-029136.hdr.sgml : 20210429
20210429205156
ACCESSION NUMBER: 0001209191-21-029136
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210427
FILED AS OF DATE: 20210429
DATE AS OF CHANGE: 20210429
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROCKLAGE SCOTT M
CENTRAL INDEX KEY: 0001219014
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873233
MAIL ADDRESS:
STREET 1: 179 SANDY POND ROAD
CITY: LINCOLN
STATE: MA
ZIP: 01773
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PARMAR KUSH
CENTRAL INDEX KEY: 0001664281
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873234
MAIL ADDRESS:
STREET 1: C/O AUDENTES THERAPEUTICS, INC.
STREET 2: 101 MONTGOMERY ST., SUITE 2650
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Schwab Andrew J.
CENTRAL INDEX KEY: 0001598549
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873232
MAIL ADDRESS:
STREET 1: C/O 5AM VENTURES, 2200 SAND HILL ROAD
STREET 2: SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Partners V, LLC
CENTRAL INDEX KEY: 0001791889
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873235
BUSINESS ADDRESS:
STREET 1: 501 SECOND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: 650-233-8600
MAIL ADDRESS:
STREET 1: 501 SECOND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Ventures V, L.P.
CENTRAL INDEX KEY: 0001674324
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873236
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD, SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 233-8600
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD, SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Opportunities I, L.P.
CENTRAL INDEX KEY: 0001753000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873231
BUSINESS ADDRESS:
STREET 1: 501 SECOND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: 415-993-8570
MAIL ADDRESS:
STREET 1: 501 SECOND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Opportunities I (GP), LLC
CENTRAL INDEX KEY: 0001790778
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21873230
BUSINESS ADDRESS:
STREET 1: 501 2ND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: (650) 233-86000
MAIL ADDRESS:
STREET 1: 501 2ND STREET, SUITE 350
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: IMPEL NEUROPHARMA INC
CENTRAL INDEX KEY: 0001445499
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 263058238
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 201 ELLIOTT AVE. W
STREET 2: SUITE 260
CITY: SEATTLE
STATE: WA
ZIP: 98119
BUSINESS PHONE: 206-568-1466
MAIL ADDRESS:
STREET 1: 201 ELLIOTT AVE. W
STREET 2: SUITE 260
CITY: SEATTLE
STATE: WA
ZIP: 98119
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-04-27
0
0001445499
IMPEL NEUROPHARMA INC
IMPL
0001674324
5AM Ventures V, L.P.
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001791889
5AM Partners V, LLC
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001664281
PARMAR KUSH
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001219014
ROCKLAGE SCOTT M
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001598549
Schwab Andrew J.
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001753000
5AM Opportunities I, L.P.
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
0001790778
5AM Opportunities I (GP), LLC
501 2ND STREET, SUITE 350
SAN FRANCISCO
CA
94107
0
0
1
0
Common Stock
2021-04-27
4
C
0
808259
A
808259
I
See footnote
Common Stock
2021-04-27
4
C
0
540265
A
1348524
I
See footnote
Common Stock
2021-04-27
4
C
0
500932
A
1849456
I
See footnote
Common Stock
2021-04-27
4
C
0
358878
A
2208334
I
See footnote
Common Stock
2021-04-27
4
C
0
101457
13.50
A
2309791
I
See footnote
Common Stock
2021-04-27
4
P
0
575000
15.00
A
575000
I
See footnote
Series C-1 Preferred Stock
2021-04-27
4
C
0
13233885
0.00
D
Common Stock
808259
0
I
See Footnote
Series C-2 Preferred Stock
2021-04-27
4
C
0
8845942
0.00
D
Common Stock
540265
0
I
See Footnote
Series C-3 Preferred Stock
2021-04-27
4
C
0
8201930
0.00
D
Common Stock
500932
0
I
See Footnote
Series D Preferred Stock
2021-04-27
4
C
0
5876034
0.00
D
Common Stock
358878
0
I
See Footnote
5% Convertible Note due 2021
13.50
2021-04-27
4
C
0
1359799.28
0.00
D
2021-12-31
Common Stock
101457
0
I
See Footnote
Each share Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series C-3 Preferred Stock and Series D Preferred Stock automatically converted into shares of Common Stock upon the closing of the Issuer's initial public offering (the "IPO") for no additional consideration, on a 16.37332-for-one basis, and had no expiration date.
The shares are directly held by 5AM Ventures V, L.P. ("Ventures V"). 5AM Partners V, LLC ("Partners V") is the sole general partner of Ventures V. Andrew J. Schwab, Dr. Scott M. Rocklage and Dr. Kush Parmar, are the managing members of Partners V and may be deemed to have shared voting and investment power over the shares beneficially owned by Ventures V. Each of Partners V, Mr. Schwab, Dr. Rocklage and Dr. Parmar disclaims beneficial ownership of such shares except to the extent of its or his pecuniary interest therein.
The shares are directly held by 5AM Opportunities I, L.P ("Opportunities LP"). 5AM Opportunities I (GP), LLC ("Opportunities GP") is the sole general partner of Opportunities LP. Andrew J. Schwab and Dr. Kush Parmar are the managing members of Opportunities GP and may be deemed to have shared voting and investment power over the shares beneficially owned by Opportunities LP. Each of Opportunities GP, Mr. Schwab and Dr. Parmar disclaims beneficial ownership of such shares held directly by Opportunities LP, except to the extent of its or his pecuniary interest therein.
Represents the principal amount of the Note.
The outstanding principal and accrued interest on the convertible promissory note automatically converted into shares of Common Stock upon the closing of the IPO at a conversion price of $13.50 per share.
5AM Ventures V, L.P., By: 5AM Partners V, LLC, its General Partner, By /s/ Scott M. Rocklage, Managing Member
2021-04-29
/s/ Scott M. Rocklage
2021-04-29
/s/ Kush Parmar
2021-04-29
/s/ Scott M. Rocklage
2021-04-29
/s/ Andrew J. Schwab
2021-04-29
5AM Opportunities I, L.P., By: 5AM Opportunities I (GP), LLC, its General Partner, By /s/ Andrew J. Schwab, Managing Member
2021-04-29
5AM Opportunities I (GP), LLC, By /s/ Andrew J. Schwab, Managing Member
2021-04-29