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