0000899243-18-029481.txt : 20181120
0000899243-18-029481.hdr.sgml : 20181120
20181120171216
ACCESSION NUMBER: 0000899243-18-029481
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181116
FILED AS OF DATE: 20181120
DATE AS OF CHANGE: 20181120
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilde Healthcare Holding B.V.
CENTRAL INDEX KEY: 0001420106
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38740
FILM NUMBER: 181196244
BUSINESS ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
BUSINESS PHONE: 31(0)30-2192549
MAIL ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: VAPOTHERM INC
CENTRAL INDEX KEY: 0001253176
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 DOMAIN DRIVE
CITY: EXETER
STATE: NH
ZIP: 03833
BUSINESS PHONE: 603-658-0411
MAIL ADDRESS:
STREET 1: 100 DOMAIN DRIVE
CITY: EXETER
STATE: NH
ZIP: 03833
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-11-16
1
0001253176
VAPOTHERM INC
VAPO
0001420106
Gilde Healthcare Holding B.V.
NEWTONLAAN 91 3584 BP UTRECHT
THE NETHERLANDS
0
0
1
0
Common Stock
2018-11-16
4
C
0
1028079
A
1028079
I
See Footnote
Common Stock
2018-11-16
4
C
0
68447
A
1096526
I
See Footnote
Common Stock
2018-11-16
4
P
0
92500
14.00
A
1189026
I
See Footnote
Series B Convertible Preferred Stock
2018-11-16
4
C
0
482142
0.00
D
Common Stock
482142
0
I
See Footnote
Series C Convertible Preferred Stock
2018-11-16
4
C
0
401527
0.00
D
Common Stock
401527
0
I
See Footnote
Series D Convertible Preferred Stock
2018-11-16
4
C
0
144410
0.00
D
Common Stock
144410
0
I
See Footnote
Series D-1 Convertible Preferred Stock
2018-11-16
4
C
0
68447
0.00
D
Common Stock
68447
0
I
See Footnote
Upon 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.
Upon 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.
The 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
/s/ Marc Perret, on behalf of Gilde, Healthcare Holding B.V.
2018-11-20