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