0000899243-20-009529.txt : 20200326
0000899243-20-009529.hdr.sgml : 20200326
20200326164358
ACCESSION NUMBER: 0000899243-20-009529
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181116
FILED AS OF DATE: 20200326
DATE AS OF CHANGE: 20200326
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 3x5 Partners, LLC
CENTRAL INDEX KEY: 0001762924
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38740
FILM NUMBER: 20746628
BUSINESS ADDRESS:
STREET 1: 2540 NE MARTIN LUTHER KING, JR. BOULEVAR
CITY: PORTLAND
STATE: OR
ZIP: 97212
BUSINESS PHONE: 503-808-9645
MAIL ADDRESS:
STREET 1: 2540 NE MARTIN LUTHER KING, JR. BOULEVAR
CITY: PORTLAND
STATE: OR
ZIP: 97212
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/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0306
4/A
2018-11-16
2020-01-24
0
0001253176
VAPOTHERM INC
VAPO
0001762924
3x5 Partners, LLC
2540 NE MARTIN LUTHER KING JR. BLVD.
PORTLAND
OR
97212
0
0
1
0
Common Stock
2018-11-16
4
C
0
2042595
A
2042595
I
By Vapotherm Investors, LLC
Common Stock
2018-11-16
4
C
0
208752
A
2251347
I
By Vapotherm Investors, LLC
Common Stock
2018-11-16
4
C
0
1049958
A
1049958
I
By 3x5 Special Opportunity Fund, L.P.
Series A Convertible Preferred Stock
2018-11-16
4
C
0
227600
0.00
D
Common Stock
227600
0
I
By Vapotherm Investors, LLC
Series B Convertible Preferred Stock
2018-11-16
4
C
0
75700
0.00
D
Common Stock
75700
0
I
By Vapotherm Investors, LLC
Series C Convertible Preferred Stock
2018-11-16
4
C
0
849239
0.00
D
Common Stock
849239
0
I
By Vapotherm Investors, LLC
Series D Convertible Preferred Stock
2018-11-16
4
C
0
890056
0.00
D
Common Stock
890056
0
I
By Vapotherm Investors, LLC
Series D-1 Convertible Preferred Stock
2018-11-16
4
C
0
208752
0.00
D
Common Stock
208752
0
I
By Vapotherm Investors, LLC
Warrant to purchase Series A Convertible Preferred Stock
14.48
2018-11-16
4
J
0
42857
0.00
D
2018-11-16
2022-09-07
Common Stock
42857
42857
I
By Vapotherm Investors, LLC
Series A Convertible Preferred Stock
2018-11-16
4
C
0
500000
0.00
D
Common Stock
500000
0
I
By 3x5 Special Opportunity Fund, L.P.
Series B Convertible Preferred Stock
2018-11-16
4
C
0
285714
0.00
D
Common Stock
285714
0
I
By 3x5 Special Opportunity Fund, L.P.
Series C Convertible Preferred Stock
2018-11-16
4
C
0
264244
0.00
D
Common Stock
264244
0
I
By 3x5 Special Opportunity Fund, L.P.
Upon closing of the Issuer's initial public offering, each share of Series A Convertible Preferred Stock, 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 A Convertible Preferred Stock, 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 Reporting Person is the managing member of Vapotherm Investors, LLC, the direct beneficial owner of these securities. The Reporting Person disclaims beneficial ownership, within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise, of such securities except to the extent of its pecuniary interest therein.
The Reporting Person is a member of 3x5 Special Opportunity Partners, LLC. 3x5 Special Opportunity Partners, LLC is the general partner of 3x5 Special Opportunity Fund, L.P., the direct beneficial owner of these securities. The Reporting Person disclaims beneficial ownership, within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise, of such securities except to the extent of its pecuniary interest therein.
Immediately prior to the closing of the Issuer's initial public offering, each outstanding Warrant to Purchase Series A Convertible Preferred Stock automatically converted into a Warrant to Purchase Common Stock.
/s/ Anthony Ten Haagen, as Attorney-In-Fact
2020-03-26