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