0001213900-21-022631.txt : 20210422
0001213900-21-022631.hdr.sgml : 20210422
20210422213031
ACCESSION NUMBER: 0001213900-21-022631
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210422
FILED AS OF DATE: 20210422
DATE AS OF CHANGE: 20210422
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Vivo Capital Fund VIII, L.P.
CENTRAL INDEX KEY: 0001618788
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21846510
BUSINESS ADDRESS:
STREET 1: 505 HAMILTON AVENUE, SUITE 200
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650 688 0818
MAIL ADDRESS:
STREET 1: 505 HAMILTON AVENUE, SUITE 200
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Vivo Capital Surplus Fund VIII, L.P.
CENTRAL INDEX KEY: 0001628048
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21846509
BUSINESS ADDRESS:
STREET 1: 505 HAMILTON AVENUE, SUITE 200
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650 688 0818
MAIL ADDRESS:
STREET 1: 505 HAMILTON AVENUE, SUITE 200
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Vivo Capital VIII, LLC
CENTRAL INDEX KEY: 0001618789
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40353
FILM NUMBER: 21846511
BUSINESS ADDRESS:
STREET 1: 192 LYTTON AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650 688 0822
MAIL ADDRESS:
STREET 1: 192 LYTTON AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94301
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
3
1
ownership.xml
X0206
3
2021-04-22
0
0001445499
IMPEL NEUROPHARMA INC
IMPL
0001618789
Vivo Capital VIII, LLC
C/O VIVO CAPITAL LLC
192 LYTTON AVENUE
PALO ALTO
CA
94301
0
0
1
0
0001618788
Vivo Capital Fund VIII, L.P.
192 LYTTON AVENUE
PALO ALTO
CA
94301
0
0
1
0
0001628048
Vivo Capital Surplus Fund VIII, L.P.
192 LYTTON AVENUE
PALO ALTO
CA
94301
0
0
1
0
Series C-1 Redeemable Convertible Preferred Stock
Common Stock
710190
I
See footnote
Series C-1 Redeemable Convertible Preferred Stock
Common Stock
98068
I
See footnote
Series C-2 Redeemable Convertible Preferred Stock
Common Stock
474713
I
See footnote
Series C-2 Redeemable Convertible Preferred Stock
Common Stock
65552
I
See footnote
Series C-3 Redeemable Convertible Preferred Stock
Common Stock
440119
I
See footnote
Series C-3 Redeemable Convertible Preferred Stock
Common Stock
60813
I
See footnote
Series D Redeemable Convertible Preferred Stock
Common Stock
315328
I
See footnote
Series D Redeemable Convertible Preferred Stock
Common Stock
43550
I
See footnote
Each share of Series C-1, Series C-2, Series C-3 and Series D Redeemable Convertible Preferred Stock is convertible at any time at the option of the holder, without payment of additional consideration, into Common Stock, on a one share of common stock for 16.37332 preferred shares basis, has no expiration date and is expected to automatically convert into shares of Common Stock upon the closing of the Issuer's initial public offering.
The securities reported herein are held of record by Vivo Capital Fund VIII, L.P. Vivo Capital VIII, LLC is the general partner of Vivo Capital Fund VIII, L.P. As the managing members of Vivo Capital VIII, LLC, Frank Kung, Edgar Engleman and Shan Fu share voting and dispositive power over the shares held by Vivo Capital Fund VIII, L.P., but each disclaims beneficial ownership of such shares except to the extent of their individual pecuniary interest therein.
The securities reported herein are held of record by Vivo Capital Surplus Fund VIII, L.P. Vivo Capital VIII, LLC is the general partner of Vivo Capital Surplus Fund VIII, L.P. As the managing members of Vivo Capital VIII, LLC, Frank Kung, Edgar Engleman and Shan Fu share voting and dispositive power over the shares held by Vivo Capital Surplus Fund VIII, L.P., but each disclaims beneficial ownership of such shares except to the extent of their individual pecuniary interest therein.
/s/ Frank Kung as a managing member of Vivo Capital VIII, LLC
2021-04-22
/s/ Frank Kung, as a managing member of Vivo Capital VIII, LLC, General Parnter of Vivo Capital Fund VIII, L.P.
2021-04-22
/s/ Frank Kung, as a managing member of Vivo Capital VIII, LLC, General Partner of Vivo Capital Surplus Fund VIII, L.P.
2021-04-22