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