0001213900-21-023652.txt : 20210429 0001213900-21-023652.hdr.sgml : 20210429 20210429211051 ACCESSION NUMBER: 0001213900-21-023652 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210427 FILED AS OF DATE: 20210429 DATE AS OF CHANGE: 20210429 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40353 FILM NUMBER: 21873299 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40353 FILM NUMBER: 21873298 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40353 FILM NUMBER: 21873300 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 4 1 ownership.xml X0306 4 2021-04-27 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 Common Stock 2021-04-27 4 C 0 710190 A 710190 I See footnote Common Stock 2021-04-27 4 C 0 98068 A 98068 I See footnote Common Stock 2021-04-27 4 C 0 474713 A 1184903 I See footnote Common Stock 2021-04-27 4 C 0 65552 A 163620 I See footnote Common Stock 2021-04-27 4 C 0 440119 A 1625022 I See footnote Common Stock 2021-04-27 4 C 0 60813 A 224433 I See footnote Common Stock 2021-04-27 4 C 0 315328 A 1940350 I See footnote Common Stock 2021-04-27 4 C 0 43550 A 267983 I See footnote Common Stock 2021-04-27 4 C 0 89145 13.5 A 2029495 I See footnote Common Stock 2021-04-27 4 C 0 12311 13.5 A 280294 I See footnote Common Stock 2021-04-27 4 P 0 505620 15 A 2535115 I See footnote Common Stock 2021-04-27 4 P 0 69380 15 A 349674 I See footnote Series C-1 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 11628174 0 D Common Stock 710190 0 I See footnote Series C-1 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 1605711 0 D Common Stock 98068 0 I See footnote Series C-2 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 7772634 0 D Common Stock 474713 0 I See footnote Series C-2 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 1073308 0 D Common Stock 65552 0 I See footnote Series C-3 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 7206216 0 D Common Stock 440119 0 I See footnote Series C-3 Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 995714 0 D Common Stock 60813 0 I See footnote Series D Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 5162969 0 D Common Stock 315328 0 I See footnote Series D Redeemable Convertible Preferred Stock 2021-04-27 4 C 0 713064 0 D Common Stock 43550 0 I See footnote 5% Convertible Note due 2021 13.5 2021-04-27 4 C 0 1194785.75 0 D 2021-12-31 Common Stock 89145 0 I See footnote 5% Convertible Note due 2021 13.5 2021-04-27 4 C 0 165013.49 0 D 2021-12-31 Common Stock 12311 0 I See footnote Each share of Series C-1, C-2, C-3 and D Redeemable Convertible Preferred Stock is automatically converted into shares of Common Stock upon the closing of the Issuer's initial public offering for no additional consideration, on a one share of common stock for 16.37332 preferred shares basis. The convertible promissory note was issued by the issuer on March 5, 2021 and the outstanding principal and accrued interest is automatically converted into shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering at $13.50 per share (90% of the IPO price). 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 2021-04-29 /s/ Frank Kung, as a managing member of Vivo Capital VIII, LLC, General Partner of Vivo Capital Fund VIII, L.P. 2021-04-29 /s/ Frank Kung, as a managing member of Vivo Capital VIII, LLC, General Partner of Vivo Capital Surplus Fund VIII, L.P. 2021-04-29