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