SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Chapin Jeffery R.

(Last) (First) (Middle)
C/O CASPER SLEEP INC. THREE WORLD TRADE
CENTER, FLOOR 39, 175 GREENWICH STREET

(Street)
NEW YORK NY 10007

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/06/2020
3. Issuer Name and Ticker or Trading Symbol
Casper Sleep Inc. [ CSPR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Product Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 263,464 D
Common Stock 135,000 I Jeffrey R. Chapin 2015 Family Trust
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (1) 01/01/2028 Common Stock 225,000 $13.6 D
Stock Option (2) 07/18/2029 Common Stock 120,000 $19.65 D
Explanation of Responses:
1. The option vested and became exercisable as to 25% of the shares on January 2, 2019 and vests in equal monthly installments thereafter until January 2, 2022.
2. The option fully vests and becomes exercisable on July 16, 2023.
Remarks:
Exhibit 24 - Power of Attorney.
/s/ Jonathan Truppman, Attorney-in-Fact for Jeffrey R. Chapin 02/06/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.