Statement of Changes in Beneficial Ownership (4)
November 29 2022 - 04:50PM
Edgar (US Regulatory)
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FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
| 1. Name
and Address of Reporting Person * Arnerich Anthony
L. |
2. Issuer Name and Ticker or Trading
Symbol VAPOTHERM INC [ VAPO ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
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(Last)
(First)
(Middle)
100 DOMAIN DRIVE |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/28/2022
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(Street)
EXETER, NH 03833
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
|
Code |
V |
Amount |
(A) or (D) |
Price |
|
Common Stock |
11/28/2022 |
|
P |
|
100000 |
A |
$0.76 |
223374 |
I |
By Anthony L. Arnerich
Trust |
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Common Stock |
|
|
|
|
|
|
|
48898 |
I |
By Christine A. Arnerich
Trust |
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Common Stock |
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|
|
|
|
|
|
22576 (1) |
D |
|
|
Common Stock |
|
|
|
|
|
|
|
1193621 (2) |
I |
By 3x5 Partners, LLC (3) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
|
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of
Responses: |
| (1) |
Includes 5,000 shares held
by the Reporting Person's IRA. |
| (2) |
Consists of (i) 7,885 shares
held by Arnerich 3x5 Special Opportunity Managers, L.P., of which
3x5 Partners, LLC is the general manager, (ii) 790,754 shares
directly held by Vapotherm Investors, LLC, and (iii) 394,982 shares
directly held by 3x5 Special Opportunity Fund, L.P. |
| (3) |
The Reporting Person is a
managing member of 3x5 Partners, LLC. 3x5 Partners, LLC is the
managing member of Vapotherm Investors, LLC and a member of 3x5
Special Opportunity Partners, LLC, which is the general partner of
3x5 Special Opportunity Fund, L.P., and by virtue of these
relationships 3x5 Partners, LLC may be deemed to indirectly
beneficially own the shares directly held by Vapotherm Investors,
LLC and 3x5 Special Opportunity Fund, L.P. As a managing member of
3x5 Partners, LLC the Reporting Person shares voting and
dispositive power over such securities. The Reporting Person
disclaims beneficial ownership, within the meaning of Section 16 of
the Securities Exchange Act of 1934, as amended, or otherwise, of
such securities except to the extent of his pecuniary interest
therein. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Arnerich Anthony L.
100 DOMAIN DRIVE
EXETER, NH 03833 |
X |
|
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Signatures
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/s/ Adrain Bryant, as Attorney In
Fact |
|
11/29/2022 |
| **Signature of
Reporting Person |
Date |
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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 4(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 control number. |
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