Statement of Changes in Beneficial Ownership (4)
January 04 2023 - 05:38PM
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 * Landry
John |
2. Issuer Name and Ticker or Trading
Symbol VAPOTHERM INC [ VAPO ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
SVP & Chief Financial Officer |
|
(Last)
(First)
(Middle)
100 DOMAIN DRIVE |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/2/2023
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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 |
1/2/2023 |
|
A |
|
5684 (1) |
A |
$2.7 (1) |
308758 (2) |
D |
|
|
Common Stock |
|
|
|
|
|
|
|
13550 (3) |
I |
Roth IRA I |
|
Common Stock |
|
|
|
|
|
|
|
3400 (3) |
I |
Roth IRA II |
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 |
|
Stock Option (right to buy) |
$2.7 |
1/2/2023 |
|
A |
|
54675 |
|
(4) |
1/2/2033 |
Common Shares |
54675 |
$0 |
54675 |
D |
|
| Explanation of
Responses: |
| (1) |
Restricted stock unit award
granted under the Vapotherm, Inc. Amended and Restated 2018 Equity
Incentive Plan (the "2018 Equity Plan") in lieu of an annual
increase in the reporting person's 2023 base salary. The restricted
stock unit award will vest in full on December 31, 2023, subject to
the reporting person's continued service as an employee or other
service provider to the Issuer through the vesting
date. |
| (2) |
Includes 60,501 shares that
will be issued over time upon vesting and settlement of restricted
stock unit awards and 45,000 shares held by the reporting person's
Roth IRA. |
| (3) |
The reporting person
disclaims beneficial ownership of these securities, and this report
shall not be deemed an admission that the reporting person is the
beneficial owner of such securities for purposes of Section 16 or
for any other purpose. |
| (4) |
This option was granted
under the 2018 Equity Plan and will vest as to 25% of the
underlying shares on January 2, 2024, and thereafter, as to the
remaining 75% of underlying shares, in 36 monthly installments,
subject to the reporting person's continued service as an employee
or other service provider to the Issuer through the vesting
dates. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Landry John
100 DOMAIN DRIVE
EXETER, NH 03833 |
|
|
SVP & Chief Financial Officer |
|
Signatures
|
|
/s/Adrain Bryant, as Attorney In
Fact |
|
1/4/2023 |
| **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 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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