Statement of Changes in Beneficial Ownership (4)
January 04 2023 - 05:50PM
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 * Ramade
Gregoire |
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 Commercial
Officer |
|
(Last)
(First)
(Middle)
100 DOMAIN DRIVE |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/2/2023
|
|
(Street)
EXETER, NH 03833
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 |
|
5320 (1) |
A |
$2.7 (1) |
88434 (2) |
D |
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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 |
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(3) |
1/2/2033 |
Common Stock |
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") and the Vapotherm, Inc.
Amended and Restated 2019 French Qualifying Sub Plan (the "French
Sub 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 58,553 shares that
will be issued over time upon vesting and settlement of restricted
stock unit awards. |
| (3) |
This option was granted
under the 2018 Equity Plan and the French Sub 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 |
Ramade Gregoire
100 DOMAIN DRIVE
EXETER, NH 03833 |
|
|
SVP & Chief Commercial
Officer |
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Signatures
|
|
/s/Adrain Bryant, as Attorney In
Fact |
|
1/4/2023 |
| **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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