Statement of Changes in Beneficial Ownership (4)
February 14 2023 - 05:44PM
Edgar (US Regulatory)
|
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)
2/10/2023
|
|
(Street)
EXETER, NH 03833
(City)
(State)
(Zip)
|
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 |
2/10/2023 |
|
P |
|
71428 |
A |
$1.05 (1) |
381392 (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 |
|
Warrant |
$1.17 |
2/10/2023 |
|
P |
|
71428 |
|
2/10/2023 |
2/10/2028 |
Common Stock |
71428 |
(1) |
71428 |
D |
|
| Explanation of
Responses: |
| (1) |
$1.05 per unit, each unit
consisted of one share of common stock and a warrant to purchase
one share of common stock. |
| (2) |
Includes 60,501 shares that
will be issued over time upon vesting and settlement of restricted
stock unit awards, 83,095 shares held by the reporting person's
Roth IRA and 1,206 shares purchased under the Vapotherm, Inc. 2018
Employee Stock Purchase Plan. |
| (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. |
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 |
|
2/14/2023 |
| **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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