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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 08/06/2021 | 3. Issuer Name and Ticker or Trading Symbol VAPOTHERM INC [ VAPO ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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 | 4,100(1) | D | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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 (right to buy) | (2) | 01/20/2030 | Common Stock | 7,000 | 12.28 | D | |
| Stock Option (right to buy) | (3) | 01/01/2030 | Common Stock | 5,000 | 12.16 | D | |
| Stock Option (right to buy) | (4) | 01/01/2031 | Common Stock | 3,200 | 26.86 | D | |
| Explanation of Responses: |
| 1. These shares will be issued over time subject to restricted stock units granted under the Vapotherm, Inc. 2018 Equity Incentive Plan. |
| 2. This option is eligible to vest as to 25% of the underlying shares on December 2, 2020, and thereafter, as to the remaining 75% of underlying shares, in 36 monthly installments, provided that the Reporting Person continues to serve as an employee or other service provider to the Issuer on each vesting date and otherwise subject to the Company's applicable equity incentive plan. |
| 3. This option is eligible to vest as to 25% of the underlying shares on January 1, 2021, and thereafter, as to the remaining 75% of underlying shares, in 36 monthly installments, provided that the Reporting Person continues to serve as an employee or other service provider to the Issuer on each vesting date and otherwise subject to the Company's applicable equity incentive plan. |
| 4. This option is eligible to vest as to 25% of the underlying shares on January 1, 2022 and thereafter, as to the remaining 75% of underlying shares, in 36 monthly installments, provided that the Reporting Person continues to serve as an employee or other service provider to the Issuer on each vesting date and otherwise subject to the Company's applicable equity incentive plan. |
| /s/Adrain Bryant, as Attorney In Fact | 08/12/2021 | |
| ** 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. | ||