Sec Form 4 Filing - Arnerich Anthony L. @ VAPOTHERM INC - 2020-10-01

Insider filing report for Changes in Beneficial Ownership
"Insiders might sell their shares for any number of reasons, but they buy them for only one: they think the price will rise"
- Peter Lynch
What is insider trading>>
FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Expires: November 30, 2011
Estimated average burden hours per response... 0.5
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 X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O VAPOTHERM INVESTORS, LLC, 2540 NE MARTIN LUTHER KING JR. BLVD.
3. Date of Earliest Transaction (MM/DD/YY)
10/01/2020
(Street)
PORTLAND, OR97212
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 10/01/2020 X 42,857 A $ 14 2,686,673 I By 3x5 Partners, LLC ( 2 )
Common Stock 10/01/2020 S( 3 ) 20,689 D $ 29 2,665,984 ( 4 ) I By 3x5 Partners, LLC ( 2 )
Common Stock 1,492 I By Anthony L. Arnerich Trust
Common Stock 8,812 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 D erivative 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 to Purchase Common Stock ( 1 ) $ 14 10/01/2020 X 42,857 09/07/2012 09/07/2022 Common Stock ( 1 ) 42,857 $ 0 0 I By 3x5 Partners, LLC ( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Arnerich Anthony L.
C/O VAPOTHERM INVESTORS, LLC
2540 NE MARTIN LUTHER KING JR. BLVD.
PORTLAND, OR97212
X X
Signatures
/s/ Anthony Ten Haagen, as Attorney-In-Fact 10/02/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Warrants to purchase Series A Convertible Preferred Stock converted automatically into Warrants to purchase Common Stock upon the consummation of the Issuer's initial public offering.
( 2 )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.
( 3 )On October 1, 2020, Vapotherm Investors, LLC exercised the warrant on a cashless basis, resulting in the Issuer's withholding of 20,689 of the warrant shares to pay the exercise price and issuing to Vapotherm Investors, LLC the remaining 22,168 shares.
( 4 )Consists of (i) 30,000 shares directly held by 3x5 Partners, LLC, (ii) 2,625 shares held by Arnerich 3x5 Special Opportunity Managers, L.P., of which 3x5 Partners, LLC is the general manager, (iii) 1,793,393 shares directly held by Vapotherm Investors, LLC and (iv) 839,966 shares directly held by 3x5 Special Opportunity Fund, L.P.

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 Number.