Sec Form 4 Filing - DOYLE WILLIAM F @ OptiNose, Inc. - 2017-10-17

Insider filing report for Changes in Beneficial Ownership
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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).
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
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1. Name and Address of Reporting Person
DOYLE WILLIAM F
2. Issuer Name and Ticker or Trading Symbol
OptiNose, Inc. [ OPTN]
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 WFD VENTURES LLC, 1500 BROADWAY, 17TH FLOOR
3. Date of Earliest Transaction (MM/DD/YY)
10/17/2017
(Street)
NEW YORK, NY10036
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 10/17/2017 C 18,803 ( 1 ) A 18,803 D
Common Stock 10/17/2017 C 3,013,139 ( 1 ) A 3,013,139 I TKWD Ventures LLC ( 3 )
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 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
Series B-2 Convertible Preferred Stock ( 2 ) 10/17/2017 C 4,563 ( 2 ) ( 2 ) Common Stock 13,177 $ 0 0 D
Series C-1 Convertible Preferred Stock ( 2 ) 10/17/2017 C 1,142 ( 2 ) ( 2 ) Common Stock 3,297 $ 0 0 D
Series C-2 Convertible Preferred Stock ( 2 ) 10/17/2017 C 473 ( 2 ) ( 2 ) Common Stock 1,365 $ 0 0 D
Series D Convertible Preferred Stock ( 2 ) 10/17/2017 C 334 ( 2 ) ( 2 ) Common Stock 964 $ 0 0 D
Series B-2 Convertible Preferred Stock ( 2 ) 10/17/2017 C 719,225 ( 2 ) ( 2 ) Common Stock 2,077,049 $ 0 0 I TKWD Ventures LLC ( 3 )
Series C Convertible Preferred Stock ( 2 ) 10/17/2017 C 41,160 ( 2 ) ( 2 ) Common Stock 118,865 $ 0 0 I TKWD Ventures LLC ( 3 )
Series C-1 Convertible Preferred Stock ( 2 ) 10/17/2017 C 190,440 ( 2 ) ( 2 ) Common Stock 549,971 $ 0 0 I TKWD Ventures LLC ( 3 )
Series C-2 Convertible Preferred Stock ( 2 ) 10/17/2017 C 92,543 ( 2 ) ( 2 ) Common Stock 267,254 $ 0 0 I TKWD Ventures LLC ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DOYLE WILLIAM F
C/O WFD VENTURES LLC
1500 BROADWAY, 17TH FLOOR
NEW YORK, NY10036
X X
Signatures
/s/ Leanne Kelly, attorney-in-fact 10/19/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents the total number of shares of Common Stock received upon conversion of Series B-2, Series C, Series C-1, Series C-2 and Series D Preferred Stock in connection with the closing of the Issuer's initial public offering.
( 2 )The Series B-2, Series C, Series C-1, Series C-2 and Series D Preferred Stock converted into Common Stock on a 2.8879-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series B-2, Series C, Series C-1, Series C-2 and Series D Preferred Stock were convertible at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The Preferred Stock had no expiration date.
( 3 )Mr. Doyle is a managing director of WFD Ventures LLC, which is the general partner of TKWD Ventures LLC. Mr. Doyle possesses sole voting and investment power over shares owned by TKWD Ventures LLC.

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