Statement of Changes in Beneficial Ownership (4)
January 23 2020 - 5:11PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
|
|
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
*
Blouin David |
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)
Officer |
|
(Last)
(First)
(Middle)
100 DOMAIN DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/22/2020 |
|
(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
|
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 Options (Right to buy) | $17.15 | 1/22/2020 | | A | | 12279.00 | | (1) | 1/11/2029 | Common Stock | 12279.00 | $0.00 | 12279.00 | D | |
| Explanation of Responses: |
| (1) | This option is eligible to vest as to 25% of the underlying shares, the total number of which were determined at the Issuer's Compensation Committee meeting on January 22, 2020, on January 11, 2020, and thereafter, as to the remaining 75% of underlying shares, in 36 equal 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. |
Reporting Owners
|
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Blouin David
100 DOMAIN DRIVE
EXETER, NH 03833 |
|
| Officer |
|
Signatures
|
| /s/Anthony Ten Haagen, as Attorney In Fact | | 1/23/2020 |
| **Signature of Reporting Person | Date |
Vapotherm (QX) (USOTC:VAPO)
Historical Stock Chart
From Jun 2024 to Jul 2024
Vapotherm (QX) (USOTC:VAPO)
Historical Stock Chart
From Jul 2023 to Jul 2024
