0000899243-18-028779.txt : 20181113 0000899243-18-028779.hdr.sgml : 20181113 20181113180404 ACCESSION NUMBER: 0000899243-18-028779 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20181113 FILED AS OF DATE: 20181113 DATE AS OF CHANGE: 20181113 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Helman Richelle CENTRAL INDEX KEY: 0001753050 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38740 FILM NUMBER: 181179570 MAIL ADDRESS: STREET 1: 100 DOMAIN DRIVE CITY: EXETER STATE: NH ZIP: 03833 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VAPOTHERM INC CENTRAL INDEX KEY: 0001253176 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 100 DOMAIN DRIVE CITY: EXETER STATE: NH ZIP: 03833 BUSINESS PHONE: 603-658-0411 MAIL ADDRESS: STREET 1: 100 DOMAIN DRIVE CITY: EXETER STATE: NH ZIP: 03833 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2018-11-13 0 0001253176 VAPOTHERM INC VAPO 0001753050 Helman Richelle C/O VAPOTHERM, INC. 100 DOMAIN DRIVE EXETER NH 03833 0 1 0 0 See Remarks Common Stock 7575 D Option to purchase Common Stock 1.54 2023-11-18 Common Stock 357 D Option to purchase Common Stock 1.54 2025-03-10 Common Stock 250 D Option to purchase Common Stock 1.54 2025-07-22 Common Stock 142 D Option to purchase Common Stock 1.68 2026-01-01 Common Stock 5178 D Option to purchase Common Stock 1.68 2026-03-08 Common Stock 142 D Option to purchase Common Stock 1.68 2027-01-18 Common Stock 714 D Option to purchase Common Stock 1.68 2027-10-18 Common Stock 768 D Option to purchase Common Stock 1.68 2028-05-01 Common Stock 22727 D The option vested and became exercisable as to 25% of the underlying shares on November 18, 2014 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter. The option vests and becomes exercisable as to 25% of the underlying shares on March 10, 2016 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on July 22, 2016 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on January 1, 2017 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on March 8, 2017 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on January 18, 2018 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on October 18, 2018 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. The option vests and becomes exercisable as to 25% of the underlying shares on May 1, 2019 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. Vice President, Regulatory Affairs & Quality Exhibit List Exhibit 24 - Power of Attorney /s/ John Landry, as Attorney-In-Fact 2018-11-13 EX-24 2 attachment1.htm EX-24 DOCUMENT

                             LIMITED POWER OF ATTORNEY

    The undersigned hereby constitutes and appoints Joseph Army, John Landry and
Anthony Ten Haagen, and each of them individually, with full power of
substitution, as the undersigned's true and lawful attorney-in-fact to:

    (1) prepare, execute in the undersigned's name and on the undersigned's
        behalf, and submit to the U.S. Securities and Exchange Commission (the
        "SEC") a Form ID, including amendments thereto, and any other documents
        necessary or appropriate to obtain codes and passwords enabling the
        undersigned to make electronic filings with the SEC of reports required
        by Section 16(a) of the Securities Exchange Act of 1934, as amended, or
        any rule or regulation of the SEC;

    (2) execute for and on behalf of the undersigned, in the undersigned's
        capacity as officer and/or director of Vapotherm, Inc. (the "Company"),
        Forms 3, 4, 5 and any Schedules 13D or 13G in accordance with Section
        16(a) of the Securities Exchange Act of 1934, as amended, and the rules
        thereunder;

    (3) do and perform any and all acts for and on behalf of the undersigned
        that may be necessary or desirable to complete and execute any such Form
        3, 4, or 5 or Schedule 13D or 13G, complete and execute any amendment or
        amendments thereto, and timely file such form with the SEC and any stock
        exchange or similar authority; and

    (4) take any other action of any type whatsoever in connection with the
        foregoing that, in the opinion of each such attorney-in-fact, may be of
        benefit to, in the best interest of, or legally required by, the
        undersigned, it being understood that the documents executed by each
        such attorney-in-fact on behalf of the undersigned pursuant to this
        Power of Attorney shall be in such form and shall contain such terms and
        conditions as each such attorney-in-fact may approve in each such
        attorney-in-fact's discretion.

    The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that each such attorney-in-fact, or each
such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to
be done by virtue of this power of attorney and the rights and powers herein
granted.  The undersigned acknowledges that each foregoing attorney-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934, as amended.

    This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, 5, and any Schedules 13D
or 13G with respect to the undersigned's holdings of and transactions in
securities issued by the Company, unless earlier revoked by the undersigned in a
signed writing delivered to each foregoing attorney-in-fact.

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    IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 11/07/18 day of November, 2018.

                                        /s/ Richelle Helman
                                        -----------------------
                                        Richelle Helman