0001104659-17-062780.txt : 20171018 0001104659-17-062780.hdr.sgml : 20171018 20171018171133 ACCESSION NUMBER: 0001104659-17-062780 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171012 FILED AS OF DATE: 20171018 DATE AS OF CHANGE: 20171018 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TKWD Ventures LLC CENTRAL INDEX KEY: 0001719928 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38241 FILM NUMBER: 171143131 BUSINESS ADDRESS: STREET 1: C/O WFD VENTURES LLC STREET 2: 1500 BROADWAY, 17TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 212-767-7500 MAIL ADDRESS: STREET 1: C/O WFD VENTURES LLC STREET 2: 1500 BROADWAY, 17TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WFD Ventures LLC CENTRAL INDEX KEY: 0001720002 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38241 FILM NUMBER: 171143132 BUSINESS ADDRESS: STREET 1: 1500 BROADWAY, 17TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 BUSINESS PHONE: 212-767-7500 MAIL ADDRESS: STREET 1: 1500 BROADWAY, 17TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10036 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OptiNose, Inc. CENTRAL INDEX KEY: 0001494650 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 421771610 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1020 STONY HILL ROAD STREET 2: SUITE 300 CITY: YARDLEY STATE: PA ZIP: 19067 BUSINESS PHONE: 267-364-3500 MAIL ADDRESS: STREET 1: 1020 STONY HILL ROAD STREET 2: SUITE 300 CITY: YARDLEY STATE: PA ZIP: 19067 3 1 a3.xml 3 X0206 3 2017-10-12 0 0001494650 OptiNose, Inc. OPTN 0001720002 WFD Ventures LLC C/O WFD VENTURES LLC 1500 BROADWAY, 17TH FLOOR NEW YORK NY 10036 0 0 1 0 0001719928 TKWD Ventures LLC C/O WFD VENTURES LLC 1500 BROADWAY, 17TH FLOOR NEW YORK NY 10036 0 0 1 0 Series B-2 Convertible Preferred Stock Common Stock 2077049 I By: TKWD Ventures LLC Series C Convertible Preferred Stock Common Stock 118865 I By: TKWD Ventures LLC Series C-1 Convertible Preferred Stock Common Stock 549971 I By: TKWD Ventures LLC Series C-2 Convertible Preferred Stock Common Stock 267254 I By: TKWD Ventures LLC Warrant (Right to Buy) 8.16 2020-11-01 Common Stock 1488366 I By: TKWD Ventures LLC On October 10, 2017, the Issuer effected a 2.8879-for-1 stock split of its issued and outstanding shares of common stock. All series of Convertible Preferred Stock will automatically convert into OptiNose, Inc. common stock on a 1-to-2.8879 basis upon the closing of the initial public offering into the number of shares of common stock shown in column 3 above and have no expiration date. The reportable securities are owned directly by TKWD Ventures LLC. WFD Ventures LLC is the general partner of TKWD Ventures LLC and may be deemed to have sole voting and investment power over the shares owned by TKWD Ventures LLC. All warrants are currently exercisable. Exercise price and number of warrant shares have been adjusted to reflect the Issuer's 2.8879-for-1 stock split of its issued and outstanding shares of common stock effected on October 10, 2017. TKWD Ventures LLC, by WFD Ventures LLC, its general partner /s/ William F. Doyle, Managing Partner 2017-10-16 WFD Ventures LLC /s/ William F. Doyle, Managing Partner 2017-10-16