Filing Details

Accession Number:
0001209191-21-029115
Form Type:
4
Zero Holdings:
No
Publication Time:
2021-04-29 19:45:05
Reporting Period:
2021-04-27
Accepted Time:
2021-04-29 19:45:05
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1445499 Impel Neuropharma Inc IMPL () CA
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1089744 Promod Haque 525 University Avenue
Suite 800
Palo Alto CA 94301
No No Yes No
1535261 Jeffrey Crowe 525 University Avenue
Suite 800
Palo Alto CA 94301
No No Yes No
1726084 Erik Jon Kossow 525 University Avenue
Suite 800
Palo Alto CA 94301
No No Yes No
1842721 Norwest Venture Partners Xiv, Lp 525 University Avenue
Suite 800
Palo Alto CA 94301
No No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2021-04-27 98,927 $13.50 98,927 No 4 C Direct
Common Stock Acquisiton 2021-04-27 2,153,271 $0.00 2,252,198 No 4 C Direct
Common Stock Acquisiton 2021-04-27 825,000 $15.00 3,077,198 No 4 P Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 C Direct
No 4 C Direct
No 4 P Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock 5% Convertible Note due 2021 Disposition 2021-04-27 0 $0.00 98,927 $13.50
Common Stock Series D Preferred Stock Disposition 2021-04-27 35,256,206 $0.00 2,153,271 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 2021-12-31 No 4 C Direct
0 No 4 C Direct
Footnotes
  1. The securities shown represent securities held of record by Norwest Venture Partners XIV, LP ("NVP XIV"). Genesis VC Partners XIV, LLC ("Genesis XIV") is the general partner of NVP XIV and may be deemed to have sole voting and dispositive power over the shares held by NVP XIV. NVP Associates, LLC ("NVP Associates"), the managing member of Genesis XIV, and Jeffrey Crowe, Promod Haque and Jon E. Kossow, as Co-Chief Executive Officers of NVP Associates, may be deemed to share voting and dispositive power with respect to such securities. Such entities and Messrs. Crowe, Haque and Kossow disclaim beneficial ownership of all such securities, except to the extent of any pecuniary interest therein.
  2. The shares of the Issuer's Series D Preferred Stock automatically converted into the number of shares of the Issuer's Common Stock on a 16.37332-for-one basis, for no additional consideration, immediately prior to the closing of the Issuer's initial public offering of Common Stock (the "IPO") and had no expiration date.
  3. The convertible promissory note was issued by the Issuer in March 2021 and the outstanding principal and accrued interest automatically converted into the number of shares of the Issuer's Common Stock set forth above upon the closing of the IPO at $13.50 per share (90% of the IPO price).