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Filing Details

Accession Number:: 0001209191-21-029136
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2021-04-29 20:51:56
Reporting Period:: 2021-04-27

Accepted Time:: 2021-04-29 20:51:56
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1445499	Impel Neuropharma Inc	IMPL	()	4

Insiders

Cik	Name	Reported Address	Director	Officer	Large Shareholder	Other
1219014	M Scott Rocklage	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1598549	J. Andrew Schwab	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1664281	Kush Parmar	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1674324	5Am Ventures V, L.p.	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1753000	5Am Opportunities I, L.p.	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1790778	5Am Opportunities I (Gp), Llc	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No
1791889	5Am Partners V, Llc	501 2Nd Street, Suite 350 San Francisco CA 94107	No	No	Yes	No

Reported Non-Derivative Transactions

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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	808,259	$0.00	808,259	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2021-04-27	540,265	$0.00	1,348,524	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2021-04-27	500,932	$0.00	1,849,456	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2021-04-27	358,878	$0.00	2,208,334	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2021-04-27	101,457	$13.50	2,309,791	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2021-04-27	575,000	$15.00	575,000	No	4	P	Indirect	See footnote

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	P	Indirect	See footnote

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Common Stock	Series C-1 Preferred Stock	Disposition	2021-04-27	13,233,885	$0.00	808,259	$0.00
Common Stock	Series C-2 Preferred Stock	Disposition	2021-04-27	8,845,942	$0.00	540,265	$0.00
Common Stock	Series C-3 Preferred Stock	Disposition	2021-04-27	8,201,930	$0.00	500,932	$0.00
Common Stock	Series D Preferred Stock	Disposition	2021-04-27	5,876,034	$0.00	358,878	$0.00
Common Stock	5% Convertible Note due 2021	Disposition	2021-04-27	1,359,799	$0.00	101,457	$13.50

Expiration Date	Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
	No	4	C	Indirect
	No	4	C	Indirect
	No	4	C	Indirect
	No	4	C	Indirect
2021-12-31	No	4	C	Indirect

Footnotes

Each share Series C-1 Preferred Stock, Series C-2 Preferred Stock, Series C-3 Preferred Stock and Series D Preferred Stock automatically converted into shares of Common Stock upon the closing of the Issuer's initial public offering (the "IPO") for no additional consideration, on a 16.37332-for-one basis, and had no expiration date.
The shares are directly held by 5AM Ventures V, L.P. ("Ventures V"). 5AM Partners V, LLC ("Partners V") is the sole general partner of Ventures V. Andrew J. Schwab, Dr. Scott M. Rocklage and Dr. Kush Parmar, are the managing members of Partners V and may be deemed to have shared voting and investment power over the shares beneficially owned by Ventures V. Each of Partners V, Mr. Schwab, Dr. Rocklage and Dr. Parmar disclaims beneficial ownership of such shares except to the extent of its or his pecuniary interest therein.
The shares are directly held by 5AM Opportunities I, L.P ("Opportunities LP"). 5AM Opportunities I (GP), LLC ("Opportunities GP") is the sole general partner of Opportunities LP. Andrew J. Schwab and Dr. Kush Parmar are the managing members of Opportunities GP and may be deemed to have shared voting and investment power over the shares beneficially owned by Opportunities LP. Each of Opportunities GP, Mr. Schwab and Dr. Parmar disclaims beneficial ownership of such shares held directly by Opportunities LP, except to the extent of its or his pecuniary interest therein.
Represents the principal amount of the Note.
The outstanding principal and accrued interest on the convertible promissory note automatically converted into shares of Common Stock upon the closing of the IPO at a conversion price of $13.50 per share.