SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DOYLE WILLIAM F

(Last) (First) (Middle)
C/O WFD VENTURES LLC
1500 BROADWAY, 17TH FLOOR

(Street)
NEW YORK NY 10036

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
OptiNose, Inc. [ OPTN ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/28/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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
Common Stock 06/28/2018 J(1) 2,195,914 D $0 817,225(2) I TKWD Ventures LLC(3)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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
Warrant (Right to Buy) $8.16 06/28/2018 J(1) 1,488,366 (4) 11/01/2020 Common Stock 1,488,366 $0 0(5) I By: TKWD Ventures LLC(3)
Explanation of Responses:
1. TKWD Ventures LLC distributed these shares to its members on a pro rata basis, for no consideration.
2. WFD Ventures LLC is the general partner of TKWD Ventures LLC and owns an approximately 10% interest therein. WFD Ventures LLC therefore received 221,288 shares of Optinose common stock distributed by TKWD Ventures LLC and now owns those shares directly. Additionally, WFD Ventures LLC may be deemed to have sole voting and investment power over the 817,225 shares owned by TKWD Ventures LLC following the distribution of shares reported herein.
3. Mr. Doyle is a managing director of WFD Ventures LLC, which is the general partner of TKWD Ventures LLC. Mr. Doyle possesses sole voting and investment power over shares owned by TKWD Ventures LLC.
4. All warrants are currently exercisable.
5. WFD Ventures LLC is the general partner of TKWD Ventures LLC and owns an approximately 10% interest therein. WFD Ventures LLC therefore received 158,571 warrants to purchase shares of Optinose common stock distributed by TKWD Ventures LLC and now owns those warrants directly.
Remarks:
/s/ Leanne Kelly, attorney-in-fact 07/02/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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