# EDGAR Filing Document

**Accession Number:** 0001445499
**File Stem:** 0001209191-23-017826
**Filing Date:** 2023-3
**Character Count:** 8775
**Document Hash:** 6092064b18d28b6dfc39c758b0ad9993
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-017826.hdr.sgml**: 20230310

**ACCESSION NUMBER**: 0001209191-23-017826

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20230310

**FILED AS OF DATE**: 20230310

**DATE AS OF CHANGE**: 20230310

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Amin Rajiv
- **CENTRAL INDEX KEY:** 0001968339

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40353
- **FILM NUMBER:** 23724191

**MAIL ADDRESS:**
- **STREET 1:** C/O IMPEL PHARMACEUTICALS INC.
- **STREET 2:** 201 ELLIOTT AVENUE WEST, STE 260
- **CITY:** SEATTLE
- **STATE:** WA
- **ZIP:** 98119
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** IMPEL PHARMACEUTICALS INC
- **CENTRAL INDEX KEY:** 0001445499
- **STANDARD INDUSTRIAL CLASSIFICATION:** PHARMACEUTICAL PREPARATIONS [2834]
- **IRS NUMBER:** 263058238
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 0426

**BUSINESS ADDRESS:**
- **STREET 1:** 201 ELLIOTT AVE. W
- **STREET 2:** SUITE 260
- **CITY:** SEATTLE
- **STATE:** WA
- **ZIP:** 98119
- **BUSINESS PHONE:** 206-568-1466

**MAIL ADDRESS:**
- **STREET 1:** 201 ELLIOTT AVE. W
- **STREET 2:** SUITE 260
- **CITY:** SEATTLE
- **STATE:** WA
- **ZIP:** 98119

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** IMPEL NEUROPHARMA INC
- **DATE OF NAME CHANGE:** 20080917

## Ex-24

```

POWER OF ATTORNEY

KNOW ALL BY THESE PRESENTS, that the undersigned hereby constitutes and appoints
Adrian Adams and John Hoekman, Ph.D., and each of them, his/her true and lawful
attorney-in-fact to:

(1)	execute for and on behalf of the undersigned, in the undersigned's capacity
as a representative of Impel Pharmaceuticals Inc. (f/k/a Impel NeuroPharma,
Inc.) (the "Company"), any and all Form 3, 4 or 5 reports required to be filed
by the undersigned in accordance with Section 16(a) of the Securities Exchange
Act of 1934, as amended ("Exchange Act"), and the rules thereunder with respect
to transactions in securities of the Company;

(2)	do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4 or 5
report and timely file such report with the U.S. Securities and Exchange
Commission and any stock exchange or similar authority; and

(3)	take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of 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 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 such attorney-in-fact may approve in
her/his discretion.

The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform each and every act and thing whatsoever requisite,
necessary and 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 such attorney-in-fact, or her/his
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 no such attorney in-fact, in serving in such
capacity at the request of the undersigned, is hereby assuming, nor is the
Company hereby assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act.

This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Form 3, 4 or 5 reports 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 the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of March 2, 2023.

/s/ Rajiv Amin

```

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] 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**<sup>*</sup><br>Amin Rajiv<br><sub>(Last) (First) (Middle)</sub><br>C/O IMPEL PHARMACEUTICALS INC.<br>201 ELLIOTT AVE W, STE. 260<br><sub>(Street)</sub><br>SEATTLE, WA 98119<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>IMPEL PHARMACEUTICALS INC [ IMPL ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-03-10 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [ ] 10% Owner<br>[X] Officer (give title below)   [ ] Other (specify below)<br>_VP, Controller & Interim CFO_ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| No securities beneficially held | 0 | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Stock Option (right to buy) | <sup>(1)</sup> | 2031-07-14<sup>(1)</sup> | Common Stock | 15500 | $10.02 | D |  |
| Stock Option (right to buy) | <sup>(2)</sup> | 2031-07-19<sup>(2)</sup> | Common Stock | 10000 | $12.16 | D |  |
| Stock Option (right to buy) | <sup>(3)</sup> | 2032-01-25 | Common Stock | 7500 | $9.85 | D |  |
| Stock Option (right to buy) | <sup>(4)</sup> | 2033-02-13 | Common Stock | 12000 | $2.29 | D |  |

---

### Footnotes:

(1) The option vests as to 25% of the total shares on July 13, 2022, then 2.0833% of the total shares vest monthly thereafter, with 100% of the total shares vested and exercisable on July 13, 2025, subject to the reporting person's provision of service to the issuer on each vesting date.

(2) The option vests as to 2.0833% of the total shares on August 22, 2021 and then 2.0833% of the total shares vests monthly thereafter, with 100% of the total shares vested and exercisable on July 22, 2025, subject to the reporting person's provision of service to the issuer on each vesting date.

(3) The option vests as to 2.0833% of the total shares on February 26, 2022 and then 2.0833% of the total shares vests monthly thereafter, with 100% of the total shares vested and exercisable on January 26, 2026, subject to the reporting person's provision of service to the issuer on each vesting date.

(4) The option vests as to 2.0833% of the total shares on March 14, 2023 and then 2.0833% of the total shares vests monthly thereafter, with 100% of the total shares vested and exercisable on February 14, 2027, subject to the reporting person's provision of service to the issuer on each vesting date.

**Remarks:**
Exhibit 24.1 - Power of Attorney

**Signature:** /s/ Adrian Adams as attorney-in-fact  
**Date:** 2023-03-10

### Remarks:

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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**