# EDGAR Filing Document

**Accession Number:** 0001814114
**File Stem:** 0000899243-23-002966
**Filing Date:** 2023-1
**Character Count:** 9807
**Document Hash:** 10f4478fd8133cb685c76cae5ea6f100
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0000899243-23-002966.hdr.sgml**: 20230130

**ACCESSION NUMBER**: 0000899243-23-002966

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230126

**FILED AS OF DATE**: 20230130

**DATE AS OF CHANGE**: 20230130

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Smith Geoffrey Wade
- **CENTRAL INDEX KEY:** 0001418239

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39421
- **FILM NUMBER:** 23567939

**MAIL ADDRESS:**
- **STREET 1:** 6740 SHADY OAK ROAD
- **CITY:** EDEN PRAIRIE
- **STATE:** MN
- **ZIP:** 55344
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Orchestra BioMed Holdings, Inc.
- **CENTRAL INDEX KEY:** 0001814114
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **IRS NUMBER:** 000000000
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 150 UNION SQUARE DRIVE
- **CITY:** NEW HOPE
- **STATE:** PA
- **ZIP:** 18938
- **BUSINESS PHONE:** 646-343-9298

**MAIL ADDRESS:**
- **STREET 1:** 150 UNION SQUARE DRIVE
- **CITY:** NEW HOPE
- **STATE:** PA
- **ZIP:** 18938

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Health Sciences Acquisitions Corp 2
- **DATE OF NAME CHANGE:** 20200603

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

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Smith Geoffrey Wade<br><sub>(Last) (First) (Middle)</sub><br>C/O ORCHESTRA BIOMED HOLDINGS, INC.<br>150 UNION SQUARE DRIVE<br><sub>(Street)</sub><br>NEW HOPE, PA 18938<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-01-26 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Orchestra BioMed Holdings, Inc. [ OBIO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **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

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-01-26 |  | A |  | 3488<sup>(1)</sup> | A | <sup>(2)</sup> | 3488 | D |  |
| Common Stock | 2023-01-26 |  | A |  | 201319 | A | <sup>(3)</sup> | 201319 | I | By Ascent Biomedical Ventures II NY, LP<sup>(4)</sup> |
| Common Stock | 2023-01-26 |  | A |  | 1049224 | A | <sup>(3)</sup> | 1049224 | I | By Ascent Biomedical Ventures II, LP<sup>(4)</sup> |
| Common Stock | 2023-01-26 |  | A |  | 256623 | A | <sup>(3)</sup> | 256623 | I | By Ascent Biomedical Ventures Synecor, LP<sup>(4)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Warrants (Right to Buy) | $11.50 |  |  |  |  |  |  | <sup>(5)</sup> | 2028-01-26 | Common Stock | 15000 |  | 15000 | D |  |
| Warrants (Right to Buy) | $21.5054 | 2023-01-26 |  | A |  | 43940 |  | <sup>(6)</sup> | 2023-05-31 | Common Stock | 43940 | <sup>(7)</sup> | 43940 | I | By Ascent Biomedical Ventures II NY, LP<sup>(4)</sup> |
| Warrants (Right to Buy) | $21.5054 | 2023-01-26 |  | A |  | 136097 |  | <sup>(6)</sup> | 2023-05-31 | Common Stock | 136097 | <sup>(8)</sup> | 136097 | I | By Ascent Biomedical Ventures II, LP<sup>(4)</sup> |
| Warrants (Right to Buy) | $21.5054 | 2023-01-26 |  | A |  | 519 |  | <sup>(6)</sup> | 2023-05-31 | Common Stock | 519 | <sup>(9)</sup> | 519 | I | By Ascent Biomedical Ventures Synecor, LP<sup>(4)</sup> |
| Stock Options (Right to Buy) | $4.3011 | 2023-01-26 |  | A |  | 18600 |  | <sup>(10)</sup> | 2028-08-07 | Common Stock | 18600 | <sup>(11)</sup> | 18600 | D |  |
| Stock Options (Right to Buy) | $4.3011 | 2023-01-26 |  | A |  | 6975 |  | <sup>(10)</sup> | 2029-08-06 | Common Stock | 6975 | <sup>(12)</sup> | 6975 | D |  |
| Stock Options (Right to Buy) | $10.00 | 2023-01-26 |  | A |  | 23250 |  | <sup>(13)</sup> | 2032-08-25 | Common Stock | 23250 | <sup>(14)</sup> | 23250 | D |  |

---

### Footnotes:

(1) Represents restricted stock awards ("RSAs") that vest in two equal annual installments beginning on April 12, 2023, subject to the reporting person's continued service with Orchestra BioMed Holdings, Inc. ("New Orchestra") on such vesting date.

(2) Received in connection with the business combination of Orchestra BioMed, Inc. ("Orchestra") with Health Sciences Acquisitions Corporation 2 (the "Business Combination") in exchange for 1,621 RSAs of Orchestra.

(3) Received in exchange for shares of Orchestra common stock that automatically converted into shares of New Orchestra common stock on a 1 for 0.465 basis upon the closing date of the Business Combination.

(4) The Reporting Person is a managing member of ABV, LLC, which serves as general partner to Ascent Biomedical Ventures II NY, LP, Ascent Biomedical Ventures II, LP and Ascent Biomedical Ventures Synecor, LP. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of his pecuniary interest, if any, therein.

(5) Fifty percent (50%) of these warrants will become exercisable 24 months after completion of the business combination and the remaining fifty percent (50%) of these warrants will become exercisable 36 months after completion of the business combination, in each case subject to the reporting person's continued service with New Orchestra or one of its subsidiaries through such date.

(6) The warrants are immediately exercisable in full.

(7) Received in connection with the Business Combination in exchange for warrants to acquire 94,494 shares of Orchestra common stock for $10.00 per share.

(8) Received in connection with the Business Combination in exchange for warrants to acquire 292,682 shares of Orchestra common stock for $10.00 per share.

(9) Received in connection with the Business Combination in exchange for warrants to acquire 1,117 shares of Orchestra common stock for $10.00 per share.

(10) The stock option is fully vested and exercisable.

(11) Received in connection with the Business Combination in exchange for options to acquire 40,000 shares of Orchestra common stock for $2.00 per share.

(12) Received in connection with the Business Combination in exchange for options to acquire 15,000 shares of Orchestra common stock for $2.00 per share.

(13) The stock option vests in quarterly installments with a one year cliff beginning on August 18, 2023.

(14) Received in connection with the Business Combination in exchange for options to acquire 50,000 shares of Orchestra common stock for $4.65 per share.

**Signature:** /s/ Todd Finger, Attorney-in-Fact  
**Date:** 2023-01-30

### 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.**