Document:

EX-4.2

 Exhibit 4.2 

VAPOTHERM, INC. 
 TENTH
AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT 
 THIS TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT (the
“Agreement”) is dated as of September 27, 2018, by and among VAPOTHERM, INC., a Delaware corporation (the “Company”); holders of shares of the Company’s Series A Preferred Stock (the
“Series A Investors”); holders of shares of the Company’s Series B Preferred Stock (the “Series B Investors”); holders of shares of the Company’s Series C Preferred Stock (the
“Series C Investors”); holders of shares of the Company’s Series D Preferred Stock (the “Series D Investors”); holders of shares of the Company’s Series
D-1 Preferred Stock (the “Series D-1 Investors”); Bridge Bank, National Association (“Bridge Bank”), and Comerica Bank
(“Comerica,” and together with the Series A Investors, the Series B Investors, the Series C Investors, the Series D Investors, the Series D-1 Investors, and Bridge Bank, the
“Investors”); in each case, as listed on Exhibit A, which may be amended from time to time by the Company. 

WHEREAS, this Agreement shall supersede the prior Ninth Amended and Restated Registration Rights Agreement by and among the Company, the
Series A Investors, the Series B Investors, the Series C Investors, the Series D Investors (each as defined therein), Bridge Bank and Comerica dated as of May 11, 2017, as amended (the “Prior Agreement”); 

WHEREAS, unless otherwise provided in this Agreement, capitalized terms used herein shall have the meanings set forth in
Section 1 hereof; and 
 NOW, THEREFORE, for and in consideration of the foregoing and of the mutual covenants and
agreements hereinafter set forth, the parties hereto agree to amend and restate the Prior Agreement in its entirety as follows: 

AGREEMENT 
 The parties
hereto agree to amend and restate the Prior Agreement as follows: 
 1. Definitions. 

“Affiliate” means, as applied to a specified Person, any Person directly or indirectly controlling, controlled by or
under common control with the specified Person. For the purposes of this definition, “control” shall have the meaning specified as of the date of this Agreement for that word in Rule 405 promulgated by the Commission under the Securities
Act. For purposes of this Agreement, Kaiser Foundation Hospitals, The Permanente Federation LLC-Series F, The Permanente Federation LLC-Series G, The Permanente
Federation LLC-Series I and The Permanente Federation, LLC – Series J shall be deemed to be Affiliates of each other. 

“Commission” means the Securities and Exchange Commission and any successor thereto. 

“Common Stock” means the Company’s Common Stock, $0.001 par value per share, and any shares into which such
Common Stock shall have been changed, or any shares resulting from any reclassification of the Common Stock. 
  

 “Exchange Act” means the Securities Exchange Act of 1934, as amended
prior to or after the date of this Agreement, or any federal statute or statutes that shall be enacted to take the place of such Act, together with all rules and regulations promulgated thereunder. 

“Person” means an individual, partnership, corporation, business trust, limited liability company, joint stock
company, trust, unincorporated association, joint venture, or other entity of whatever nature. 
 “Preferred Stock”
means Series A Preferred Stock, the Series B Preferred Stock, the Series C Preferred Stock, the Series D Preferred Stock, and the Series D-1 Preferred Stock. 

The terms “register,” “registered,” and “registration” refer to a registration effected by
preparing and filing a registration statement or similar document in compliance with the Act, and the declaration or ordering of effectiveness of such registration statement or document. 

“Registrable Securities” means (i) any Common Stock now held or hereafter acquired by the Investors;
(ii) any Common Stock issued or issuable upon the conversion of the Preferred Stock, (iii) any Common Stock issued or issuable to Bridge Bank upon exercise of (A) that certain Warrant by the Company in favor of Bridge Bank dated as of
September 2, 2011, or (B) that certain Warrant by the Company in favor of Bridge Bank dated as of September 27, 2013, (iv) any Common Stock issued or issuable to Comerica upon exercise of (A) that certain Warrant by the Company
in favor of Comerica dated as of June 10, 2014, (B) that certain Warrant by the Company in favor of Comerica dated as of November 19, 2014, or (C) that certain Warrant by the Company in favor of Comerica dated as of July 28,
2015, (iv) any Common Stock issued or issuable with respect to the securities referred to in clause (i), (ii), (iii) or (iv) by way of a stock dividend or stock split or in connection with a combination of shares, recapitalization, merger,
consolidation or other reorganization, and (v) any other shares of Common Stock, and any shares of Common Stock issuable upon the conversion or exercise of any other securities, held by Persons holding securities described in clauses (i), (ii),
(iii) and (iv) above. As to any particular Registrable Securities, such securities will cease to be Registrable Securities when (i) they have been distributed to the public pursuant to an offering registered under the Securities Act so
that all transfer restrictions and restrictive legends with respect thereto are removed upon the consummation of such distribution or (ii) they have been sold to the public through a broker, dealer or market maker in compliance with Rule 144
under the Securities Act (or any similar rule then in force) so that all transfer restrictions and restrictive legends with respect thereto are removed upon the consummation of such distribution. For purposes of this Agreement, a Person will be
deemed to be a holder of Registrable Securities whenever such Person has the right to acquire directly or indirectly such Registrable Securities (upon conversion or exercise in connection with a transfer of securities or otherwise, but disregarding
any restrictions or limitations upon the exercise of such right), whether or not such acquisition has actually been effected. 

“Rule 144” means Rule 144 promulgated by the Commission under the Securities Act, as such rule may be amended from
time to time, or any successor Rule thereto. 
 “Rule 415” means Rule 415 promulgated by the Commission under the
Securities Act, as such rule may be amended from time to time, or any successor Rule thereto. 

  
 2 

 “Securities Act” means the Securities Act of 1933, as amended prior
to or after the date of this Agreement, or any federal statute or statutes that shall be enacted to take the place of such Act, together with all rules and regulations promulgated thereunder. 

“Series A Preferred Stock” means shares of the Company’s Series A Preferred Stock, $0.001 par value per share.

 “Series B Preferred Stock” means shares of the Company’s Series B Preferred Stock, $0.001 par value per
share. 
 “Series C Preferred Stock” means shares of the Company’s Series C Preferred Stock, $0.001 par value
per share. 
 “Series D Preferred Stock” means shares of the Company’s Series D Preferred Stock, $0.001 par
value per share. 
 “Series D-1 Preferred Stock” means shares of the
Company’s Series D-1 Preferred Stock, $0.001 par value per share. 
 2. Demand
Registrations. 
 (a) Requests for Registration. Subject to the other provisions set forth in this Agreement, at any time
following the earliest to occur of (A) 180 days after the Company has completed an initial public offering of securities under the Securities Act and (B) the five-year anniversary of the first issuance of shares of Series D-1 Preferred Stock, (i) the holders of at least a majority of the Registrable Securities may request registration under the Securities Act of all or part of their Registrable Securities on Form S-1 or any similar long-form registration form hereafter adopted by the Commission (“Long-Form Registrations”), provided that the aggregate offering value of the Registrable Securities
requested to be registered in any Long-Form Registration must exceed $5,000,000 (based on the then current public market price), and (ii) the holders of the Registrable Securities may request registration under the Securities Act of all or part
of their Registrable Securities on Form S-3 or any successor short form hereafter adopted by the Commission that permits inclusion or incorporation of substantial information by reference to other documents
filed by the Company with the SEC (“Form S-3 Registrations”) if available, provided that the aggregate offering value of the Registrable Securities requested to be registered in any
Form S-3 Registration must exceed $1,000,000. Each request for a Demand Registration (as defined below) shall specify the approximate number of Registrable Securities requested to be registered. Within ten
(10) days after receipt of any such request, the Company will give written notice of such requested registration to all other holders of Registrable Securities and will include in such registration all Registrable Securities with respect to
which the Company has received written requests for inclusion therein within fifteen (15) days after the receipt of the Company’s notice. All registrations requested pursuant to this Section 2(a) are referred to
herein as “Demand Registrations.” 

  
 3 

 (b) Long-Form Registrations. The holders of Registrable Securities will be entitled
to request two (2) Long-Form Registrations. A registration will not count as one of the permitted Long-Form Registrations until it has become effective or is withdrawn at the request of the holders of at least a majority of the Registrable
Securities (other than as a result of a material adverse change to the Company), and unless all of the Registrable Securities requested to be included are covered thereby or, if underwritten, the holders of Registrable Securities are able to sell at
least 75% of the Registrable Securities requested to be included in such registration. 
 (c) Form
S-3 Registrations. Subject to Section 2(e), after the Company has become subject to the reporting requirements of the Exchange Act and is eligible to register securities for resale on Form S-3 (or any successor form), the holders of Registrable Securities may request Form S-3 Registrations or that the Company take all steps necessary to include such Registrable
Securities in a Form S-3 that the Company has previously filed under Rule 415 under the Securities Act (to the extent reasonably practicable); provided that the aggregate offering value of the Registrable
Securities requested to be registered in any Form S-3 Registration must exceed $1,000,000 (based on the then current public market price). Upon receiving such request, the Company shall use its best efforts to
promptly file a registration statement on Form S-3 (or any successor form), or file an appropriate post-effective amendment or supplement to an existing registration statement, to register under the Securities
Act for public sale in accordance with the method of disposition specified in such request the number of shares of Registrable Securities specified in such request. The Company shall use its best efforts to take any action reasonably necessary to
maintain its eligibility to utilize Form S-3 (or any successor form) in order to permit resales by the holders of Registrable Securities. 

(d) Priority on Demand Registrations. The Company will not include in any Demand Registration any securities that are not Registrable
Securities without the prior written consent of the holders of at least 75% of the Registrable Securities initially requesting such registration. If a Demand Registration is an underwritten offering and the managing underwriters advise the Company
in writing that in their opinion the number of Registrable Securities and, if permitted hereunder, other securities requested to be included in such offering exceeds the number of Registrable Securities and other securities, if any, which can be
sold therein without adversely affecting the marketability of the offering, the Company will include in such registration prior to the inclusion of any securities which are not Registrable Securities the number of Registrable Securities requested to
be included which in the opinion of such underwriters can be sold without adversely affecting the marketability of the offering, pro rata among the respective holders thereof on the basis of the amount of Registrable Securities that each such holder
requested to be included in such registration. 
 (e) Restrictions on Demand Registrations. The Company will not be obligated to
effect, or to take any action to effect, any Long-Form Registration (i) within six (6) months after the effective date of a previous Long-Form Registration; (ii) after the Company has effected two (2) Long-Form Registrations;
(iii) if the Company delivers notice to the holders of Registrable Securities within thirty (30) days of any registration request of its intent to file a registration statement for an initial public offering of the Company’s
securities within ninety (90) days following such notice; or (iv) if the holders of Registrable Securities propose to dispose of shares of Registrable Securities that may, at the time of such request, be registered on Form S-3 pursuant to a request made pursuant to Section 2(c). The Company will not be obligated to effect, or to take any action to effect, any Form S-3
Registration pursuant to Section 2(c) if (i) the Company has effected two (2) Form S-3 Registrations pursuant to Section 2(c) within the twelve
(12) month period immediately preceding the date of such request; or (ii) the Company delivers notice to the 

  
 4 

 
holders of Registrable Securities within thirty (30) days of any Form S-3 Registration request of its intent to make a public offering for its own
behalf within ninety (90) days following such notice. The Company may postpone for up to 90 days the filing or the effectiveness of a registration statement for a Demand Registration if, in the good faith determination of the Company’s
Board of Directors, such Demand Registration would reasonably be expected to have an adverse effect on any proposal or plan by the Company or any of its subsidiaries to engage in any acquisition of assets (other than in the ordinary course of
business) or any merger, consolidation, reorganization, or similar transaction; provided that (i) in such event, the holders of Registrable Securities initially requesting such Demand Registration will be entitled to withdraw such request and,
if such request is withdrawn, such Demand Registration will not count as one of the permitted Demand Registrations hereunder and the Company will pay all Registration Expenses (as defined in Section 6(a)) in connection with
such registration and (ii) the Company may not postpone the filing or the effectiveness of such registration statement, as applicable, more than once in any 12-month period. 

(f) Underwritten Registration. In the event that the registration requested by the holders of Registrable Securities pursuant to this
Section 2 is a registered public offering involving an underwriting, the right of any other holder of Registrable Securities to include its Registrable Securities in such registration shall be conditioned upon such
holder’s participation in such underwriting (unless otherwise mutually agreed by such holder and a majority in interest of the holders requesting such registration) on the terms set forth therein and each such holder shall be required to enter
into an underwriting agreement in customary form with the underwriter or underwriters selected for the underwriting pursuant to the terms hereof. 

(g) Termination of Demand Registration Rights. The rights of holders of Registrable Securities to effect Demand Registrations pursuant
to this Section 2 shall terminate upon the earliest to occur of (i) the date that is five (5) years after the completion of the Company’s initial underwritten public offering of its securities pursuant to an effective
registration statement under the Securities Act (an “IPO”), (ii) the occurrence of a Deemed Liquidation Event (as defined in the Company’s Ninth Amended & Restated Certificate of Incorporation, as amended from
time to time) and (iii) as to any holder, such earlier time after the IPO at which such holder (A) can sell all shares held by it in compliance with Rule 144(b)(1)(i) or (B) holds one percent (1%) or less of the Company’s
outstanding Common Stock and all Registrable Securities held by such holder (together with any Affiliate of the holder with whom such holder must aggregate its sales under Rule 144) can be sold in any three (3) month period without
registration in compliance with Rule 144. 
 3. Piggyback Registrations. 

(a) Right to Piggyback. Whenever the Company proposes to register any of its securities under the Securities Act (other than a
registration on Form S-8, Form S-4 or similar successor forms hereafter adopted by the Commission) and the registration form to be used may be used for the registration
of Registrable Securities (a “Piggyback Registration”), the Company will give prompt written notice to all holders of Registrable Securities of its intention to effect such a registration and will include in such registration
all Registrable Securities with respect to which the Company has received written requests for inclusion therein within 15 days after the receipt of the Company’s notice. 

  
 5 

 (b) Priority on Qualified Public Offering. If a Piggyback Registration is for a
Qualified Public Offering (as defined in the Company’s Ninth Amended and Restated Certificate of Incorporation, as amended from time to time), and the managing underwriters advise the Company in writing that in their opinion the number of
securities requested to be included in such registration exceeds the number which can be sold in such offering without adversely affecting the marketability of the offering, the Company will include in such registration (i) first, the
securities the Company proposes to sell, (ii) second, the Registrable Securities requested to be included in such registration, pro rata among the holders of such Registrable Securities on the basis of the amount of Registrable Securities that
each such holder requested to be included in such registration, and (iii) third, other securities requested to be included in such registration. 

(c) Priority on Primary Registrations. If a Piggyback Registration is an underwritten primary registration on behalf of the Company
other than for a Qualified Public Offering, and the managing underwriters advise the Company in writing that in their opinion the number of securities requested to be included in such registration exceeds the number which can be sold in such
offering without adversely affecting the marketability of the offering, the Company will include in such registration (i) first, the securities the Company proposes to sell, (ii) second, the Registrable Securities requested to be included
in such registration, pro rata among the holders of such Registrable Securities on the basis of the amount of Registrable Securities that each such holder requested to be included in such registration, and (iii) third, other securities
requested to be included in such registration; provided that in any event the holders of Registrable Securities shall be entitled to register at least 30% of the Registrable Securities requested to be included in any such registration. 

(d) Secondary Registrations. If a Piggyback Registration is an underwritten secondary registration on behalf of holders of the
Company’s securities (other than a Demand Registration), and the managing underwriters advise the Company in writing that in their opinion the number of securities requested to be included in such registration exceeds the number which can be
sold in such offering without adversely affecting the marketability of the offering, the Company will include in such registration (i) first, the securities requested to be included therein by the holders requesting such registration and
(ii) second, the Registrable Securities requested to be included in such registration, pro rata among all of such holders, on the basis of the amount of Registrable Securities and the other securities that each requesting holder requested to be
included in such registration; provided, that, the holders of Registrable Securities shall be entitled to register at least 30% of the Registrable Securities requested to be included in the registration. 

(e) Other Registrations. If the Company has previously filed a registration statement with respect to Registrable Securities pursuant to
Section 2 or pursuant to this Section 3, and if such previous registration has not been withdrawn or abandoned, the Company will not file or cause to be effected any other registration of any of
its equity securities or securities convertible or exchangeable into or exercisable for its equity securities under the Securities Act (except on Form S-8, Form S-4 or
any successor form), whether on its own behalf or at the request of any holder or holders of such securities, until a period of at least six (6) months has elapsed from the effective date of such previous registration. 

  
 6 

 (f) Termination of Piggyback Registration Rights. The rights of holders of
Registrable Securities to effect Piggyback Registrations pursuant to this Section 3 shall terminate upon the earliest to occur of (i) the date that is five (5) years after the completion of the Company’s IPO, (ii) the
occurrence of a Deemed Liquidation Event and (iii) as to any holder, such earlier time after the IPO at which such holder (A) can sell all shares held by it in compliance with Rule 144(b)(1)(i) or (B) holds one percent (1%) or
less of the Company’s outstanding Common Stock and all Registrable Securities held by such holder (together with any Affiliate of the holder with whom such holder must aggregate its sales under Rule 144) can be sold in any three (3)
month period without registration in compliance with Rule 144. 
 4. Holdback Agreements. 

(a) Each holder of Registrable Securities hereby agrees, in connection with the IPO (if any), that it will not, without the prior written
consent of the managing underwriter, during the period commencing on the date of the final prospectus relating to the registration by the Company of shares of its Common Stock or any other equity securities under the Securities Act on a
registration statement on Form S-1 or Form S-3, and ending on the date specified by the Company and the managing underwriter (such period not to exceed one hundred eighty (180) days, or such other
period as may be requested by the Company or an underwriter to accommodate regulatory restrictions on (1) the publication or other distribution of research reports and (2) analyst recommendations and opinions, including, but not limited
to, the restrictions contained in FINRA Rule 2711(f)(4) or NYSE Rule 472(f)(4), or any successor provisions or amendments thereto), (i) lend; offer; pledge; sell; contract to sell; sell any option or contract to purchase; purchase any option or
contract to sell; grant any option, right, or warrant to purchase; or otherwise transfer or dispose of, directly or indirectly, any shares of Common Stock or any securities convertible into or exercisable or exchangeable (directly or indirectly) for
Common Stock held immediately before the effective date of the registration statement for such offering or (ii) enter into any swap or other arrangement that transfers to another, in whole or in part, any of the economic
consequences of ownership of such securities, whether any such transaction described in clause (i) or (ii) above is to be settled by delivery of Common Stock or other securities, in cash, or otherwise. The foregoing provisions of this
Section 4 shall apply only to the IPO, shall not apply to the sale of any shares to an underwriter pursuant to an underwriting agreement, and shall be applicable to the holders of Registrable Securities only if all
officers and directors are subject to the same restrictions and the Company uses commercially reasonable efforts to obtain a similar agreement from all stockholders individually owning more than one percent (1%) of the Company’s outstanding
Common Stock (after giving effect to conversion into Common Stock of all outstanding Preferred Stock). The underwriters in connection with such registration are intended third-party beneficiaries of this
Section 4 and shall have the right, power, and authority to enforce the provisions hereof as though they were a party hereto. Each holder of Registrable Securities further agrees to execute such agreements as may be
reasonably requested by the underwriters in connection with such registration that are consistent with this Section 4 or that are necessary to give further effect thereto. Any discretionary waiver or termination of the
restrictions of any or all of such agreements by the Company or the underwriters shall apply pro rata to all holders of Registrable Securities subject to such agreements, based on the number of shares subject to such agreements. 

  
 7 

 (b) The Company agrees not to effect any public sale or distribution of its equity
securities, or any securities convertible into or exchangeable or exercisable for such securities, during the seven days prior to and during the 90-day period beginning on the effective date of any
underwritten Demand Registration or any underwritten Piggyback Registration (except as part of such underwritten registration or pursuant to registrations on Form S-8 or any successor form), unless the
underwriters managing the registered public offering otherwise agree that to do so would not adversely affect the marketability of the registered public offering. 

5. Registration Procedures. Whenever the holders of Registrable Securities have requested that any Registrable Securities be registered
pursuant to this Agreement, the Company will use its reasonable best efforts to effect the registration and the sale of such Registrable Securities in accordance with the intended method of disposition thereof, and pursuant thereto the Company will
as expeditiously as possible: 
 (a) prepare and file with the Commission a registration statement, or an appropriate post-effective
amendment or supplement to an existing registration statement, with respect to such Registrable Securities and use its reasonable best efforts to cause such registration statement, post-effective amendment or supplement to become effective (provided
that before filing a registration statement or prospectus or any amendments or supplements thereto, the Company will furnish to the counsel selected by the holders of a majority of the Registrable Securities covered by such registration statement
copies of all such documents proposed to be filed, which documents will be subject to the reasonable review of such counsel); 
 (b) prepare
and file with the Commission such amendments and supplements to such registration statement and the prospectus used in connection therewith as may be necessary to keep such registration statement effective for a period of not less than twelve months
and comply with the provisions of the Securities Act (including the anti-fraud provisions thereof) with respect to the disposition of all securities covered by such registration statement during such period in accordance with the intended methods of
disposition by the sellers thereof set forth in such registration statement; 
 (c) furnish to each seller of Registrable Securities such
number of copies of such registration statement, each amendment and supplement thereto, the prospectus included in such registration statement (including each preliminary prospectus) and such other documents as such seller may reasonably request in
order to facilitate the disposition of the Registrable Securities owned by such seller; 
 (d) use its reasonable efforts to register or
qualify such Registrable Securities under such other securities or blue sky laws of such jurisdictions as any seller reasonably requests (and to maintain such registrations and qualifications effective for the applicable period of time set forth in
Section 5(b) hereof), and do any and all other acts and things which may be reasonably necessary or advisable to enable such seller to consummate the disposition in such jurisdictions of the Registrable Securities owned by
such seller (provided that the Company will not be required to (i) qualify generally to do business in any jurisdiction where it would not otherwise be required to qualify but for this subparagraph, (ii) subject itself to taxation in any
such jurisdiction or (iii) consent to general service of process in any such jurisdiction); 

  
 8 

 (e) notify each seller of such Registrable Securities, at any time when a prospectus
relating thereto is required to be delivered under the Securities Act, of the happening of any event as a result of which the prospectus included in such registration statement contains an untrue statement of a material fact or omits any fact
necessary to make the statements therein not misleading, and to promptly prepare a supplement or amendment to such prospectus so that, as thereafter delivered to the purchasers of such Registrable Securities, such prospectus will not contain an
untrue statement of a material fact or omit to state any fact necessary to make the statements therein not misleading; 
 (f) cause all such
Registrable Securities to be listed on each securities exchange on which similar securities issued by the Company are then listed; 
 (g)
provide a transfer agent and registrar for all such Registrable Securities not later than the effective date of such registration statement; 

(h) enter into such customary agreements (including underwriting agreements in customary form) and take all such other actions as the holders
of a majority of the Registrable Securities being sold or the underwriters, if any, reasonably request in order to expedite or facilitate the disposition of such Registrable Securities (including, without limitation, effecting a stock split or a
combination of shares); 
 (i) make available for inspection by any seller of Registrable Securities, any underwriter participating in any
disposition pursuant to such registration statement and any attorney, accountant or other agent retained by any such seller or underwriter, all financial and other records, pertinent corporate documents and properties of the Company, and cause the
Company’s officers, directors, employees and independent accountants to supply all information reasonably requested by any such seller, underwriter, attorney, accountant or agent in connection with such registration statement; 

(j) otherwise use its best efforts to comply with all applicable rules and regulations of the Commission, and make available to its security
holders, as soon as reasonably practicable, an earnings statement covering the period of at least twelve months beginning with the first day of the Company’s first full calendar quarter after the effective date of the registration statement,
which earnings statement shall satisfy the provisions of Section 11(a) of the Securities Act and Rule 158 thereunder; 
 (k) permit any
holder of Registrable Securities, which holder, in its judgment, might be deemed to be an underwriter or a controlling Person of the Company, (i) to review and comment on the registration or comparable statement to be filed with the Commission
and all preliminary versions thereof, (ii) to require the insertion therein of material, furnished to the Company in writing, which in the reasonable judgment of such holder and its counsel should be included therein in order to reduce the risk
that such holder may be deemed to be an underwriter or a controlling Person of the Company, or to reduce the risk and potential liability associated therewith in the event that such holder is deemed to be an underwriter or controlling Person of the
Company (including, without limitation, that the holding by such holder of such securities is not to be construed as a recommendation by such holder of the investment quality of the Company’s securities covered thereby and that such holding
does not imply that such holder will assist in meeting any future financial requirements of the Company), provided that such material does not contain a material misstatement or omission and (iii) in the event that reference to such holder by
name or otherwise is not required by the Securities Act or any similar Federal statute then in force, the deletion of any reference to such holder (provided that such holder shall furnish to the Company an opinion of counsel to such effect, which
opinion shall be reasonably satisfactory to the Company); 

  
 9 

 (l) in the event of the issuance of any stop order suspending the effectiveness of a
registration statement, or of any order suspending or preventing the use of any related prospectus or suspending the qualification of any Registrable Securities included in such registration statement for sale in any jurisdiction, the Company will
use its reasonable best efforts promptly to obtain the withdrawal of such order; 
 (m) use its reasonable efforts to cause such Registrable
Securities covered by such registration statement to be registered with or approved by such other governmental agencies or authorities as may be necessary to enable the sellers thereof to consummate the disposition of such Registrable Securities;

 (n) obtain a cold comfort letter from the Company’s independent public accountants in customary form and covering such matters of the
type customarily covered by cold comfort letters as the holders of a majority of the Registrable Securities being sold reasonably request (provided that such Registrable Securities constitute at least 10% of the securities covered by such
registration statement) and use its reasonable efforts to cause its legal counsel to render customary opinions to the underwriters and the sellers of Registrable Securities; 

(o) notify each seller of Registrable Securities promptly after it shall receive notice thereof, of the time when such registration statement
has become effective or a supplement to any prospectus forming part of such registration statement has been filed; and 
 (p) following the
effectiveness of such registration statement, notify each seller of Registrable Securities of any request by the Commission for the amending or supplementing of such registration statement or prospectus. 

6. Registration Expenses. 

(a) All expenses incident to the Company’s performance of or compliance with this Agreement, including without limitation all registration
and filing fees, fees and expenses of compliance with securities or blue sky laws, printing expenses, messenger and delivery expenses, and fees and disbursements of counsel for the Company and all independent certified public accountants,
underwriters (excluding stock transfer taxes, underwriting discounts and commissions) and other Persons retained by the Company (all such expenses being herein called “Registration Expenses”), will be borne by the Company.
Registration Expenses shall also include the Company’s internal expenses (including, without limitation, all salaries and expenses of its officers and employees performing legal or accounting duties), the expense of any annual audit or
quarterly review, the expense of any liability insurance and the expenses and fees for listing the securities to be registered on each securities exchange on which similar securities issued by the Company are then listed. 

  
 10 

 (b) In connection with each Demand Registration and each Piggyback Registration, the Company
will reimburse the holders of Registrable Securities covered by such registration for the reasonable fees and disbursements (which shall not exceed $60,000 in the aggregate for each such registration) of one counsel chosen by the holders of a
majority of the Registrable Securities covered by such registration statement. 
 7. Indemnification. 

(a) The Company agrees to indemnify, to the extent permitted by law, each holder of Registrable Securities, its officers, directors and
employees and each Person who controls such holder (within the meaning of the Securities Act or the Exchange Act) against all losses, claims, damages, liabilities and expenses caused by, arising out of, resulting from or based upon (i) any
untrue or alleged untrue statement of material fact contained in any registration statement filed by the Company in respect of Registrable Securities, or any prospectus, preliminary prospectus or free writing prospectus relating thereto or any
amendment thereof or supplement thereto, (ii) any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein not misleading, or (iii) any violation by the Company of any rule
or regulation promulgated under the Securities Act or state securities laws applicable to the Company and relating to action or inaction required of the Company in connection with any such registration, and the Company will reimburse such holder of
Registrable Securities and each such officer, director, employee and controlling person for any legal or any other expenses reasonably incurred by such Person in connection with investigating or defending any such loss, claim, damage, liability or
expense; except, in each case, insofar as the same are caused by, arise out of, result from or are based upon any information regarding the holder furnished in writing to the Company by such holder specifically for use in the preparation of such
registration statement, prospectus, preliminary prospectus or free writing prospectus or any amendment thereof or supplement thereto. In connection with an underwritten offering, the Company will indemnify such underwriters, their officers and
directors and each Person who controls such underwriters (within the meaning of the Securities Act or the Exchange Act) to the same extent as provided above with respect to the indemnification of the holders of Registrable Securities. 

(b) In connection with any registration statement relating to an offering in which a holder of Registrable Securities is participating
hereunder, each such holder will furnish to the Company in writing such information and affidavits as the Company reasonably requests for use in connection with any such registration statement or prospectus and, to the extent permitted by law, will,
severally and not jointly, indemnify the Company, its directors and officers and each Person who controls the Company (within the meaning of the Securities Act or the Exchange Act) against any losses, claims, damages, liabilities and expenses caused
by, arising out of, resulting from or based upon (i) any untrue or alleged untrue statement of material fact contained in such registration statement, or the prospectus, preliminary prospectus or free writing prospectus relating thereto or any
amendment thereof or supplement thereto or (ii) any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein not misleading, but only to the extent that such untrue statement or
omission is contained in (or omitted from) any information or affidavit regarding the holder furnished in writing by such holder specifically for use in connection with the preparation of such registration statement, prospectus, preliminary
prospectus, free writing prospectus, amendment or supplement; provided that the obligation to indemnify will be individual to each holder and will be limited to the net amount of proceeds received by such holder from the sale of Registrable
Securities pursuant to such registration statement. 

  
 11 

 (c) Any Person entitled to indemnification hereunder will (i) give prompt written
notice to the indemnifying party of any claim with respect to which it seeks indemnification, provided that the failure of the indemnified party to give notice as herein provided shall not relieve the indemnifying party of its indemnification
obligations hereunder except to the extent that the indemnifying party is adversely effected by such failure and (ii) unless in such indemnified party’s reasonable judgment a conflict of interest between such indemnified and indemnifying
parties may exist with respect to such claim, permit such indemnifying party to assume the defense of such claim with counsel reasonably satisfactory to the indemnified party. If such defense is assumed, the indemnifying party will not be subject to
any liability for any settlement made by the indemnified party without its consent (but such consent will not be unreasonably withheld). An indemnifying party who is not entitled to, or elects not to, assume the defense of a claim will not be
obligated to pay the fees and expenses of more than one counsel for all parties indemnified by such indemnifying party with respect to such claim, unless in the reasonable judgment of any indemnified party a conflict of interest may exist between
such indemnified party and any other of such indemnified parties with respect to such claim. No indemnifying party, in the defense of any such claim or litigation, shall, except with the consent of each indemnified party, consent to entry of any
judgment or enter into any settlement which does not include as an unconditional term thereof the giving by the claimant or plaintiff to such indemnified party of a release from all liability in respect of such claim or litigation. 

(d) The indemnification provided for under this Agreement will remain in full force and effect regardless of any investigation made by or on
behalf of the indemnified party or any officer, director or controlling Person of such indemnified party and will survive the transfer of securities. 

(e) If for any reason the indemnification provided for in this Section 7 from an indemnifying party, although
otherwise applicable by its terms, is determined by a court of competent jurisdiction to be unavailable to an indemnified party hereunder, then the indemnifying party, in lieu of indemnifying such indemnified party, shall contribute to the amount
paid or payable by the indemnified parties as a result of such losses, claims, damages, liabilities or expenses in such proportion as is appropriate to reflect the relative fault of such indemnifying party and the indemnified parties in connection
with the actions that resulted in such losses, claims, damages, liabilities or expenses, as well as any other relevant equitable considerations. The relative fault of such indemnifying party and the indemnified parties shall be determined by
reference to, among other things, whether any action in question, including any untrue or alleged untrue statement of a material fact, has been made by, or relates to information supplied by, such indemnifying party or the indemnified parties, and
the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent such action. The amount paid or payable by a party as a result of the losses, claims, damages, liabilities and expenses referred to above shall
be deemed to include, subject to the limitations set forth in Section 7(c), any legal or other fees or expenses reasonably incurred by such party in connection with any investigation or proceeding. The Company and the
Investors agree that it would not be just and equitable if contribution pursuant to this Section 7(e) were determined by pro rata allocation or by any other method of allocation which does not take account of the equitable
considerations referred to above. 

  
 12 

 
Notwithstanding the provisions of this Section 7(e), (i) in no case shall any one holder of Registrable Securities be liable or responsible for any amount in excess of
the net proceeds received by such holder from the offering of Registrable Securities, and (ii) no Person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution
from any Person who was not guilty of such fraudulent misrepresentation. No party shall be liable for contribution with respect to any action, suit, proceeding or claim settled without its prior written consent, which consent shall not be
unreasonably withheld. 
 (f) For so long as Maryland law places restrictions on the indemnification obligations of state agencies in
accordance with the Opinion of the Maryland Attorney General No. 86-064 dated December 1, 1986 (the “Opinion”), it is expressly acknowledged and agreed that in accordance with
the terms of the Opinion, absent already available appropriations to fund indemnification or contribution obligations that may arise under Section 7, any and all such obligations of the Maryland Department of Business and
Economic Development (“DBED”) are conditioned upon the availability of appropriations for use by DBED at the time such indemnification or contribution obligations arise, and are further limited to the extent of the State of
Maryland’s statutory waiver of its sovereign immunity. 
 8. Rule 144 Requirements. After the earliest of (i) the closing
of the sale of the securities of the Company pursuant to a registration statement under the Securities Act, (ii) the registration by the Company of a class of securities under Section 12 of the Exchange Act, or (iii) the issuance by
the Company of an offering circular pursuant to Regulation A under the Securities Act, the Company agrees to: 
 (a) make and keep current
public information about the Company available, as those terms are understood and defined in Rule 144; 
 (b) use its reasonable best efforts
to file with the Commission in a timely manner all reports and other documents required of the Company under the Securities Act and the Exchange Act (at any time after it has become subject to such reporting requirements); and 

(c) furnish to any holder of Registrable Securities upon request (i) a written statement by the Company as to its compliance with the
reporting requirements of Rule 144 and of the Securities Act and the Exchange Act (at any time after it has become subject to such reporting requirements), (ii) a copy of the most recent annual or quarterly report of the Company, and (iii) such
other reports and documents of the Company as such holder may reasonably request to avail itself of any similar rule or regulation of the Commission allowing it to sell such securities without registration. 

9. Miscellaneous. 
 (a)
Selection of Investment Bankers. The holders of Registrable Securities initiating the registration pursuant to Section 2 hereof shall have the right to select the managing underwriters for any underwritten offering
requested pursuant to Section 2, subject to the approval of the Company, which approval will not be unreasonably withheld or delayed. 

  
 13 

 (b) No Inconsistent Agreements; Other Registration Rights. The Company will not
hereafter enter into any agreement with respect to its securities which is inconsistent with or violates the rights granted to the holders of Registrable Securities in this Agreement. The Company agrees that it shall not grant to any Person any
registration rights more favorable than, on parity with, or inconsistent with any of those contained herein for so long as any of the registration rights under this Agreement remain in effect without the written consent of the holders of at least 66-2/3% of the Registrable Securities. 
 (c) Adjustments Affecting Registrable Securities. The
Company will not take any action, or permit any change to occur, with respect to its securities which would adversely affect the ability of the holders of Registrable Securities to include such Registrable Securities in a registration undertaken
pursuant to this Agreement or which would adversely affect the marketability of such Registrable Securities in any such registration (including, without limitation, effecting a stock split or a combination of shares). 

(d) Remedies. Any person having rights under any provision of this Agreement will be entitled to enforce such rights specifically to
recover damages caused by reason of any breach of any provision of this Agreement and to exercise all other rights granted by law. The parties hereto agree and acknowledge that money damages may not be an adequate remedy for any breach of the
provisions of this Agreement and that any party may in its sole discretion apply to any court of law or equity of competent jurisdiction (without posting any bond or other security) for specific performance and for other injunctive relief in order
to enforce or prevent violation of the provisions of this Agreement. 
 (e) Successors and Assigns. The registration rights hereunder
may be assigned in connection with a private transfer of Registrable Securities or related shares of Preferred Stock upon written notice to the Company; provided that (i) the transferee is an Affiliate of the transferor, (ii) the
transferee is a constituent partner or other equity owner of the transferor, or (iii) the transferee acquires Registrable Securities equivalent to at least 20,000 shares of Common Stock (as such number is adjusted for stock splits, stock
dividends, recapitalizations, combinations, reclassifications and similar events). All covenants and agreements in this Agreement by or on behalf of any of the parties hereto will bind and inure to the benefit of the respective successors and
assigns of the parties hereto whether so expressed or not. In addition, whether or not any express assignment has been made, the provisions of this Agreement which are for the benefit of purchasers or holders of Registrable Securities are also for
the benefit of, and enforceable by, any subsequent holder of Registrable Securities. 
 (f) Severability. Whenever possible, each
provision of this Agreement will be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this Agreement is held to be prohibited by or invalid under applicable law, such provision will be ineffective
only to the extent of such prohibition or invalidity, without invalidating the remainder of this Agreement. 
 (g) Counterparts. This
Agreement may be executed simultaneously in two or more counterparts, any one of which need not contain the signatures of more than one party, but all such counterparts taken together will constitute one and the same Agreement. This Agreement may be
executed by facsimile signatures. 

  
 14 

 (h) Descriptive Headings. The descriptive headings of this Agreement are inserted for
convenience only and do not constitute a part of this Agreement. 
 (i) Governing Law. All questions concerning the construction,
validity and interpretation of this Agreement and the exhibits and schedules hereto will be governed by the internal law, and not the law of conflicts, of Delaware. 

(j) Notices. All notices, demands or other communications to be given or delivered under or by reason of the provisions of this
Agreement shall be in writing and shall be deemed to have been given (i) when received if delivered personally to the recipient, (ii) when receipt is electronically confirmed, if sent by fax (with hard copy to follow) to the recipient,
(iii) one business day after deposit for next business day delivery to the recipient by reputable express courier service (charges prepaid) or (iv) three (3) business days after being mailed to the recipient by certified or registered
mail, return receipt requested and postage prepaid. Such notices, demands and other communications shall be sent to the Investors at the addresses listed on Exhibit A and to the Company at the address set forth below: 

Vapotherm, Inc. 
 22 Industrial
Drive, Suite 1 
 Exeter, NH 03833 

Telecopy No.: (xxx) xxx-xxxx 

Attention: Joseph Army, CEO 

with a copy to: 

Ropes & Gray LLP 

Prudential Tower 
 800 Boylston
Street 
 Boston, MA 02199 

Attention: Steven A. Wilcox 
 or to such other
address or to the attention of such other person as the recipient party has specified by prior written notice to the sending party. 
 (k)
Amendments and Waivers. Any term of this Agreement may be amended or terminated and the observance of any term of this Agreement may be waived (either generally or in a particular instance and either retroactively or prospectively), with the
written consent of the Company and the holders of at least 66-2/3% of the Registrable Securities; provided, that this Agreement may be amended with the consent of the holders of less than all Registrable
Securities only in a manner which applies to all such holders in the same fashion. Any such amendment, termination or waiver effected in accordance with this Section 9(l) shall be binding on all parties hereto, even if they
do not execute such consent. No waivers of or exceptions to any term, condition or provision of this Agreement, in any one or more instances, shall be deemed to be, or construed as, a further or continuing waiver of any such term, condition or
provision. 

  
 15 

 (l) Additional Investors. Notwithstanding anything to the contrary contained herein,
if the Company issues additional Registrable Securities after the date hereof, any holder of such Registrable Securities, if not then a party to this Agreement, become a party to this Agreement by executing and delivering an additional counterpart
signature page to this Agreement or a joinder agreement in form and substance satisfactory to the Company, and thereafter shall be deemed an “Investor” for all purposes hereunder. No action or consent by the Investors shall be required for
such joinder to this Agreement by such additional Investor, so long as such additional Investor has agreed in writing to be bound by all of the obligations as an “Investor” hereunder. From time to time, the Company shall amend Exhibit
A to reflect the addition of Investors who become party to this Agreement after the date hereof. 
 [SIGNATURE PAGES FOLLOW] 

  
 16 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	COMPANY:
	
	VAPOTHERM, INC.
		
	By:	 	 /s/ Joseph Army

	Name:	 	Joseph Army
	Title:	 	President

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	Redmile Capital Fund, LP
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the General Partner
		 	and the Investment Manager
	
	Redmile Capital Offshore Fund, Ltd.
	Redmile Capital Offshore Fund II, Ltd.
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the Investment
		 	Manager
	
	Redmile Private Investments II, L.P.
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the Management
		 	Company and General Partner
	
	Redmile Strategic Master Fund, LP
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the General Partner
		 	and Investment Manager

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	INVESTORS:
	
	Coöperatieve Gilde Healthcare III Sub-Holding U.A.
		
	By:	 	 /s/ P.H. van der Meer

	Name:	 	P.H. van der Meer
	Title:	 	Managing Director

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 
			
	INVESTORS:
	
	ADAGE CAPITAL PARTNERS, L.P.
		
	By:	 	 /s/ Dan Lehan

	Name:	 	Dan Lehan
	Title:	 	COO

 Signature Page to Tenth Amended and Restated Registration Rights Agreement 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	MORGENTHALER VENTURE PARTNERS IX, L.P.
	
	By: Morgenthaler Management Partners IX, LLC, Its Managing Partner
		
	By:	 	 /s/ Jason Lettmann

	Name:	 	Jason Lettmann
	Title:	 	Partner

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	 3X5 SPECIAL OPPORTUNITY FUND, L.P.

	
	By: 3x5 Special Opportunity Partners, LLC, its general partner
	
	By: Arnerich 3x5 Special Opportunity Managers, LLC, its member
		
	By:	 	 /s/ Nicholas Walrod

	Name:	 	Nicholas Walrod
	Title:	 	Authorized Signatory
	
	VAPOTHERM INVESTORS, LLC
		
	By:	 	 /s/ Nicholas Walrod

	Name:	 	Nicholas Walrod
	Title:	 	Authorized Person

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II, L.P.
	
	BY: SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS: GENERAL PARTNER
	BY: SIGHTLINE PARTNERS LLC,
	ITS: MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-A, L.P.
	
	BY: SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS: GENERAL PARTNER
	BY: SIGHTLINE PARTNERS LLC,
	ITS: MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-B, L.P.
	
	BY: SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS: GENERAL PARTNER
	BY: SIGHTLINE PARTNERS LLC,
	ITS: MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE INVESTORS, LLC
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	QUESTMARK PARTNERS II, L.P.
		 	By: QuestMark Advisers II, LLC
		 	Its: General Partner
		
	By:	 	 /s/ Benjamin S. Schapiro

	Name:	 	Benjamin S. Schapiro
	Title:	 	Chairman & CEO
	
	QUESTMARK PARTNERS SIDE FUND II, L.P.
		 	By: QuestMark Advisers II, LLC
		 	Its: General Partner
		
	By:	 	 /s/ Benjamin S. Schapiro

	Name:	 	Benjamin S. Schapiro
	Title:	 	Chairman & CEO

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	Integral Capital Holdings VIII, LLC
	By: Crestline Management, L.P., its Investment Manager
	By: Crestline Investors, Inc., its General Partner
		
	By:	 	 /s/ John S. Cochran

	Name:	 	John S. Cochran
	Title:	 	Vice President

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	CROSS CREEK CAPITAL, L.P.
		
	By:	 	Cross Creek Capital GP, L.P.
		 	Its Sole General Partner
		
	By:	 	 /s/ Tyler Christenson

		 	Name: Tyler Christenson
		 	Title: Managing Director
	
	CROSS CREEK CAPITAL EMPLOYEES’ FUND, L.P.
		
	By:	 	Cross Creek Capital GP, L.P.
		 	Its Sole General Partner
		
	By:	 	 /s/ Tyler Christenson

		 	Name: Tyler Christenson
		 	Title: Managing Director

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

	
	 /s/ John Landry

	JOHN LANDRY

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

	
	 /s/ Joseph Army

	JOSEPH ARMY 

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	KAISER FOUNDATION HOSPITALS
		
	By:	 	 /s/ Thomas Meier

	Name:	 	Thomas Meier
	Title:	 	SVP & Treasurer
	
	THE PERMANENTE FEDERATION LLC-SERIES F
		
	By: 	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES G
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES I
		
	By: 	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES J
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 IN WITNESS WHEREOF, the parties have executed this Tenth Amended and Restated Registration
Rights Agreement as of the date first written above. 
  

			
	PERCEPTIVE LIFE SCIENCES MASTER FUND LTD.
	By: Perceptive Advisors LLC
	Its: Manager
		
	By:	 	 /s/ James H. Mannix

	Name:	 	James H. Mannix
	Title:	 	COO

 [SIGNATURE PAGE TO TENTH AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT] 

 EXHIBIT A 

Investors 
 REDMILE GROUP, LLC 

PERCEPTIVE LIFE SCIENCES MASTER FUND LTD. 

COOPERATIEVE GILDE HEALTHCARE III SUB-HOLDING U.A. 

ADAGE CAPITAL PARTNERS, LP 
 MORGENTHALER VENTURE
PARTNERS IX, L.P. 
 3X5 SPECIAL OPPORTUNITY FUND, L.P. 

VAPOTHERM INVESTORS, LLC 
 SIGHTLINE HEALTHCARE
OPPORTUNITY FUND II, L.P. 
 SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-A, L.P. 

SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-B, L.P. 

SIGHTLINE INVESTORS, LLC 
 Integral Capital Holdings
VIII, LLC 
 Cross Creek Capital, L.P. 
 Cross
Creek Capital Employees’ Fund, L.P. 
 QuestMark Partners II, L.P. 

QuestMark Partners Side Fund II, L.P. 
 Kaiser
Foundation Hospitals 
 c/o Kaiser Permanente Ventures 

 The Permanente Federation LLC-Series F 

c/o Kaiser Permanente Ventures 
 The Permanente
Federation LLC-Series G 
 c/o Kaiser Permanente Ventures 

The Permanente Federation LLC-Series I 

c/o Kaiser Permanente Ventures 
 The Permanente
Federation LLC-Series J 
 c/o Kaiser Permanente Ventures 

Joseph Army 
 John LandryEX-4.3

 Exhibit 4.3 

VAPOTHERM, INC. 

TWELFTH AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

THIS TWELFTH AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT (this “Agreement”) is made and entered into as of
September 27, 2018 by and among Vapotherm, Inc., a Delaware corporation (the “Company”), and the Persons named in Schedule A hereto (the “Stockholders”). 

WHEREAS, in connection with the Company’s issuance and sale of shares of Series D-1 Preferred
Stock (as such term is defined in the Charter), the Required Preferred Stockholders (as defined in the Prior Agreement) and the holders of a majority of the Equity Securities (as defined in the Prior Agreement) held by the Restricted Stockholders
(as defined in the Prior Agreement) wish to amend and restate in its entirety the Eleventh Amended and Restated Stockholders’ Agreement, dated as of October 13, 2017 (the “Prior Agreement”), by and among the Company
and the stockholders named therein, in order to make certain changes thereto. 
 NOW, THEREFORE, for and in consideration of the foregoing
and of the mutual covenants and agreements hereinafter set forth, the parties hereto agree to amend and restate the Prior Agreement as follows: 

1. DEFINITIONS 
 For all
purposes of this Agreement, certain capitalized terms specified in Exhibit A shall have the meanings set forth in Exhibit A, except as otherwise expressly provided. 

2. DIRECTORS OF THE COMPANY 

2.1 Board of Directors 

The Company and each Stockholder (for so long as such Stockholder owns any Equity Securities of the Company) shall take or cause to be taken
all such action within their respective power and authority (including without limitation the voting of all Equity Securities held by such Stockholder or the taking of action by consent with respect to such shares) as may be required to effect the
following: 
 2.1.1 to establish and maintain the authorized size of the Board of Directors of the Company (the
“Board”) at ten (10) directors; to maintain the quorum requirements for actions of the Board at a majority of the entire number of directors, and to maintain the voting requirements for actions of the Board at a majority
of directors present at a meeting at which there is a quorum, except in respect of such matters as this Agreement, the Charter or the Bylaws of the Company may impose a greater voting requirement; 

2.1.2 to cause to be elected to the Board: 

(1) one director designated by Coöperatieve Gilde Healthcare III Sub-Holding U.A.
(“Gilde”), which individual shall initially be Geoff Pardo, for so long as such Stockholder and its Affiliates continue to own beneficially at least 1,000,000 shares of Preferred Stock (the “Series B
Director”), 
  

 (2) one director designated by Morgenthaler Venture Partners IX, L.P.
(“Morgenthaler”), which individual shall initially be Jason Lettmann, for so long as such Stockholder and its Affiliates continue to own beneficially at least 1,000,000 shares of Preferred Stock, 

(3) one director designated by 3x5 Special Opportunity Fund, L.P. (“3x5”), which individual shall initially be Anthony
Arnerich, for so long as such Stockholder and its Affiliates continue to own beneficially at least 1,000,000 shares of Preferred Stock, 

(4) one director designated by QuestMark Partners II, L.P., which individual shall initially be Michael J. Ward, for so long as such
Stockholder and its Affiliates continue to own beneficially at least 1,000,000 shares of Preferred Stock, 
 (5) one director designated by
the Nominating Committee of the Board and approved by holders of at least 64% of the outstanding shares of Series A Preferred Stock, which individual shall initially be Bess Weatherman (the directors designated as provided in clause (2), (3), (4)
and (5), collectively, the “Series A Directors,” and together with the Series B Director, the “Preferred Directors”), 

(6) one director who will be the Company’s Chief Executive Officer (excluding any individual appointed to such position on an interim
basis), who shall initially be Joseph Army, provided that if for any reason such individual shall cease to serve as the Chief Executive Officer of the Company, each of the Stockholders shall promptly vote their respective Equity Securities
(i) to remove the former Chief Executive Officer from the Board if such person has not resigned as a member of the Board and (ii) to elect such person’s replacement as Chief Executive Officer of the Company to replace such individual
on the Board, 
 (7) three directors who are not Affiliates of the Company or any Stockholder (other than solely as a result of being
elected director), designated by a majority of the other directors, including at least three (3) of the Preferred Directors, who shall initially be J. Neal Armstrong, James W. Liken and Marina Hahn, and 

(8) one director designated by the holders of a majority of the Common Stock (excluding for purposes of this Section 2.1.2(8) any
Excluded Shares), who shall initially be Craig Reynolds (the directors designated as provided in clause (6), (7) and (8), collectively, the “Common and Preferred Directors”); 

2.1.3 to remove forthwith from the Board (or any committee thereof) any director when removal is requested for any reason by the
Stockholder group designating the election of such director pursuant to Section 2.1.2(1), (2), (3), (4), (5), (6), (7) or (8) above (each a “Designating Group”), with or without cause; 

  
 2 

 2.1.4 in the case of death, resignation or other removal as herein provided of such
director, to elect another person designated by the respective Designating Group to fill the vacancy created thereby; and 
 2.1.5 to
use its best efforts to prevent any action from being taken by the Board (or any committee thereof) during the pendency of any vacancy due to death, resignation or removal of a director, unless the Designating Group shall have failed for a period of
ten (10) days after written notice of such vacancy to designate a replacement. 
 2.2 Observer Rights. 

Each of (a) SightLine Healthcare Opportunity Fund II, L.P. (collectively with SightLine Healthcare Opportunity Fund II-A, L.P. and SightLine Healthcare Opportunity Fund II-B, L.P., “Sightline”), (b) Cross Creek Capital, L.P. and Cross Creek Capital Employees’
Fund, L.P. (which for purposes of this Agreement shall be deemed to be Affiliates of each other and shall collectively have one Representative), (c) Vapotherm Investors, LLC, (d) Kaiser Foundation Hospitals (“KFH”), The
Permanente Federation LLC – Series F (“PF”), The Permanente Federation LLC-Series G (“PG”), The Permanente Federation
LLC-Series I (“PI”) and The Permanente Federation LLC – Series J (“PJ”) (for purposes of this Agreement, KFH, PF, PG, PI and PJ shall be deemed to be
Affiliates of each other and shall collectively have one Representative), (e) Adage Capital Partners, LP (“Adage”) and (f) Redmile Fund (“Redmile”), in each case for so long as it (collectively
with its respective Affiliates) owns at least 100,000 shares of Common Stock issued or issuable upon conversion of the Preferred Stock (as adjusted for stock splits, stock dividends, combinations and other recapitalizations), shall be permitted to
send a representative (each, a “Representative”) to attend, as nonvoting observer, all meetings of the Board or committees thereof and, in this respect, the Company shall provide each Representative copies of all notices,
minutes, consents, and other material that it provides to its Directors at the same time as such materials are provided to the Directors; provided, however, that the Company reserves the right to exclude any Representative from access to any
material or meeting or portion thereof if the Company in good faith believes upon advice of counsel that such exclusion is reasonably necessary to preserve the attorney-client privilege or to protect highly confidential proprietary information. Each
Representative may participate in discussions of matters brought to the Board or the committees thereof. The Company shall not reimburse expenses incurred by each Representative in attending any meeting of the Board or any committees thereof. 

2.3 Board Meetings 
 The
Company and each Stockholder agree to take, or cause the Board to take, all such actions necessary to hold meetings of the Board at least once every calendar quarter in accordance with the Bylaws of the Company, unless otherwise agreed by the
vote of a majority of Directors then in office. 
 3. TRANSFER OF EQUITY SECURITIES; PREEMPTIVE RIGHTS 

Until the termination of this Agreement, the following restrictions shall apply to the Transfer of Equity Securities: 

  
 3 

 3.1 Restrictions on Transfer of Shares by the Stockholders 

3.1.1 Except as otherwise provided in this Agreement, no Stockholder shall
Transfer to any Person any Equity Securities. No Transfer of Equity Securities in violation of this Agreement shall be made or recorded on the books of the Company, and any such Transfer shall be void and of no effect. 

3.1.2 The provisions of this Section supersede, and shall be controlling with respect to, any conflicting provisions contained in any
other agreement between or among any of the Company, the Stockholders or any of them. 
 3.1.3 Notwithstanding anything to the
contrary contained in this Section 3, no Stockholder shall be permitted any time to Transfer to any Person any Equity Securities if such Transfer would not be in compliance with applicable Securities Laws. 

3.2 Permitted Transfers 

Subject to Section 3.1.3, a Stockholder shall be permitted to Transfer his, her or its Equity Securities pursuant to a (i) Family
Gift, (ii) Estate Planning Transfer, (iii) to an Affiliate, (iv) a repurchase of Equity Securities from such Stockholder by the Company at cost and pursuant to an agreement containing vesting and/or repurchase provisions, (v) any
sale of Equity Securities in accordance with its obligation to set under Section 3.4 hereof, or (vi) any sale of Equity Securities to the public pursuant to a registration statement filed with, and declared effective by, the Commission
under the Act. In connection with any Transfer under this Section 3.2, the transferee shall hold such Equity Securities subject to the same restrictions applicable to its transferor and shall agree in writing to be bound by the terms of this
Agreement. Additionally, an Investor Stockholder shall be permitted to Transfer its Equity Securities pursuant to a distribution without consideration to any of its partners, members or other equity owners, or retired partners, retired members or
other equity owners, or to the estate of any of the Investor Stockholder’s partners, members or other equity owners or retired partners, retired members or other equity owners. 

3.3 Rights of First Refusal and Tag-Along Rights 

3.3.1 First Offer Rights. In the event that a Stockholder or any Person who acquires any Equity Securities from a
Stockholder in accordance with Section 3.2 (a “Transferor”), desires to Transfer Equity Securities now or hereafter held or acquired by such Transferor, other than Transfers permitted under Section 3.2 above, the
Transferor may effect such Transfer without restriction hereunder, provided that the Transferor first makes the offer(s) required by this Section 3.3 and such offer(s) are not accepted as provided in this Section 3.3. 

3.3.2 Offer. Prior to effecting a Transfer, the Transferor shall first deliver a written notice (the “Transfer
Notice”) to the Company and to each Investor Stockholder (other than the Transferor) specifying (i) the name and address of the Person to whom the Transferor wishes to Transfer any Equity Securities (the “Proposed
Transferee”), (ii) the number and class or series of Equity Securities which the Transferor wishes to Transfer (the “Offered Shares”), (iii) the cash or other purchase price offered for the Equity Securities (the
“Offer Price”), and (iv) any other terms and conditions of the Transfer. In addition, the 

  
 4 

 
Transferor shall provide to the Company and each Investor Stockholder (other than the Transferor) all such other information related to the Offered Shares, the Proposed Transferee and the
proposed Transfer as the Company or any Investor Stockholder may reasonably request. The Transfer Notice shall certify that the Transferor has received a firm offer from the Proposed Transferee and in good faith believes a binding agreement for the
Transfer is obtainable on the terms set forth in the Transfer Notice. The Transfer Notice shall constitute an irrevocable offer by the Transferor to sell to the Company and to each Investor Stockholder the Offered Shares at the price, under the same
terms and conditions contained in the Transfer Notice, and pursuant to the terms of this Section 3.3. 
 3.3.3 Company
Rights. Within ten (10) Business Days following its receipt of the Transfer Notice, the Company shall notify the Transferor and each Investor Stockholder in writing as to the number of the Offered Shares, if any, that it is electing to
purchase (the “Company Acceptance”). The election to purchase Offered Shares shall be made on behalf of the Company and approved by those members of the Board of the Company who are not and have not been designated by, or are
not Affiliates of, the Transferor. The Company Acceptance shall be deemed to be an irrevocable commitment to purchase from the Transferor that number of the Offered Shares which the Company has elected to purchase pursuant to the Company Acceptance.
If the Company delivers the Company Acceptance to the Transferor, then payment for the Offered Shares shall be made by check or wire transfer against delivery of the Offered Shares to be purchased at a time and place agreed upon between the parties,
which time shall be no later than forty-five (45) days after delivery to the Company of the Transfer Notice, unless the Transfer Notice contemplated a later closing with the Proposed Transferee or unless the value of the consideration to be
paid for the Offered Shares has not yet been established pursuant to Section 3.3.6(2). 
 3.3.4 Investor Stockholder
Rights. If the Company does not elect to purchase all of the Offered Shares, then the Investor Stockholders (other than the Transferor) shall have the right to purchase any remaining Offered Shares that the Company has not agreed to
purchase (the “Remaining Offered Shares”). Within fifteen (15) Business Days following its receipt of the Company Acceptance, each Investor Stockholder shall notify the Company and the Transferor as to the number of the
Remaining Offered Shares, if any, that each such Investor Stockholder is electing to purchase (each such notice being an “Investor Stockholder Acceptance”). If the number of Remaining Offered Shares is less than the total
number included in all Investor Stockholder Acceptances (as verified by the Company), then the number of Remaining Offered Shares shall be allocated as nearly as practicable among the Investor Stockholders
pro-rata in proportion to the number of shares of Common Stock that are held by each such Investor Stockholder on a Fully-Diluted Basis. Each of the Investor Stockholders shall have the right of
over-subscription such that if any of the Investor Stockholders fails to exercise the right to purchase its pro rata portion of the Remaining Offered Shares, the Company shall promptly notify each of the other Investor Stockholders and each of the
other Investor Stockholders may purchase the non-purchasing Investor Stockholder’s portion, within five (5) Business Days of the date of such subsequent notice from the Company, allocated as nearly
as practicable among the Investor Stockholders pro-rata in proportion to the number of shares of Common Stock that are held by each Investor Stockholder on a Fully-Diluted Basis. Each Investor Stockholder
Acceptance shall be deemed to be an irrevocable commitment to purchase from the Transferor that number of the Remaining Offered Shares which the Investor Stockholder has elected to purchase pursuant to its Investor Stockholder Acceptance. Each
Investor Stockholder shall be entitled to apportion Remaining Offered Shares to be purchased among its partners and Affiliates, provided that such Investor Stockholder notifies the Transferor of such allocation. 

  
 5 

 3.3.5 Sale by Transferor If the Company and the Investor Stockholders
do not deliver to the Transferor a Company Acceptance and the Investor Stockholder Acceptances to purchase all of the Offered Shares within the time frames set forth in Sections 3.3.3 and 3.3.4 above, the Transferor may, subject to
Section 3.3.7 below, within a period of 90 days from the date of the Transfer Notice, sell to the Proposed Transferee all, but not less than all, of the Offered Shares remaining unsubscribed by the Company and the Investor Stockholders, on the
terms specified in the Transfer Notice. Upon any such sale, the Proposed Transferee of the Offered Shares shall execute an agreement in form and substance satisfactory to the Company and the Investor Stockholders pursuant to which the Proposed
Transferee agrees that the Equity Securities it acquired from the Transferor are subject to the provisions of this Section 3 and otherwise agrees to become a party to this Agreement as a Restricted Stockholder. Any Proposed Transferee to whom
Offered Shares are Transferred pursuant to and in compliance with this Section 3.3 shall, upon consummation of such Transfer, be deemed a Restricted Stockholder. If the Transferor does not complete the sale of the Offered Shares within the 90-day period, the provisions of this Section 3 shall again apply, and no Transfer of Equity Securities held by the Transferor shall be made otherwise than in accordance with the terms of this Agreement. 

3.3.6 Closing 
 (1) The
closing of purchases of Offered Shares by the Company and the Investor Stockholders pursuant to this Section 3.3. shall take place at the principal offices of the Company within 90 days after the date of the Transfer Notice at 11:00 A.M. local
time, unless the Transfer Notice contemplated a later closing with the Proposed Transferee or unless the value of the consideration to be paid for the Offered Shares has not yet been established pursuant to Section 3.3.6(2), or at such other
date, time or place as the parties to the sale may agree. At least five (5) Business Days prior to the closing, the Company shall notify the Transferor in writing of the name and number of purchasers and the portion of the Offered Shares to be
purchased by the Company and each of the Investor Stockholders. At the closing, the Transferor shall sell, transfer and deliver to the Company and each of the Investor Stockholders participating in the purchase, and the Company and each of the
Investor Stockholders participating in the purchase shall receive, full right, title and interest in and to the Offered Shares so purchased, free and clear of all liens, security interests or adverse claims of any kind and nature (except as
otherwise set forth in the Charter and this Agreement and applicable securities laws) and shall deliver to the Company and all participating Investor Stockholders a certificate or certificates representing the Offered Shares sold, in each case duly
endorsed for transfer or accompanied by appropriate stock transfer powers duly endorsed with signatures guaranteed by a commercial bank, trust company or registered broker dealer. Simultaneously with delivery of the certificates, the Company and
each of the participating Investor Stockholders shall deliver to the Transferor, in full payment of the purchase price of the Offered Shares purchased, (a) any cash consideration for the shares by wire transfer of immediately available funds to
the bank and the account designated by the Transferor and/or (b) any non-cash consideration for the shares in person to the Transferor at closing. 

  
 6 

 (2) Should the purchase price specified in the Transfer Notice be payable in a form of
consideration other than cash or evidences of indebtedness, the Company (and the Investor Stockholders) shall have the right to pay such purchase price in an amount of cash equal to the fair market value of such consideration. If the Transferor and
the Company (or the Investor Stockholders) cannot agree on such fair market value within ten (10) days after delivery to the Company of the Transfer Notice, the valuation shall be made by an appraiser of recognized standing selected by the
Transferor and the Company (or a majority-in-interest of the Investor Stockholders) or, if they cannot agree on an appraiser within twenty (20) days after delivery
to the Company of the Transfer Notice, each shall select an appraiser of recognized standing and those appraisers shall designate a third appraiser of recognized standing, whose appraisal shall be determinative of such value. The cost of such
appraisal shall be shared equally by the Transferor, on the one hand, and the Company (and, to the extent there are any, the participating Investor Stockholders, on the other hand, with that half of the cost to be borne by the Company and the
participating Investor Stockholders to be apportioned on a pro rata basis based on the number of shares each such party has expressed an interest in purchasing pursuant to this Section 3.3). If the time for the closing of the Company’s
purchase or the Investor Stockholders’ purchase has expired but the determination of the value of the purchase price offered by the prospective transferee(s) has not been finalized, then such closing shall be held on or prior to the fifth
business day after such valuation shall have been made pursuant to this Section 3.3.6(2). 
 3.3.7
Tag-Along Rights on Restricted Stockholder Transfers 
 (1) If any Transferor shall propose to
Transfer to any Proposed Transferee any Equity Securities (other than the Transfers permitted under Section 3.2 above and transfers to the Company and Investor Stockholders under Sections 3.3.3 and 3.3.4), such proposed Transfer shall be
conditioned upon receipt by each Investor Stockholder of a binding written offer (conditioned solely upon the consummation of such proposed Transfer) by such Transferor or the Proposed Transferee to purchase, at the same price and upon terms and
conditions identical in all material respects as are applicable to the Transferor as specified in the Transfer Notice, a fraction of the shares of Common Stock held by such Investor Stockholder on a Fully-Diluted Basis, the numerator of which
fraction equals the number of shares of Common Stock represented by the Equity Securities that the Transferor intends to sell on a Fully-Diluted Basis, and the denominator of which is the total number of shares of Common Stock represented by the
Equity Securities held by the Transferor on a Fully-Diluted Basis. If the offer of the Proposed Transferee states that the Proposed Transferee is unwilling to purchase, in the aggregate, more than a specified amount of Equity Securities, then the
Equity Securities being transferred by the Transferor and those Investor Stockholders accepting such offer shall be reduced pro rata in accordance with their relative holdings of Common Stock on a Fully-Diluted Basis. If an Investor Stockholder
intends to participate in the proposed Transfer pursuant to this Section 3.3.7, such Investor Stockholder shall state its intention to so participate in the Investor Stockholder Acceptance delivered to the Transferor in accordance with
Section 3.3.4. 

  
 7 

 (2) Each Investor Stockholder that intends to participate in the proposed Transfer pursuant
to this Section 3.3.7 shall effect its participation in the sale by promptly delivering to the Transferor for transfer to the Proposed Transferee one or more certificates, properly endorsed for transfer, which represent the number and type of
Securities that such Investor Stockholder elects to sell. The stock certificate or certificates that each Investor Stockholder delivers to the Transferor pursuant to this Section 3.3.7(2) shall be transferred to the Proposed Transferee in
consummation of the sale of the Equity Securities pursuant to the terms and conditions specified in the Transfer Notice, and such Transferor shall concurrently therewith remit to such Investor Stockholder that portion of the sale proceeds to which
such Investor Stockholder is entitled by reason of its participation in such sale. To the extent that any prospective purchaser or purchasers prohibits such assignment or otherwise refuses to purchase shares or other securities from an Investor
Stockholder exercising its tag-along rights hereunder, the Transferor shall not sell to such Proposed Transferee, or any other purchaser, Equity Securities unless and until, simultaneously with such sale, the
Investor Stockholder shall purchase such shares or other securities from such Transferor for the same consideration and on the same terms and conditions as the proposed transfer described in the Transfer Notice. 

3.3.8 Non-Exercise of Rights. To the extent that the Company and the Investor
Stockholders have not exercised their rights to purchase the Offered Shares or the Remaining Offered Shares within the time periods specified in this Section 3.3 and the Investor Stockholders have not exercised their rights to participate in
the sale of the Remaining Offered Shares within the time periods specified in this Section 3.3, the Transferor shall have a period of thirty (30) days from the expiration of such rights in which to sell the Offered Shares or the Remaining
Offered Shares, as the case may be, upon terms and conditions (including the purchase price) no more favorable than those specified in the Transfer Notice, to the Proposed Transferee. The Company’s first refusal rights and the Investor
Stockholders’ first refusal rights and tag-along rights shall continue to be applicable to any subsequent disposition of the Offered Shares or the Remaining Offered Shares acquired by the Proposed
Transferee until such rights lapse in accordance with the terms of this Agreement. In the event the Transferor does not consummate the sale or disposition of the Offered Shares and Remaining Offered Shares within the thirty (30) day period from
the expiration of these rights, the Company’s first refusal rights and the Investors Stockholders’ first refusal rights and tag-along rights shall continue to be applicable to any subsequent
disposition of the Offered Shares or the Remaining Offered Shares by the Transferor until such rights lapse in accordance with the terms of this Agreement. Furthermore, the exercise or non-exercise of the
rights of the Company and the Investor Stockholders under this Section 3.3 to purchase Equity Securities from the Transferor or participate in sales of Equity Securities by the Transferor shall not adversely affect their rights to make
subsequent purchases from the Transferor of Equity Securities or subsequently participate in sales of Equity Securities by the Transferor. 

3.3.9 Prohibited Transfers. 

(1) In the event a Transferor should sell any Equity Securities in contravention of the tag-along
rights of the Investor Stockholders under Section 3.3.7 (a “Prohibited Transfer”), the Investor Stockholders, in addition to such other remedies as may be available at law, in equity or hereunder, shall have the put
option provided below under Section 3.3.9(2), and such Transferor shall be bound by the applicable provisions of such option. 

  
 8 

 (2) In the event of a Prohibited Transfer, each Investor Stockholder shall have the right
to sell to the Transferor making such Prohibited Transfer the type and number of shares of Equity Securities equal to the number of shares each Investor Stockholder would have been entitled to transfer to the Proposed Transferee under
Section 3.3.7 hereof had the Prohibited Transfer been effected pursuant to and in compliance with the terms hereof. Such sale shall be made on the following terms and conditions: 

(3) The price per share at which the shares are to be sold to the Transferor shall be equal to the price per share paid by the Proposed
Transferee to the Transferor in the Prohibited Transfer. The Transferor shall also reimburse each Investor Stockholder for any and all fees and expenses, including legal fees and expenses, incurred pursuant to the exercise or the attempted exercise
of the Investor Stockholder’s rights under Section 3.3.7. 
 (4) Within ninety (90) days after the later of (X) the date
on which the Investor Stockholder receives notice of the Prohibited Transfer and (Y) the date on which the Investor Stockholder otherwise becomes aware of the Prohibited Transfer, each Investor Stockholder shall, if exercising the option
created hereby, deliver to the Transferor the certificate or certificates representing shares to be sold, each certificate to be properly endorsed for transfer. 

(5) The Transferor shall, upon receipt of the certificate or certificates for the shares to be sold by an Investor Stockholder pursuant to
this Section 3.3.9, pay the aggregate purchase price therefor and the amount of fees and expenses reimbursable under Section 3.3.9(2)(A) in cash or by other means acceptable to the Investor Stockholder. 

3.4 Obligation to Sell 

3.4.1 If (a) the Board and (b) the Required Preferred Stockholders approve a transaction in which all of the Equity
Securities would be sold or exchanged (in a merger, business combination or otherwise) in a bona fide arms-length transaction to a Third Party (other than a public offering under the Act) or a bona fide arms-length transaction with a Third Party
which would constitute a Deemed Liquidation Event (as defined in the Charter) (the “Recommended Transaction”), the Stockholders shall be obligated to, and shall, Transfer to such Third Party all Equity Securities owned by
such Stockholder, if applicable, on the terms and conditions of such Recommended Transaction. 
 3.4.2 Each Stockholder will take all
necessary and desirable actions in connection with the consummation of a Recommended Transaction, including, without limitation: 
 (1) if
such transaction requires stockholder approval, with respect to all Equity Securities that such Stockholder owns or over which such Stockholder otherwise exercises voting power, to vote (in person, by proxy or by action by written consent, as
applicable) all Equity Securities in favor of, and adopt, such Recommended Transaction (together with any related amendment to the Charter required in order to implement such 

  
 9 

 
Recommended Transaction),to vote in opposition to any and all other proposals that could reasonably be expected to delay or impair the ability of the Company to consummate such Recommended
Transaction, and raise no objections against such Recommended Transaction or the process pursuant to which such Recommended Transaction was arranged; 

(2) to execute and deliver all related documentation and take such other action in support of the Recommended Transaction as shall reasonably
be requested by the Company in order to carry out the terms and provision of this Section 3.4, including without limitation executing and delivering instruments of conveyance and transfer, and any purchase agreement, merger agreement, indemnity
agreement, escrow agreement, consent, waiver, governmental filing, share certificates duly endorsed for transfer (free and clear of impermissible liens, claims and encumbrances) and any similar or related documents; 

(3) if such transaction is structured as a Stock Sale, to sell the same proportion of his, her or its Equity Securities as is being sold by
the Required Parties, and, except as permitted in subsection (3) below, on the same terms and conditions as the Required Parties; 

(4) not to deposit, and to cause their Affiliates not to deposit, except as provided in this Agreement, any Equity Securities of the Company
owned by such party or Affiliate in a voting trust or subject any Equity Securities to any arrangement or agreement with respect to the voting of such Equity Securities, unless specifically requested to do so by the acquiror in connection with the
Recommended Transaction; and 
 (5) to refrain from exercising any dissenters’ rights or rights of appraisal under applicable law at
any time with respect to such Recommended Transaction. 
 3.4.3 The obligations of the Stockholders pursuant to this Section 3.4
are subject to the satisfaction of the following conditions: 
 (1) if any Stockholders of a class or series are given an option as to the
form and amount of consideration to be received, all holders of such class or series will be given the same option; 
 (2) the liability for
indemnification, if any, of such Stockholder in the Recommended Transaction and for the inaccuracy of any representations and warranties made by the Company or its Stockholders in connection with such Recommended Transaction, is several and not
joint with any other Person (except to the extent that funds may be paid out of an escrow established to cover breach of representations, warranties and covenants of the Company as well as breach by any stockholder of any of identical
representations, warranties and covenants provided by all stockholders), and is pro rata in proportion to, and does not exceed, the amount of consideration paid to such Stockholder in connection with such Recommended Transaction; 

(3) Unless the Required Preferred Stockholders elect to receive a lesser amount by written notice given to the Company at least fifteen
(15) days prior to the effective date of any such Recommended Transaction, the aggregate consideration receivable by all holders of the Preferred Stock and Common Stock shall be allocated among the holders of

  
 10 

 
Preferred Stock and Common Stock on the basis of the relative liquidation preferences to which the holders of each respective series of Preferred Stock and the holders of Common Stock are
entitled in a Deemed Liquidation Event (as defined in the Charter) (assuming for this purpose that the Recommended Transaction is a Deemed Liquidation Event) in accordance with the Charter. 

(4) any representations and warranties to be made by such Stockholder in connection with the Recommended Transaction are limited to
representations and warranties related to authority, ownership and the ability to convey title to such Equity Securities, including but not limited to representations and warranties that (i) the Stockholder holds all right, title and interest
in and to the Equity Securities such Stockholder purports to hold, free and clear of all liens and encumbrances, (ii) the obligations of the Stockholder in connection with the transaction have been duly authorized, if applicable, (iii) the
documents to be entered into by the Stockholder have been duly executed by the Stockholder and delivered to the acquirer and are enforceable against the Stockholder in accordance with their respective terms and (iv) neither the execution and
delivery of documents to be entered into in connection with the transaction, nor the performance of the Stockholder’s obligations thereunder, will cause a breach or violation of the terms of any agreement, law or judgment, order or decree of
any court or governmental agency; and 
 (5) the Stockholder will not be liable for the inaccuracy of any representation or warranty made by
any other Person in connection with the Recommended Transaction, other than the Company (except to the extent that funds may be paid out of an escrow established to cover breach of representations, warranties and covenants of the Company as well as
breach by any stockholder of any of identical representations, warranties and covenants provided by all stockholders). 
 3.4.4 As
security for each Stockholder’s obligations hereunder, each Stockholder hereby grants to the Chief Executive Officer or President of the Company, with full power of substitution and re-substitution, an
irrevocable proxy to vote, if and only if the Stockholder (i) fails to vote or (ii) attempts to vote (whether by proxy, in person or by written consent), in a manner which is inconsistent with the terms of this Agreement, all Equity
Securities, at all meetings of the Stockholders held or taken after the date of this Agreement with respect to a Recommended Transaction, or to execute any written consent in lieu thereof, and hereby irrevocably appoints the Chief Executive Officer
or President of the Company as such Stockholder’s attorney-in-fact with authority to sign any documents with respect to any such vote or any actions by written
consent of the Stockholders taken after the date of this Agreement. This proxy shall be deemed to be coupled with an interest and shall be irrevocable; provided, however, that this proxy shall terminate upon an initial public offering of the
Company’s Common Stock. For the avoidance of doubt, this proxy will not apply to a Stockholder’s right to determine if the actions sought to be taken are in accord with the terms of this Agreement, including, but not limited to, whether a
proposed transaction qualifies as a Recommended Transaction. 

  
 11 

 3.5 Preemptive Rights 

3.5.1 The Company hereby grants to each Investor Stockholder the right (but not the obligation) to purchase the Investor
Stockholder’s pro rata share of all (or any part) of New Securities (as hereinafter defined) that the Company may, from time to time, propose to sell and issue. A pro rata share, for purposes of this preemptive right, is the portion of the New
Securities obtained by multiplying the total New Securities by a fraction, the numerator of which is the sum of the number of shares of Common Stock (excluding any Excluded Shares) that are then held by an Investor Stockholder on a Fully-Diluted
Basis, and the denominator of which is the total number of shares of Common Stock then outstanding on a Fully-Diluted Basis. For purposes of this Section 3.5, capitalized terms not otherwise defined herein shall have the meanings ascribed to
them in the Charter, and “New Securities” shall mean any common stock or preferred stock of the Company, whether now authorized or not, and rights, options or warrants to purchase such common stock or preferred stock, and
securities of any type whatsoever that are, or may become, exercisable for, convertible into or exchangeable for common stock or preferred stock of the Company, but shall not include: 

(1) shares of Common Stock, Options or Convertible Securities issued or deemed issued as a dividend or distribution on Preferred Stock; 

(2) shares of Common Stock, Options or Convertible Securities issued or issuable by reason of a dividend, stock split, split-up or other distribution on shares of Common Stock that is covered by Subsection 4.5, 4.6, 4.7 or 4.8 of the Charter; 

(3) shares of Common Stock or Options issued or deemed issued to employees or directors of, or consultants or advisors to, the Company or any
of its subsidiaries pursuant to a plan, agreement or arrangement approved by the Board, including at least three Preferred Directors; 
 (4)
shares of Common Stock or Convertible Securities actually issued upon the exercise of Options or shares of Common Stock actually issued upon the conversion or exchange of Convertible Securities, in each case provided such issuance is pursuant to the
terms of such Option or Convertible Security; 
 (5) shares of Common Stock, Options or Convertible Securities issued to banks, equipment
lessors or other financial institutions, or to real property lessors, pursuant to a debt financing, equipment leasing or real property leasing transaction approved by the Board, including at least three Preferred Directors; 

(6) shares of Common Stock, Options or Convertible Securities issued to suppliers or third party service providers in connection with the
provision of goods or services pursuant to transactions approved by the Board, including at least three Preferred Directors; 
 (7) shares
of Common Stock, Options or Convertible Securities issued pursuant to the acquisition of another commercial operating entity by the Company, whether by merger, purchase of substantially all of the assets, other reorganization, pursuant to a joint
venture agreement or otherwise, provided, that such issuances are approved by the Board, including at least three Preferred Directors; 

  
 12 

 (8) shares of Common Stock, Options or Convertible Securities issued in connection with
sponsored research, collaboration, technology license, development, OEM, marketing or other similar agreements or strategic partnerships, provided such issuances are (A) for other than primarily capital raising purposes and (B) approved by
the Board, including at least three Preferred Directors; or 
 (9)shares of Series D-1 Preferred
Stock issued pursuant to the Purchase Agreement. 
 3.5.2 In the event the Company issues New Securities, it shall give the Investor
Stockholders written notice (the “Offer Notice”) of such issuance within thirty (30) days prior to the issuance thereof, describing the type of New Securities, the price and the general terms upon which the Company
issued the same. By written notification to the Company within twenty (20) days from the date of receipt of any such notice, each Investor Stockholder may elect to purchase or otherwise acquire, at the price and on terms specified in the Offer
Notice, up to that portion of such New Securities that equals the proportion that the Common Stock issued and held by such Investor on a Fully-Diluted Basis bears to the total outstanding stock of the Company on a Fully-Diluted Basis. At the
expiration of such twenty 20-day period, the Company shall promptly notify each Investor Stockholder that elects to purchase or acquire all the shares available to it (each, a “Fully Exercising
Investor”) of any other Investor Stockholder’s failure to do likewise. During the ten (10) day period commencing after the Company has given such notice, each Fully Exercising Investor may, by giving notice to the Company, elect
to purchase or acquire, in addition to the number of shares specified above, up to that portion of the New Securities for which Investor Stockholders were entitled to subscribe but that were not subscribed for by the Investor Stockholders. If, as a
result thereof, such Fully Exercising Investor subscriptions exceed the total number of New Securities available under this Section 3.5.2 to Investor Stockholders, the Fully Exercising Investors shall be cut back with respect to
oversubscriptions on a pro rata basis in accordance with their respective ownership of Common Stock on a Fully-Diluted Basis or as they may otherwise agree among themselves. 

3.5.3 If all New Securities referred to in the Offer Notice are not elected to be purchased or acquired as provided in
Section 3.5.2, the Company may, during the sixty (60) day period following the expiration of the periods provided in Section 3.5.2, offer and sell the remaining unsubscribed portion of such New Securities to any third party at a price
not less than, and upon terms no more favorable to the offeree than, those specified in the Offer Notice. If the Company does not enter into an agreement for the sale of the New Securities within such period, or if the sale under such agreement is
not consummated within twenty (20) days of the execution thereof, the right provided hereunder shall be deemed to be revived and such New Securities shall not be offered unless first reoffered to the Investor Stockholders in accordance with
this Section 3.5. 
 3.5.4 The rights provided in this Section 3.5 may not be assigned or transferred by any Investor
Stockholder; provided, however, that an Investor Stockholder that is a venture capital fund may assign or transfer such rights to its Affiliates. 

3.5.5 The rights arising under this Section 3.5 with respect to the issuance of any New Securities may be waived, either
prospectively or retrospectively, by vote or consent of the Required Preferred Stockholders. Any such waiver shall be effective as to all Investor Stockholders. 

  
 13 

 4. ADDITIONAL COVENANTS OF THE COMPANY AND STOCKHOLDERS 

The Company hereby covenants with each Investor Stockholder as follows: 

4.1 Books and Records 
 The
Company shall keep and maintain adequate and proper books and records of account, in which complete entries are made in accordance with GAAP consistently applied and in accordance with all applicable laws, rules, and regulations, reflecting all
financial and other transactions of the Company normally or customarily included in books and records of account of companies engaged in the same or similar businesses and activities as the Company. The Company will set aside on its books such
proper reserves as shall be required by GAAP. 
 4.2 Access and Examination Rights 

The Company shall permit each Investor Stockholder who, together with its Affiliates, holds at least 1,000,000 shares of Common Stock on a
Fully-Diluted Basis (as adjusted for stock splits, stock dividends, combinations and other recapitalizations) that is not a Competitor of the Company (each a “Major Stockholder”) and any agents or representatives thereof to
visit and inspect the properties of the Company, to examine and make abstracts from any of the Company’s books and records (including agreements, licenses, and similar documents) at any reasonable time and as often as such Investor Stockholder
or such agents or representatives may reasonably request, and to discuss the business, operations, prospects, assets, properties, and condition (financial or otherwise) of the Company with any of the officers, directors, employees, agents, or
representatives of the Company; provided, however, that such rights of access and examination shall be subject to such security or safety rules and regulations as the Company may have in effect from time to time that are applicable to all visitors
to its facilities and to applicable laws and regulations, including those applying to classified material and facilities. 
 4.3 Financial
and Business Information 
 The Company shall furnish to each Major Stockholder: 

4.3.1 as soon as available and in any event within 120 days after the end of each fiscal year of the Company, a copy of the audited
consolidated balance sheet as of the end of such fiscal year and the related audited consolidated statements of income and cash flows of the Company and its subsidiaries, if any, on a consolidated basis, for such fiscal year, in each case
(a) prepared in accordance with GAAP, (b) prepared in reasonable detail and including footnotes, (c) certified by independent certified public accountants of recognized national standing as presenting fairly the consolidated financial
position of the Company, (d) approved by the Board, (e) setting forth in comparative form the corresponding figures for preceding fiscal year and the figures for such fiscal year set forth in the operating plan and budget delivered by the
Company pursuant to Section 4.3(4) hereof, and (f) accompanied by a report from the Company’s Chief Financial Officer (or other member of management acting in such capacity) summarizing the Company’s financial condition and
results of operations during such fiscal year and in comparison to the periods set forth in (e) immediately preceding; 

  
 14 

 4.3.2 as soon as available and in any event within 45 days after the end of each
fiscal quarter of the Company (other than the last quarter of each fiscal year) in the case of quarterly statements and within 30 days after the close of each month of each fiscal year in the case of monthly statements, a copy of the unaudited
consolidated balance sheet as of the end of the quarter or month and the related unaudited consolidated statements of income and cash flows of the Company and its subsidiaries, if any, on a consolidated basis, for the periods commencing at the end
of the previous quarter or month and ending at the end of the quarter or month and commencing at the beginning of the fiscal year and ending at the end of the quarter or month, in each case (a) prepared in accordance with GAAP,
(b) prepared in reasonable detail, (c) setting forth in comparative form the corresponding figures for the corresponding period of the preceding fiscal year and the figures for the period set forth in the operating plan and budget
delivered by the Company pursuant to Section 4.3(4) hereof, and (d) in the case of quarterly financial statements, accompanied by a report from the Company’s Chief Financial Officer (or other member of management acting in such
capacity) summarizing the Company’s financial condition and results of operations during such period and in comparison to the periods set forth in (c) immediately preceding; 

4.3.3 promptly after the sending or filing thereof, copies of all financial statements and reports that the Company sends to its
stockholders and copies of all regular, periodic, and special reports which the Company files with any governmental authority, including, without limitation the United States Securities and Exchange Commission; 

4.3.4 as soon as available and in any event no later than 30 days prior to the first day of each fiscal year of the Company beginning
after the date hereof, an annual operating plan and budget (including cash flow data) for the Company for the upcoming fiscal year, each prepared in reasonable detail, as each operating plan and budget has been approved by the Board of the Company;
and 
 4.3.5 such other information relating to the financial condition, business or corporate affairs of the Company as the Major
Stockholder may from time to time reasonably request; provided, however, that the Company shall not be obligated under this subsection 4.3.5 or any other subsection of 4.3 to provide information that (A) it deems in good faith to be a
trade secret or similar confidential information or (B) the disclosure of which would adversely affect the attorney-client privilege between the Company and its counsel. 

All financial statements to be furnished by the Company pursuant to this Section 4.3 shall be prepared in accordance with GAAP. 

  
 15 

 4.4 Material Changes; Defaults; Litigation 

The Company shall furnish to the Investor Stockholders notifications of any material adverse change in the business, assets, results of
operations or condition, financial or otherwise, of the Company, any material defaults under any of its contracts or agreements and information concerning any litigation or governmental proceeding or investigation brought against the Company or any
of its officers, directors, key employees, or principal stockholders or any overtly threatened litigation that, if adversely determined, could have a Material Adverse Effect; provided that the Company may withhold any such information from any
Investor Stockholder which is a Competitor. 
 4.5 Additional Information 

The Company shall furnish to the Major Stockholders such additional information as any Major Stockholder may reasonably request. 

4.6 Proprietary Information and Inventions Agreement; Non-Competition and Non-Solicitation 
 The Company shall require all officers, employees (including part-time employees)
and consultants to execute and deliver a Proprietary Information and Inventions Agreement in the form approved by the Board. The Company shall also require each executive-level employee (including division director and vice president-level
positions) as well as any employee who, either alone or in concert with others, develops, invents, programs or designs any Company Proprietary Rights (as defined in the Purchase Agreement), to enter into a one year noncompetition and nonsolicitation
agreement, substantially in the form approved by the Board. The Company shall not amend, modify, terminate, waive or otherwise alter, in whole or in part, any of the above referenced agreements between the Company and any employee, without the
consent of the Board. 
 4.7 Directors Expenses 

The Company shall reimburse members of the Board designated by holders of the Preferred Stock for reasonable expenses, including, without
limitation, travel and lodging expenses, incurred in attending meetings of the Board (including any meetings of committees thereof) and any other meetings or events attended at the request of the Company. 

4.8 Qualified Small Business 

The Company will use its commercially reasonable efforts to comply with the reporting and record keeping requirements of Section 1202 of
the Internal Revenue Code of 1986, as amended, any regulations promulgated thereunder and any similar state laws and regulations, and agrees not to repurchase any stock of the Company if such purchase would cause the Preferred Stock not to so
qualify as “Qualified Small Business Stock;” provided, however, that such requirement shall not be applicable if the Board determines, in its good faith business judgment, that such qualification is inconsistent with the best interests of
the Company. 
 4.9 Insurance 

The Company shall procure and maintain, with financially sound and reputable insurance companies: (a) such insurance as may be required by
law and such other insurance in such amounts and against such hazards as is customary in the case of reputable firms engaged in the same or similar business and similarly situated and (b) directors and officers liability

  
 16 

 
insurance. The terms of all such insurance shall be reasonably acceptable to the Required Preferred Stockholders. If the Company or any of its successors or assignees consolidates with or merges
into any other Person and is not the continuing or surviving corporation or entity of such consolidation or merger, then to the extent necessary, proper provision shall be made so that the successors and assignees of the Company assume the
obligations of the Company with respect to indemnification of members of the Board as in effect immediately before such transaction, whether such obligations are contained in the Company’s Bylaws, its Charter, or elsewhere, as the case may be.

 4.10 Employee Vesting 

Unless otherwise approved by the Board, all future employees and consultants of the Company who purchase, receive options to purchase, or
receive awards of shares of the Company’s Equity Securities after the date hereof shall be required to execute restricted stock or option agreements, as applicable, providing for vesting of shares over a four (4) year period, with the
first twenty-five percent (25%) of such shares vesting following twelve (12) months of continued employment or service, and the remaining shares vesting in equal monthly installments over the following
thirty-six (36) months. 
 4.11 Affiliated Transactions. 

The Company will not enter into any agreement with any stockholder, officer or director of the Company, or any “affiliate” or
“associate” of such person unless such agreement is (i) approved by a majority of the disinterested members of the Company’s Board, if any, and (ii) on terms no less favorable to the Company than would be available in an
arms-length transaction. For purposes of this Section 4.11, the terms “affiliate” and “associate” shall be as defined in the rules and regulations promulgated under the Securities Act. 

4.12 Compliance with Laws, Etc. 

The Company shall (a) comply with all laws, rules, regulations, judgments, orders and decrees of any governmental or regulatory authority,
the violation of which could have a Material Adverse Effect; and (b) comply with all material contracts and agreements to which the Company is a party or shall become a party and shall perform all material obligations which the Company has or
shall incur. 
 4.13 Preservation of Corporate Existence and Property 

The Company shall preserve, protect and maintain: (i) its corporate existence and good standing in its jurisdiction of incorporation
(provided that a subsidiary may be merged with the Company or another subsidiary or may, if it is inactive and holds no material assets be dissolved), (ii) its rights, franchises and privileges, and (iii) all of its properties necessary or
useful in the proper conduct of its business in good working order and condition, with the exception of (x) ordinary wear and tear, and (y) casualty losses covered by insurance, allowing for reasonable deductibles. 

  
 17 

 4.14 Payment of Indebtedness 

The Company shall pay or cause to be paid the principal of, and the interest and premium, if any, on all indebtedness heretofore or hereafter
incurred or assumed by the Company, as the case may be, when and as the same shall become due and payable, unless such indebtedness shall be renewed or extended, in which case such payments shall be made in accordance with the terms of such renewal
or extension. 
 4.15 Prompt Payment of Taxes, Etc. 

The Company will promptly pay and discharge, or cause to be paid and discharged, when due and payable, all lawful taxes, assessments and
governmental charges or levies imposed upon the income, profits, property or business of the Company; provided, however, that any such tax, assessment, charge or levy need not be paid if the validity thereof shall currently be contested in good
faith by appropriate proceedings and if the Company shall have set aside on its books adequate reserves with respect thereto; and provided, further, that the Company will pay all such taxes, assessments, charges or levies forthwith upon the
commencement of proceedings to foreclose any lien which may have attached as security therefor. 
 4.16 Reservation of Shares of Common
Stock for Conversion. 
 The Company shall at all times maintain in reserve authorized and unissued shares of Common Stock sufficient to
permit the conversion of all of the then-outstanding shares of Preferred Stock. 
 4.17 Status as an Operating Company. 

The Company shall maintain its status as an operating company within the meaning of the Department of Labor Regulation 2510.3-101. 
 4.18 Confidentiality 

Any information concerning the Company provided to the Stockholders or representatives thereof pursuant to this Agreement or otherwise, shall
be used by the Stockholders, the representatives thereof and any other person to whom any Stockholder discloses such information solely in connection with the Stockholders’ investment in the Company, and each Stockholder shall, and shall cause
each of its representatives, each of its Affiliates to whom it discloses such information and any other person to whom it discloses such information to (unless (i) disclosure of such information is required by law or requested by any
government, regulatory or self-regulatory agency or body; (ii) such information is or becomes generally available to the public other than as a result of a disclosure by the Stockholders, their Affiliates to whom they disclose such information,
their representatives or any other person to whom any Stockholder may have disclosed such information; (iii) such information was or becomes available to the Stockholders on a non-confidential basis from
a source other than the Company or any of its affiliates or its representatives; or (iv) such information is previously known by the Stockholders free of any obligation to keep it confidential) maintain the confidentiality of all non-public information of the Company. Nothing in this Section 4.18 shall prohibit an Stockholder from disclosing confidential information concerning the Company to (a) its attorneys, accountants,
consultants and other professionals to the extent necessary to obtain 

  
 18 

 
their services in connection with its investment in the Company, (b) any Affiliate, partner, member, shareholder, director, officer, employee, investor, prospective investor or
representative of such Stockholder in the ordinary course of business, provided that (i) such Stockholder informs such Person that such information is confidential and (ii) the Stockholder shall be liable for the failure of such Person to
maintain the confidentiality of such information to the extent required of the Stockholder hereunder, or (c) any prospective purchaser of any Equity Securities from such Stockholder as long as such prospective purchaser agrees in a writing
delivered to and enforceable by the Company to be bound by the provisions of this Section 4.18. Notwithstanding the foregoing, following the Closing (as defined in the Purchase Agreement), the Investor Stockholders acquiring shares of Preferred
Stock under the Purchase Agreement and the Company shall have the right to publicize such investment in the Company on mutually agreed, reasonably acceptable terms. 

4.19 Further Assurance. 

The Company shall cooperate with the Investor Stockholders and shall execute and deliver all such further instruments and documents and do all
such further acts and things as the Company may be reasonably requested to do from time to time by the Investor Stockholders in order to satisfy the conditions and carry out the provisions and purposes of this Agreement. 

5. Lock-up 

Each Restricted Stockholder hereby agrees that it will not, without the prior written consent of the managing underwriter, during the period
commencing on the date of the final prospectus relating to the Company’s initial public offering (the “IPO”) and ending on the date specified by the Company and the managing underwriter (such period not to exceed one hundred eighty
(180) days), or such other period as may be requested by the Company or an underwriter to accommodate regulatory restrictions on (1) the publication or other distribution of research reports and (2) analyst recommendations and
opinions, including, but not limited to, the restrictions contained in FINRA Rule 2711(f)(4) or NYSE Rule 472(f)(4), or any successor provisions or amendments thereto), (a) lend, offer, pledge, sell, contract to sell, sell any option
or contract to purchase, purchase any option or contract to sell, grant any option, right or warrant to purchase, or otherwise transfer or dispose of, directly or indirectly, any shares of Equity Securities held immediately prior to the
effectiveness of the registration statement for the IPO or (b) enter into any swap or other arrangement that transfers to another, in whole or in part, any of the economic consequences of ownership of the Equity Securities, whether any such
transaction described in clause (a) or (b) above is to be settled by delivery of Equity Securities or other securities, in cash or otherwise. The foregoing provisions of this Section 5 shall apply only to the IPO, shall not apply to
the sale of any shares to an underwriter pursuant to an underwriting agreement, and shall be applicable to the Restricted Stockholders only if all officers and directors are subject to the same restrictions and the Company uses commercially
reasonable efforts to obtain a similar agreement from all stockholders individually owning more than one percent (1%) of the Company’s outstanding Common Stock (after giving effect to conversion into Common Stock of all outstanding Preferred
Stock). The underwriters in connection with the IPO are intended third-party beneficiaries of this Section 5 and shall have the right, power and authority to enforce the provisions hereof as though they
were a party hereto. Each Restricted Stockholder further agrees to execute such agreements as may be reasonably requested by the 

  
 19 

 
underwriters in the IPO that are consistent with this Section 5 or that are necessary to give further effect thereto. In order to enforce the foregoing covenant, the Company may impose
stop-transfer instructions with respect to the shares of Equity Securities of each Restricted Stockholder (and transferees and assignees thereof) until the end of such restricted period. 

6. MISCELLANEOUS 
 6.1
Legend 
 The certificates or other evidence representing the Equity Securities held by the Stockholders shall bear a legend (the
“Legend”) in substantially the following form: 
 The shares represented by this certificate have not been registered
under the Securities Act of 1933 (the “Act”) or state securities laws and cannot be offered, sold or otherwise transferred in the absence of registration or the availability of an exemption from registration under the Act and regulations
promulgated thereunder and applicable state securities laws. The voting rights with respect to, and sale or other disposition of, the securities represented by this certificate are restricted by and subject to the provisions of a Twelfth Amended and
Restated Stockholders’ Agreement dated as of September 27, 2018, as amended or amended and restated from time to time, a copy of which is available for inspection at the offices of the Company. 

6.2 Specific Performance 

With respect to the terms of this Agreement, in addition to any other remedies which the Stockholders and the Company may have at law or in
equity, the Company and the Stockholders hereby acknowledge that the harm which might result to the Stockholders or the Company from breaches by the Company or Stockholders, as appropriate, of their respective obligations to take all necessary
actions with respect to the rights and obligations set forth in this Agreement cannot be adequately compensated by damages. Accordingly, the Company and the Stockholders agree that the parties to this Agreement shall have the right to have all
obligations and undertakings set forth in this Agreement specifically performed by each other party to this Agreement and that any Stockholder or the Company, as appropriate, shall have the right to obtain an order or decree of such specific
performance in any of the courts of the United States of America or of any state or other political subdivision thereof. 
 6.3
Termination 
 This Agreement shall terminate, and all agreements, covenants and obligations of the parties hereunder shall become wholly
void and of no effect, upon the closing of a Qualified Public Offering (as defined in the Charter) or a Deemed Liquidation Event (as defined in the Charter). 

  
 20 

 6.4 Assignment; Transferees 

6.4.1 Except for assignments by an Investor Stockholder of the rights existing under this Agreement to any transferee of any shares
held by such Investor Stockholder in compliance with this Agreement, neither the Company nor any other Stockholder shall assign this Agreement, in whole or in part, whether by operation of law or otherwise, unless (a) such person shall have
obtained the prior written consent of the Board and the Required Preferred Stockholders, or (b) such assignment is in connection with a Transfer of Equity Securities pursuant to Section 3 hereof. Any purported assignment of this Agreement
contrary to the terms hereof shall be null and void and of no force and effect. 
 6.4.2 Each and every transferee or assignee of
Equity Securities from any Stockholder shall be bound by and subject to all of the terms and conditions of this Agreement. So long as this Agreement is in effect, the Company shall require, as a condition precedent to the transfer of any Equity
Securities by any Stockholder that the transferee agrees in writing to be bound by, and subject to, the terms and conditions of this Agreement and to ensure that such transferee’s transferees shall be likewise bound. 

6.5 Entire Agreement; Amendment 

This Agreement, including the Exhibits hereto, constitutes the entire agreement among the parties hereto with respect to the matters provided
for herein, and it supersedes all prior oral or written agreements, commitments or understandings with respect to the matters provided for herein. This Agreement may only be amended, and any of the terms and provisions hereof may be waived, with the
written consent of the Company and the Required Preferred Stockholders, provided, however, that no such amendment or waiver may be effected which has the effect of: (i) altering the restrictions or obligations of the Restricted Stockholders
without the consent of a majority of the Equity Securities held by the Restricted Stockholders on an as-if-converted to Common Stock basis; (ii) altering the rights
of any Designating Group to designate one or more directors pursuant to Section 2.1 hereof without the consent of the holders of a majority of the shares of Common Stock, on an as-converted basis, held
collectively by such affected Designating Group; (iii) altering the observer rights of a Stockholder pursuant to Section 2.2 hereof without the prior written consent of such Stockholder; and (iv) altering any provision of this
Agreement that requires the consent of the Required Preferred Stockholders, including but not limited to Section 3.5 hereof, without the consent of the Required Preferred Stockholders. 

6.6 Waiver 
 No delay or
failure on the part of any party hereto in exercising any right, power or privilege under this Agreement or under any other instruments given in connection with or pursuant to this Agreement shall impair any such right, power or privilege or be
construed as a waiver of any default or any acquiescence therein. No single or partial exercise of any such right, power or privilege shall preclude the further exercise of such right, power or privilege, or the exercise of any other right, power or
privilege. No waiver shall be valid against any party hereto unless made in writing and signed by the party against whom enforcement of such waiver is sought and then only to the extent expressly specified therein. 

  
 21 

 6.7 No Third Party Beneficiaries 

It is the explicit intention of the parties hereto that no person or entity other than the parties hereto is or shall be entitled to bring any
action to enforce any provision of this Agreement against any of the parties hereto, and the covenants, undertakings and agreements set forth in this Agreement shall be solely for the benefit of, and shall be enforceable only by, the parties hereto
or their respective successors, heirs, executors, administrators, legal representatives and permitted assigns. 
 6.8 Binding Effect

 This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective successors, heirs,
executors, administrators, legal representatives and permitted assigns. 
 6.9 Governing Law 

This Agreement, the rights and obligations of the parties hereto, and any claims or disputes relating thereto, shall be governed by and
construed in accordance with the laws of the State of Delaware (excluding the choice of law rules thereof). 
 6.10 Notices 

All notices, demands, requests, consents or other communications which may be or are required to be given, served, or sent by any party to any
other party pursuant to this Agreement shall be in writing and shall be hand-delivered or mailed by first-class, registered or certified mail, return receipt requested, postage prepaid, or transmitted by telecopy as follows: 

 

	 	(i)	 If to the Company: 

Vapotherm, Inc. 
 22 Industrial
Drive, Suite 1 
 Exeter, NH 03833 

Telecopy No.: (xxx) xxx-xxxx 

Attention: Joseph Army, CEO 

with a copy (which shall not constitute notice) to: 

Ropes & Gray LLP 

Prudential Tower 
 800 Boylston
Street 
 Boston, MA 02199 

Attention: Steven A. Wilcox 
  

	 	(ii)	 If to Sightline: 

8500 Normandale Lake Blvd., Suite 1070 

Bloomington, MN 55437 
 Ph. xxx-xxx-xxxx 
 Attention: Maureen Harder and Jenny Melville 

  
 22 

	 	(iii)	 If to 3x5 or Vapotherm Investors: 

101 S. Hanley Road, Suite 1850 

St. Louis, MO 63105 
 Attention:
Nicholas Walrod 
 and: 

Vapotherm Investors LLC 
 2045
NE Martin Luther King Jr. Blvd 
 Portland, OR 97212 

Attention: Nicholar Walrod 
 with
a copy (which shall not constitute notice) to: 
 Holland & Knight LLP 

One Stamford Plaza 
 263 Tresser
Boulevard, Suite 1400 
 Stamford, CT 06901-3271 

Attention: Gloria M. Skigen, Esq. 
  

	 	(iv)	 If to Morgenthaler: 

600 Superior Avenue East 
 Suite
100 
 Cleveland, OH 44114 

Attention: Spencer Ackermann 

with a copy (which shall not constitute notice) to: 

Wilson Sonsini Goodrich & Rosati 

650 Page Mill Road 
 Palo Alto,
CA 94304 
 Attention: Philip Oettinger 
  

	 	(v)	 If to Adage: 

200 Clarendon Street 
 52nd
Floor 
 Boston, MA 02116 
  

	 	(vi)	 If to Gilde: 

Newtonlaan 91 
 3584
BP Utrecht 
 The Netherlands 

  
 23 

	 	(vii)	 If to Perceptive: 

499 Park Avenue, 25th Floor 

New York , NY 10022 
  

	 	(viii)	 If to Redmile: 

One Letterman Drive 
 Building
D, Suite D3-300 
 San Francisco CA 94129 

Attention: Robert Faulkner 
 with
a copy (which shall not constitute notice) to: 
 Wilson Sonsini Goodrich & Rosati 

650 Page Mill Road 
 Palo Alto,
CA 94304 
 Attention: J. Casey McGlynn 
  

	 	(ix)	 If to any other Stockholder: 

To the most recent address of such Stockholder as recorded in the books and records of the Company. 

Each party may designate by notice in writing a new address to which any notice, demand, request or communication may thereafter be so given, served or sent.
Each notice, demand, request, or communication which shall be hand-delivered, mailed, transmitted or telecopied in the manner described above, shall be deemed sufficiently given, served, sent, received or delivered for all purposes at such time as
it is delivered to the addressee (with the return receipt, the delivery receipt, or the answerback being deemed conclusive, but not exclusive, evidence of such delivery) or at such time as delivery is refused by the addressee upon presentation. 

6.11 Execution in Counterparts 

This Agreement may be executed in any number of counterparts, each of which shall be an original, but all of which together shall constitute
one and the same agreement. This Agreement may be executed by facsimile signatures. 
 6.12 Severability 

In case any provision of this Agreement shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining
provisions of this Agreement shall not in any way be affected or impaired thereby. 

  
 24 

 6.13 Titles and Subtitles 

The titles of the sections and subsections of this Agreement are for convenience of reference only and are not to be considered in construing
this Agreement. 
 6.14 Prior Agreement Superseded 

Pursuant to Section 6.5 of the Prior Agreement, the undersigned parties hereby amend and restate the Prior Agreement to read in its
entirety as set forth in this Agreement, all with the intent and effect that the Prior Agreement shall hereby be terminated and entirely replaced and superseded by this Agreement and all provisions of, rights granted and covenants made in the Prior
Agreement are hereby waived, released and superseded in their entirety and shall have no further force or effect, including, without limitation, all rights of first refusal and any notice period associated therewith otherwise applicable to the
transactions contemplated by the Purchase Agreement. 
 6.15 Aggregation of Stock 

All shares of Equity Securities held or acquired by Affiliates shall be aggregated together for the purpose of determining the availability of
any rights under this Agreement. 
 6.16 Additional Investors 

Notwithstanding anything to the contrary contained herein, if the Company issues additional shares of Preferred Stock after the date hereof,
whether pursuant to the Purchase Agreement or otherwise, any purchaser of such shares of Preferred Stock may become a party to this Agreement by executing and delivering an additional counterpart signature page to this Agreement or a Joinder
Agreement in the form attached hereto as Exhibit B, and thereafter shall be deemed an “Investor Stockholder” and a “Stockholder” for all purposes hereunder. No action or consent by the other parties hereto shall be required for
such joinder to this Agreement by such additional Investor Stockholder, so long as such additional Investor Stockholder has agreed in writing to be bound by all of the obligations as an “Investor Stockholder” hereunder. 

6.17 Joinder Agreement 

When the Company issues shares of any series of its stock to employees or consultants pursuant to equity incentive plans or pursuant to the
exercise of stock options, as a condition to such issuance, each such stockholder or option holder who is not already a party to this Agreement shall be made a party upon the execution and delivery to the Company of the Joinder Agreement in the form
attached hereto as Exhibit B, and the Company shall cause Schedule A hereto to be amended to reflect that each such stockholder or option holder is a Restricted Stockholder for purposes hereof. 

[SIGNATURES APPEAR ON THE FOLLOWING PAGES] 
  

  
 25 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	COMPANY:
	
	VAPOTHERM, INC.
		
	By:	 	 /s/ Joseph Army

	Name:	 	Joseph Army
	Title:	 	President and Chief Executive Officer

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	 INVESTOR STOCKHOLDERS:
  

	Redmile Capital Fund, LP
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the General Partner and the Investment Manager
	
	Redmile Capital Offshore Fund, Ltd.
	Redmile Capital Offshore Fund II, Ltd.
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the Investment
		 	Manager
	
	Redmile Private Investments II, L.P.
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the Management
		 	Company and General Partner
	
	Redmile Strategic Master Fund, LP
		
	By:	 	 /s/ Jeremy Green

	Name:	 	Jeremy Green
	Title:	 	Managing Member of the General Partner
		 	and Investment Manager

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	INVESTOR STOCKHOLDERS:
	
	Coöperatieve Gilde Healthcare III Sub-Holding U.A.
		
	By:	 	 /s/ P.H. van der Meer

	Name:	 	P.H. van der Meer
	Title:	 	Managing Director

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	INVESTOR STOCKHOLDERS:
	
	ADAGE CAPITAL PARTNERS, L.P.
		
	By:	 	 /s/ Dan Lehan

	Name:	 	Dan Lehan
	Title:	 	Chief Operating Officer

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

			
	MORGENTHALER VENTURE PARTNERS IX, L.P.
	
	By: Morgenthaler Management Partners IX, LLC, Its Managing Partner
		
	By:	 	 /s/ Jason Lettmann

	Name:	 	Jason Lettmann
	Title:	 	Partner

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	3X5 SPECIAL OPPORTUNITY FUND, L.P.
		
	By:	 	3x5 Special Opportunity Partners, LLC, its general partner
		
	By:	 	Arnerich 3x5 Special Opportunity Managers, LLC, its member
		
	By:	 	 /s/ Nicholas Walrod

	Name:	 	Nicholas Walrod
	Title:	 	Authorized Signatory
	
	VAPOTHERM INVESTORS, LLC
		
	By:	 	 /s/ Nicholas Walrod

	Name:	 	Nicholas Walrod
	Title:	 	Authorized Person

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II, L.P.
	
	BY: SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS: GENERAL PARTNER
	BY: SIGHTLINE PARTNERS LLC,
	ITS: MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-A, L.P.
	
	BY: SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS: GENERAL PARTNER
	BY:	 	SIGHTLINE PARTNERS LLC,
	ITS:	 	MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-B, L.P.
		
	BY:	 	SIGHTLINE OPPORTUNITY MANAGEMENT II, LLC
	ITS:	 	GENERAL PARTNER
	BY:	 	SIGHTLINE PARTNERS LLC,
	ITS:	 	MANAGER
		
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director
	
	SIGHTLINE INVESTORS, LLC
	By:	 	 /s/ Joseph Biller

	Name:	 	Joseph Biller
	Its:	 	Managing Director

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	QUESTMARK PARTNERS II, L.P.
	
	By: QuestMark Advisers II, LLC, General Partner
		
	By:	 	 /s/ Benjamin S. Schapiro

	Name:	 	Benjamin S. Schapiro
	Title:	 	Chairman & CEO
	
	QUESTMARK PARTNERS SIDE FUND II, L.P.
	
	By: QuestMark Advisers II, LLC, General Partner
		
	By:	 	 /s/ Benjamin S. Schapiro

	Name:	 	Benjamin S. Schapiro
	Title:	 	Chairman & CEO

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	CROSS CREEK CAPITAL, L.P.
		
	By:	 	Cross Creek Capital GP, L.P.
		 	Its Sole General Partner
		
	By:	 	 /s/ Tyler Christenson

	Name:	 	Tyler Christenson
	Title:	 	Managing Director
	
	CROSS CREEK CAPITAL EMPLOYEES’ FUND, L.P.
	By:	 	Cross Creek Capital GP, L.P.
		 	Its Sole General Partner
		
	By:	 	 /s/ Tyler Christenson

	Name:	 	Tyler Christenson
	Title:	 	Managing Director

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	Integral Capital Holdings VIII, LLC
	By: Crestline Management, L.P. its Manager
	By: Crestline Investors, Inc., its General Partner
		
	By:	 	 /s/ John S. Cochran

	Name:	 	John S. Cochran
	Title:	 	Vice President

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	KAISER FOUNDATION HOSPITALS
		
	By:	 	 /s/ Thomas Meier

	Name:	 	Thomas Meier
	Title:	 	SVP & Treasurer
	
	THE PERMANENTE FEDERATION LLC-SERIES F
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES G
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES I
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer
	
	THE PERMANENTE FEDERATION LLC-SERIES J
		
	By:	 	 /s/ Pauline Fox

	Name:	 	Pauline Fox
	Title:	 	EVP & Chief Legal Officer

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

	
	 /s/ Joseph Army

	JOSEPH ARMY

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
	
	 /s/ John Landry

	JOHN LANDRY

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

 IN WITNESS WHEREOF, the undersigned have duly executed this Twelfth Amended and Restated
Stockholders’ Agreement as of the day and year first hereinabove set forth. 
  

 
			
	INVESTOR STOCKHOLDERS:
	
	PERCEPTIVE LIFE SCIENCES MASTER FUND LTD.
	By: Perceptive Advisors LLC
	Its: Manager
		
	By:	 	 /s/ James H. Mannix

	Name:	 	James H. Mannix
	Title:	 	COO

  
 TWELFTH
AMENDED AND RESTATED STOCKHOLDERS’ AGREEMENT 

  

 EXHIBIT A 

DEFINITIONS 

“Act” means the Securities Act of 1933, as amended, or any successor federal statute and the rules and regulations of the
Commission thereunder, all as the same shall be in effect at the time. 
 “Affiliate” means, as applied to the Company or
any other specified Person, any Person directly or indirectly controlling, controlled by or under direct or indirect common control with the Company (or other specified Person) and shall also include (a) any Person who is a director or
beneficial owner of at least 5% of the Company’s then outstanding Equity Securities (or other specified Person) and Family Members of any such Person, (b) any Person of which the Company (or other specified Person) or an Affiliate (as
defined in clause (a) above) of the Company (or other specified Person) shall, directly or indirectly, either beneficially own at least 10% of such Person’s then outstanding capital stock or constitute at least a 10% equity participant and
(c) in the case of a specified Person who is an individual, any Family Member of such Person. Notwithstanding the foregoing, the Investor Stockholders shall not be considered an “Affiliate” of the Company under this Agreement.
Notwithstanding anything to the contrary herein, (i) each of Kaiser Foundation Hospitals, The Permanente Federation LLC – Series F, The Permanente Federation LLC – Series I and The Permanente Federation LLC – Series J and Kaiser
Foundation Hospitals shall be deemed to be Affiliates of one another; (ii) each of SightLine Healthcare Opportunity Fund II, L.P., SightLine Healthcare Opportunity Fund II-A, L.P. and SightLine Healthcare
Opportunity Fund II-B, L.P. shall be deemed to be Affiliates of one another; and (iii) in the case of the Investor Stockholders, “Affiliate” shall include without limitation any general partner,
managing member, officer or director of such Person or any venture capital or other fund now or hereafter existing that is controlled by one or more general partners or managing members of, or shares the same management company with, such Person.

 “Agreement” means this Ninth Amended and Restated Stockholders’ Agreement. 

“Business Day” means Monday through Friday and shall exclude any federal or banking holidays observed in New York, New York.

 “Charter” means the Ninth Amended and Restated Certificate of Incorporation of the Company, as filed with the Secretary
of State of the State of Delaware on or before the date hereof, as amended or amended and restated from time to time. 

“Commission” means the United States Securities and Exchange Commission or any other federal agency at the time administering
the Act. 
 “Common Stock” means the Common Stock, $0.001 par value per share, of the Company. 

“Company” means Vapotherm, Inc., a Delaware corporation, or any successor thereto. 

“Company Acceptance” has the meaning specified in Section 3.3.3 of this Agreement. 

  
 A-1 

  

 “Competitor” means any Person, singly, or together with any of such
Person’s Affiliates, that has (or subsequently acquires) a controlling interest in any business directly competing with the primary business of the Company; provided, however, that the term “Competitor” shall not include
any financial investment firm or collective investment vehicle that, together with its Affiliates, holds less than 30% of the outstanding equity of any Competitor. 

“Designating Group” has the meaning specified in Section 2.1 of this Agreement. 

“Equity Securities” shall mean the Common Stock, the Preferred Stock and any warrants or other rights to subscribe for or to
purchase, or any options for the purchase of, Common Stock, any stock or security convertible into or exchangeable for Common Stock or any other stock, security or interest in the Company whether or not convertible into or exchangeable for Common
Stock. 
 “Estate Planning Transfer” means a Transfer by a Restricted Stockholder of any Equity Securities to his or her
Family Members for bona fide estate planning purposes. 
 “Excluded Shares” means any shares of Common Stock issued upon
conversion of Preferred Stock pursuant to Article Fourth Section B(5A) of the Charter. 
 “Family Gift” means as to each
Restricted Stockholder the gift (without consideration) by such Restricted Stockholder of Equity Securities to such Restricted Stockholder’s Family Members. 

“Family Member” means, as applied to any individual, such individual’s spouse, child (including stepchild or an adopted
child), grandchildren, parent, grandparent, brother or sister or any spouse of any of the foregoing, each trust, family limited partnership, retirement plan or other similar estate planning vehicle created for the exclusive benefit of any one or
more of them. “Family Member” shall also include any of such persons with respect to the individual’s spouse. 

“GAAP” means United States generally accepted accounting principles, consistently applied. 

“Fully-Diluted Basis” means when used in reference to the number of shares of Common Stock held by a Person at any time, a
number of shares of Common Stock equal to the sum of (x) the number of issued and outstanding shares of Common Stock then held by such Person, plus (y) the total number of shares of Common Stock issuable upon the exercise, conversion or
exchange of all securities or obligations that are, directly or indirectly, exercisable for, convertible into, or exchangeable for shares of Common Stock, including, without limitation, the Preferred Stock, issued and outstanding at such time that
are then held by such Person. 
 “Investor Stockholders” means the Stockholders identified as such on Schedule
A under the heading “Investor Stockholders” and, thereafter, any Persons to whom any of them may Transfer their Equity Securities, but only with respect to the shares of Preferred Stock, and the shares of Common Stock issued upon
conversion of such Preferred Stock (excluding any Excluded Shares), held by any such Stockholder. 

  
 A-2 

  

 “Investor Stockholder Acceptance” has the meaning specified in
Section 3.3.4 of this Agreement. 
 “Legend” has the meaning specified in
Section 6.1 of this Agreement. 
 “Material Adverse Effect” shall mean a material adverse effect
on the business, properties, assets, liabilities, operations, financial condition or results of operations of the Company. 
 “New
Securities” has the meaning specified in Section 3.5(a) of this Agreement. 
 “Offer
Price” has the meaning specified in Section 3.3.2 of this Agreement. 
 “Offered Shares”
has the meaning specified in Section 3.3.2 of this Agreement. 
 “Person” means an individual,
partnership, corporation, limited liability company, association, trust, joint venture, unincorporated organization and any government, governmental department or agency or political subdivision thereof. 

“Preferred Stock” means the Series A Preferred Stock, the Series B Preferred Stock, the Series C Preferred Stock, the Series
D Preferred Stock, and the Series D-1 Preferred Stock. 
 “Prior Agreement” has the
meaning specified in the Recitals to this Agreement. 
 “Proposed Transferee” has the meaning specified in
Section 3.3.2 of this Agreement. 
 “Purchase Agreement” means the Series D-1 Preferred Stock Purchase Agreement of even date herewith by and between the Company and the purchasers named therein. 

“Recommended Transaction” has the meaning specified in Section 3.4 of this Agreement. 

“Registration Rights Agreement” shall mean the Tenth Amended and Restated Registration Rights Agreement, dated as of the date
hereof, by and among the Company and the Stockholders that are parties thereto, as the same may be amended from time to time. 

“Remaining Offered Shares” has the meaning specified in Section 3.3.4 of this Agreement. 

“Representative” has the meaning specified in Section 2.1 of this Agreement. 

“Required Preferred Stockholders” means the holders of at least 66-2/3% of the
outstanding shares of Preferred Stock (voting together as a single class on an as converted to Common Stock basis). 
 “Restricted
Stockholder” means the Stockholders identified as such on Schedule A under the heading “Restricted Stockholders” and, thereafter, any Persons to whom any of them may Transfer their Equity Securities, but only with
respect to the shares of Common Stock (other than shares of Common Stock issued upon conversion of Preferred Stock) held by such Stockholder. 

  
 A-3 

  

 “Securities Laws” means the Act, the Securities Exchange Act of 1934, as
amended, applicable state securities laws and all rules and regulations promulgated under all such laws. 
 “Series A Preferred
Stock” means the Series A Preferred Stock, $0.001 par value per share, of the Company. 
 “Series B Preferred
Stock” means the Series B Preferred Stock, $0.001 par value per share, of the Company. 
 “Series C Preferred
Stock” means the Series C Preferred Stock, $0.001 par value per share, of the Company. 
 “Series D Preferred
Stock” means the Series D Preferred Stock, $0.001 par value per share, of the Company. 
 “Series D-1 Preferred Stock” means the Series D-1 Preferred Stock, $0.001 par value per share, of the Company. 

“Stock Sale” means a transaction or series of related transactions in which a person, or a group of related persons, acquires
from stockholders of the Company shares representing more than fifty percent (50%) of the outstanding voting power of the Company. 

“Stockholder” shall mean any Restricted Stockholder or any Investor Stockholder. 

“Third Party” shall mean any person or entity excluding each of the following: (a) the Company and any Affiliate,
officer, director, employee or associate of the Company; (b) each of the Investor Stockholders and any of their respective successors, officers, directors, affiliates or associates, and partners (limited and general) and Family Members; or
(c) each of the Restricted Stockholders that are a party to this Agreement and any of their Family Members or Affiliates. 

“Transfer” means, with respect to the Equity Securities held by a Stockholder, any sale, gift, mortgage, pledge, exchange,
assignment or other disposition or transfer, directly or indirectly, including a disposition under judicial order, legal process, execution, attachment or enforcement of an encumbrance or through grants of options or otherwise; and in the case of a
Restricted Stockholder that is not an individual, a “Transfer” of any Equity Securities held by such Restricted Stockholder shall be deemed to have been made if any equity interest in such Restricted Stockholder is, directly or indirectly,
transferred, sold, given, exchanged, assigned, pledged or otherwise disposed of to any other Person. 
 “Transfer Notice”
has the meaning specified in Section 3.3.2 of this Agreement. 
 “Transferor” has the meaning
specified in Section 3.3.1 of this Agreement. 

  
 A-4 

 EXHIBIT B 

FORM OF JOINDER TO TWELFTH AMENDED AND RESTATED 

STOCKHOLDERS’ AGREEMENT 

This Joinder Agreement (the “Joinder Agreement”) is made as of
                                        
        ,             , by the undersigned with respect to that certain Twelfth Amended and Restated Stockholders’ Agreement dated as of
September 27, 2018 (the “Stockholders’ Agreement”), by and among Vapotherm, Inc., a Delaware corporation (the “Company”), and the Persons named in Schedule A thereto (the
“Stockholders”). A copy of the Stockholders’ Agreement is attached hereto as Exhibit 1 and is incorporated herein by reference. Capitalized terms used but not otherwise defined in this Joinder Agreement shall have the
meanings ascribed thereto in the Stockholders’ Agreement. 
 WHEREAS, in connection with [the purchase of shares of Preferred
Stock or] the exercise of options to purchase shares of the Company’s stock the undersigned has agreed to become a party to the Stockholders’ Agreement; 

NOW, THEREFORE, the undersigned hereby agrees to be bound by the terms and conditions of, and to become a party to, the
Stockholders’ Agreement as a Stockholder and [in the case of a person purchasing Preferred Stock, an Investor Stockholder or,] in the case of a person exercising an option to purchase shares of the Company’s stock, a Restricted
Stockholder thereunder, as if the undersigned had been a party to the Stockholders’ Agreement as of the date thereof. 
 This Joinder
Agreement shall act as a counterpart signature to the Stockholders’ Agreement. 
 IN WITNESS WHEREOF, the undersigned has executed this
Joinder Agreement as of the day and year first above written. 
  

			
	Name:	 	  

		
	Signature:	 	  

		
	Address:	 	  

		 	  

		 	  

	Telecopy No.:	 	  

  
 B-1 

 SCHEDULE A 

LIST OF STOCKHOLDERS 

INVESTOR STOCKHOLDERS 
 REDMILE GROUP, LLC 

PERCEPTIVE LIFE SCIENCES MASTER FUND LTD. 
 TITAN PERC, LTD. 

COOPERATIEVE GILDE HEALTHCARE III SUB-HOLDING U.A. 

ADAGE CAPITAL PARTNERS, LP 
 MORGENTHALER VENTURE PARTNERS IX,
L.P. 
 3X5 SPECIAL OPPORTUNITY FUND, L.P. 
 VAPOTHERM
INVESTORS, LLC 
 SIGHTLINE HEALTHCARE OPPORTUNITY FUND II, L.P. 

SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-A, L.P. 

SIGHTLINE HEALTHCARE OPPORTUNITY FUND II-B, L.P. 

INTEGRAL CAPITAL HOLDINGS VIII, LLC 
 CROSS CREEK CAPITAL, L.P.

 CROSS CREEK CAPITAL EMPLOYEES’ FUND, L.P. 
 MARYLAND
DEPARTMENT OF BUSINESS AND ECONOMIC DEVELOPMENT 
 QUESTMARK PARTNERS II, L.P. 

QUESTMARK PARTNERS SIDE FUND II, L.P. 
 KAISER FOUNDATION
HOSPITALS 
 THE PERMANENTE FEDERATION LLC-SERIES F 

THE PERMANENTE FEDERATION LLC-SERIES G 

THE PERMANENTE FEDERATION LLC-SERIES I 

THE PERMANENTE FEDERATION LLC-SERIES J 

WILLIAM J. CIRKSENA, MD INDIVIDUAL RETIREMENT ACCOUNT 
 MOLLY E.
CIRKSENA 
 ROCHE CAPITAL, LLC 
 JOHN SODERLUND 

BARRY STRAUCH 
 EVELYN STRAUCH 

RESTRICTED STOCKHOLDERS 
 JOSEPH ARMY 

JOHN LANDRY 
 MIKE WEBB 

LISE HALPERN 
 SOM KOVVURI 

STEVE ORWIG 
 JAMES LIKEN 

 MATTHEW WELLER 

KEVIN THIBODEAU 
 LINDSAY BECKER 

KEN PIEH 
 PETER AHN 

JAMES BAKSA 
 OWEN BAMFORD 

PENNY BAMFORD 
 WILLIAM BENNER 

PAUL BLACKMER 
 JOHN BLACKMER 

MARK BLOMQUIST 
 PETER BOYD 

JULIA BRANNON 
 JODETTE BREWER 

WILLIAM J. CIRKSENA II 
 TAMARA S. CIRKSENA 

AARON J. CIRKSENA 
 WILLIAM CIRKSENA 

MOLLY E. CIRKSENA 
 DONALD CORENMAN 

ROSE CORENMAN 
 CRISANTA CORTEZ 

FELINO CORTEZ 
 RALPH CROSBY 

RAYMOND CROSBY 
 SUSAN DENTON 

EWING BEMISS & CO. 
 MICHAEL GROSSMAN 

FIRST TRUST CORPORATION (FBO MICHAEL GROSSMAN) 
 MICHAEL J.
GUNDERSON 
 JEANINE L. HUTCHISON 
 TIMOTHY R. HUTCHISON 

INTERACTIVE COMMUNICATIONS SOLUTIONS GROUP 
 KENNETH JOHNSON 

JULIE KILLEEN 
 JOHN LAMON, III 

JAY LEON 
 DANIEL LOUBE 

ALICIA LOUBE 
 REBECCA J. MACKENZIE 

ANDREA MAGANA 
 MARATHON TRADING & INVESTMENT, LLC 

MARYLAND DEPARTMENT OF BUSINESS AND ECONOMIC DEVELOPMENT 
 MARK
MASTEN 
 DAVID MCCOUN 

 KATHLEEN MCCOUN 

JOHN MORONEY 
 THOMAS NEEVES 

CARL DOUG NELSON 
 WILLIAM NILAND 

KIM NILAND 
 JAMIE NILAND 

JEAN NILAND 
 RYAN NILAND 

DAVID PUTZI 
 MARIA PUTZI 

FIRST TRUST CORPORATION (FBO DAVID PUTZI IRA 1 AND 2) 
 BRAD QUINN

 JEFF QUINN 
 BURR RANDALL 

MARCIA RANDALL 
 STEVEN RESNICK 

PETER RICE 
 ELIZABETH RICE 

KARRI-ADA KENNEDY 
 ROCHE
CAPITAL, LLC 
 JOHN SCHEIB 
 SHARON SCHEIB 

WALTER SEAMAN 
 MARTHA JO SEAMAN 

J.D. SEGURA, JR 
 TAMMY SEGURA 

J.D. SEGURA, SR. 
 ANITA SEGURA 

JOHN SODERLUND 
 ELAINE SODERLAND 

PEYTON STICKLE 
 JAMES STOREY 

ROBIN STOREY 
 ROBERT STOREY 

ANNE STOREY 
 FIRST TRUST CORPORATION TTEE (FBO ROBERT STOREY IRA)

 BARRY STRAUCH 
 EVELYN STRAUCH 

ERIC STRAUCH 
 KIMBERLY STRAUCH 

DIANE TATTERSALL 
 JOHN TOEDTMAN 

IRA FBO JOHN TOEDTMAN STIFEL NICOLAUS AS CUSTODIAN 
 CHRISTOPHER
TOMCHIK 
 COURTNEY TOMCHIK 

 MARK TOMCHIK 

FIRST TRUST CORPORATION TTEE (FBO MARK TOMCHIK) 
 THE MARITAL
TRUST OF THE VALDESUSO FAMILY TRUSTS 
 RICHARD A. WALES 

MICHAEL WEBER 
 HILLARY WEBER 

GREG WIEDEMAN 
 LINDA WIEDMAN

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00288-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00288-of-00352.parquet"}]]