0001104659-18-031866.txt : 20180509
0001104659-18-031866.hdr.sgml : 20180509
20180509211958
ACCESSION NUMBER: 0001104659-18-031866
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180507
FILED AS OF DATE: 20180509
DATE AS OF CHANGE: 20180509
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LIDDLE DAVID E
CENTRAL INDEX KEY: 0001212726
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820230
MAIL ADDRESS:
STREET 1: C/O THE NEW YORK TIMES CO
STREET 2: 229 WEST 43RD ST
CITY: NEW YORK
STATE: NY
ZIP: 10036
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Matteucci Paul A
CENTRAL INDEX KEY: 0001370817
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820229
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FEDERMAN IRWIN
CENTRAL INDEX KEY: 0001192391
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820232
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KRAUSZ STEVEN M
CENTRAL INDEX KEY: 0001190636
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820231
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROOT JONATHAN D
CENTRAL INDEX KEY: 0001225480
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820228
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: YOUNG PHILIP M
CENTRAL INDEX KEY: 0001048637
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820227
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: U S Venture Partners IX L P
CENTRAL INDEX KEY: 0001309185
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820233
BUSINESS ADDRESS:
STREET 1: 2735 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-854-9080
MAIL ADDRESS:
STREET 1: 2735 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Presidio Management Group IX, L.L.C.
CENTRAL INDEX KEY: 0001527715
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820234
BUSINESS ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-854-9080
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Inspire Medical Systems, Inc.
CENTRAL INDEX KEY: 0001609550
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 261377674
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 9700 63RD AVENUE N
STREET 2: SUITE 200
CITY: MAPLE GROVE
STATE: X1
ZIP: 55369
BUSINESS PHONE: 763-205-7970
MAIL ADDRESS:
STREET 1: 9700 63RD AVENUE N
STREET 2: SUITE 200
CITY: MAPLE GROVE
STATE: X1
ZIP: 55369
4
1
a4.xml
4
X0306
4
2018-05-07
0
0001609550
Inspire Medical Systems, Inc.
INSP
0001527715
Presidio Management Group IX, L.L.C.
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001309185
U S Venture Partners IX L P
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001192391
FEDERMAN IRWIN
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001190636
KRAUSZ STEVEN M
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001212726
LIDDLE DAVID E
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001370817
Matteucci Paul A
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001225480
ROOT JONATHAN D
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
0001048637
YOUNG PHILIP M
1460 EL CAMINO REAL, #100
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2018-05-07
4
C
0
360902
A
360902
I
See Footnote
Common Stock
2018-05-07
4
C
0
389893
A
750795
I
See Footnote
Common Stock
2018-05-07
4
C
0
472581
A
1223376
I
See Footnote
Common Stock
2018-05-07
4
C
0
210147
A
1433523
I
See Footnote
Common Stock
2018-05-07
4
C
0
163962
A
1597485
I
See Footnote
Common Stock
2018-05-07
4
C
0
570769
A
2168254
I
See Footnote
Series A Convertible Preferred Stock
2018-05-07
4
C
0
2400000
0
D
Common Stock
360902
0
I
See Footnote
Series B Convertible Preferred Stock
2018-05-07
4
C
0
2102315
0
D
Common Stock
389893
0
I
See Footnote
Series C Convertible Preferred Stock
2018-05-07
4
C
0
3142670
0
D
Common Stock
472581
0
I
See Footnote
Series D Convertible Preferred Stock
2018-05-07
4
C
0
1397478
0
D
Common Stock
210147
0
I
See Footnote
Series E Convertible Preferred Stock
2018-05-07
4
C
0
948855
0
D
Common Stock
163962
0
I
See Footnote
Series F Convertible Preferred Stock
2018-05-07
4
C
0
3795620
0
D
Common Stock
570769
0
I
See Footnote
Shares of Series A, Series C, Series D and Series F Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1504 conversion rate immediately prior to the closing of the Issuer's initial public offering ("IPO") for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Sixth Amended and Restated Certificate of Incorporation (as amended, the "Certificate of Incorporation")). These shares had no expiration date.
Shares of Series B Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1855 conversion rate immediately prior to the closing of the Issuer's IPO for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Certificate of Incorporation). These shares had no expiration date.
Shares of Series E Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1728 conversion rate immediately prior to the closing of the Issuer's IPO for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Certificate of Incorporation). These shares had no expiration date.
The shares are held of record by U.S. Venture Partners IX, L.P. ("USVP IX"). Presidio Management Group IX, LLC ("PMG IX") is the general partner of USVP IX and may be deemed to have sole voting and dispositive power over the shares held by USVP IX. Casey Tansey, a director of the Issuer, and each of Irwin Federman, Steven M. Krausz, David E. Liddle, Paul A. Matteucci, Jonathan D. Root, and Philip M. Young, are managing members of PMG IX, and may be deemed to share voting and dispositive power over the shares held by USVP IX. Such persons and entities disclaim beneficial ownership of shares held by USVP IX, except to the extent of any proportionate pecuniary interest therein.
/s/ Richard Buchholz, as Attorney-in-Fact for Presidio Management Group IX, L.L.C.
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for U.S. Venture Partners IX, L.P.
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for Irwin Federman
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for Steven M. Krausz
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for David E. Liddle
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for Paul E. Matteucci
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for Jonathon D. Root
2018-05-09
/s/ Richard Buchholz, as Attorney-in-Fact for Philip M. Young
2018-05-09