0001246360-16-006356.txt : 20160720
0001246360-16-006356.hdr.sgml : 20160720
20160720214911
ACCESSION NUMBER: 0001246360-16-006356
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160720
FILED AS OF DATE: 20160720
DATE AS OF CHANGE: 20160720
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: IMPINJ INC
CENTRAL INDEX KEY: 0001114995
STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS, NEC [3679]
IRS NUMBER: 912041398
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 400 FAIRVIEW AVENUE NORTH
STREET 2: SUITE 1200
CITY: SEATTLE
STATE: WA
ZIP: 98109
BUSINESS PHONE: 206-517-5300
MAIL ADDRESS:
STREET 1: 400 FAIRVIEW AVENUE NORTH
STREET 2: SUITE 1200
CITY: SEATTLE
STATE: WA
ZIP: 98109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BYBEE CLINTON
CENTRAL INDEX KEY: 0001219043
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37824
FILM NUMBER: 161776418
MAIL ADDRESS:
STREET 1: 8755 W. HIGGINS ROAD
STREET 2: SUITE 1025
CITY: CHICAGO
STATE: IL
ZIP: 60631
3
1
form.xml
PRIMARY DOCUMENT
X0206
3
2016-07-20
0
0001114995
IMPINJ INC
PI
0001219043
BYBEE CLINTON
8755 WEST HIGGINS
SUITE 1025
CHICAGO
IL
60631
true
false
true
false
SERIES 1 PREFERRED STOCK
0
COMMON STOCK
820935
I
See footnote
SERIES 2 PREFERRED STOCK
0
COMMON STOCK
421684
I
See footnote
SERIES 2 WARRANT (RTB)
9.32
2017-06-30
COMMON STOCK
32022
I
See footnote
Reflects a 1-for-12 reverse stock split of the Issuer's outstanding shares effected July 8, 2016.
The Series 1 Preferred Stock will automatically convert to shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering on a 1-for-1 basis.
Each share has no expiration date.
815,666 of these shares are held of record by ARCH Venture Fund V, L.P.; and 5,269 of these shares are held of record by ARCH V Entrepreneurs Fund, L.P.
ARCH Venture Partners V, L.P., as the sole general partner of ARCH Venture Fund V, L.P. and ARCH V Entrepreneurs Fund, L.P., may be deemed to beneficially own certain of the shares held of record by ARCH Venture Fund V, L.P. and ARCH V Entrepreneurs Fund, L.P., but disclaims beneficial ownership of such shares, in which it does not have an actual pecuniary interest. ARCH Venture Partners V, LLC, as the sole general partner of ARCH Venture Partners V, L.P., may be deemed to beneficially own certain of the shares held of record by ARCH Venture Fund V, L.P. and ARCH V Entrepreneurs Fund, L.P. but disclaims beneficial ownership of such shares, in which it does not have an actual pecuniary interest.
Clinton Bybee, a member of the board of directors, is a managing director of ARCH Venture Partners V, LLC, and may be deemed to beneficially own certain of the shares held of record by ARCH Venture Fund V, L.P. and ARCH V Entrepreneurs Fund, L.P. Mr. Bybee disclaims beneficial ownership of all shares held of record by ARCH Venture Fund V, L.P. and ARCH V Entrepreneurs Fund, L.P., of which he does not have an actual pecuniary interest. By virtue of their relationship as affiliated entities who have overlapping general partners and managing directors, ARCH Venture Fund V, L.P., ARCH V Entrepreneurs Fund, L.P., ARCH Venture Partners V, L.P., ARCH Venture Partners V, LLC and Mr. Bybee may be deemed to share the voting and investment control of the record shares.
The Series 2 Preferred Stock will automatically convert to shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering on a 1.24996780424983-for-1 basis.
418,862 of these shares are held of record by ARCH Venture Fund V, L.P.; and 2,822 of these shares are held of record by ARCH V Entrepreneurs Fund, L.P.
31,808 of these shares are held of record by ARCH Venture Fund V, L.P.; and 214 of these shares are held of record by ARCH V Entrepreneurs Fund, L.P.
Power of Attorney
Mark McDonnell, as Attorney-in-Fact for Clinton Bybee
2016-07-20