0001209191-23-050224.txt : 20230920
0001209191-23-050224.hdr.sgml : 20230920
20230920200932
ACCESSION NUMBER: 0001209191-23-050224
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230918
FILED AS OF DATE: 20230920
DATE AS OF CHANGE: 20230920
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: McCARTHY BARRY
CENTRAL INDEX KEY: 0001219055
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41805
FILM NUMBER: 231267580
MAIL ADDRESS:
STREET 1: 100 WINCHESTER CIRCLE
CITY: LOS GATOS
STATE: CA
ZIP: 95032
FORMER NAME:
FORMER CONFORMED NAME: McCarthy Barry
DATE OF NAME CHANGE: 20061226
FORMER NAME:
FORMER CONFORMED NAME: MCCARTHY W BARRY JR
DATE OF NAME CHANGE: 20030214
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Maplebear Inc.
CENTRAL INDEX KEY: 0001579091
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 460723335
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 50 BEALE STREET, SUITE 600
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: (888) 246-7822
MAIL ADDRESS:
STREET 1: 50 BEALE STREET, SUITE 600
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
4
1
doc4.xml
FORM 4 SUBMISSION
X0508
4
2023-09-18
0
0001579091
Maplebear Inc.
CART
0001219055
McCARTHY BARRY
C/O MAPLEBEAR INC.
50 BEALE STREET, SUITE 600
SAN FRANCISCO
CA
94105
1
0
0
0
0
Non-Voting Common Stock
2023-09-18
4
A
0
20783
0.00
A
20783
D
Non-Voting Common Stock
33333
I
See footnote
All outstanding shares of non-voting common stock and shares of non-voting common stock underlying outstanding equity securities will convert into an equivalent number of shares of the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering.
Consists of previously granted restricted stock units ("RSUs") for which the liquidity event-based vesting condition was satisfied upon the effectiveness of the registration statement on Form S-1 filed by the Issuer in connection with the Issuer's initial public offering. Certain of the RSUs remain subject to service-based vesting conditions.
The shares are held by the Rivers Cross Trust, of which the reporting person is the manager and has sole voting and dispositive power.
/s/ Bradley Libuit, Attorney-in-fact
2023-09-20