0001144204-18-026778.txt : 20180509
0001144204-18-026778.hdr.sgml : 20180509
20180509213059
ACCESSION NUMBER: 0001144204-18-026778
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: KLEINER PERKINS CAUFIELD & BYERS XII, LLC
CENTRAL INDEX KEY: 0001355934
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820250
BUSINESS ADDRESS:
STREET 1: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-2750
MAIL ADDRESS:
STREET 1: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
FORMER NAME:
FORMER CONFORMED NAME: KLEINER PERKINS CAUFIELD & BYERS XII LLC
DATE OF NAME CHANGE: 20060313
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KPCB XII Associates, LLC
CENTRAL INDEX KEY: 0001500599
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820248
BUSINESS ADDRESS:
STREET 1: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-2750
MAIL ADDRESS:
STREET 1: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KPCB XII Founders Fund, LLC
CENTRAL INDEX KEY: 0001500600
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820249
BUSINESS ADDRESS:
STREET 1: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-2750
MAIL ADDRESS:
STREET 1: 2750 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
tv493682_4.xml
FORM 4
X0306
4
2018-05-07
0
0001609550
Inspire Medical Systems, Inc.
INSP
0001355934
KLEINER PERKINS CAUFIELD & BYERS XII, LLC
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001500600
KPCB XII Founders Fund, LLC
2750 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001500599
KPCB XII Associates, LLC
2750 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2018-05-07
4
C
0
360902
A
360902
I
By KPCB Holdings, Inc., as nominee
Common Stock
2018-05-07
4
C
0
389893
A
750795
I
By KPCB Holdings, Inc., as nominee
Common Stock
2018-05-07
4
C
0
472581
A
1223376
I
By KPCB Holdings, Inc., as nominee
Common Stock
2018-05-07
4
C
0
210147
A
1433523
I
By KPCB Holdings, Inc., as nominee
Common Stock
2018-05-07
4
C
0
163962
A
1597485
I
By KPCB Holdings, Inc., as nominee
Common Stock
2018-05-07
4
C
0
339759
A
1937244
I
By KPCB Holdings, Inc., as nominee
Series A Convertible Preferred Stock
2018-05-07
4
C
0
2400000
0.00
D
Common Stock
360902
0
I
By KPCB Holdings, Inc., as nominee
Series B Convertible Preferred Stock
2018-05-07
4
C
0
2102315
0.00
D
Common Stock
389893
0
I
By KPCB Holdings, Inc., as nominee
Series C Convertible Preferred Stock
2018-05-07
4
C
0
3142670
0.00
D
Common Stock
472581
0
I
By KPCB Holdings, Inc., as nominee
Series D Convertible Preferred Stock
2018-05-07
4
C
0
1397478
0.00
D
Common Stock
210147
0
I
By KPCB Holdings, Inc., as nominee
Series E Convertible Preferred Stock
2018-05-07
4
C
0
948855
0.00
D
Common Stock
163962
0
I
By KPCB Holdings, Inc., as nominee
Series F Convertible Preferred Stock
2018-05-07
4
C
0
2259399
0.00
D
Common Stock
339759
0
I
By KPCB Holdings, Inc., as nominee
Shares of Series A, Series B, Series C, Series D, Series E and Series F Convertible Preferred Stock (collectively, the "Convertible Preferred Stock") have no expiration date and were automatically converted into shares of Common Stock for no additional consideration immediately prior to the closing of the Issuer's initial public offering.
Shares of Series A, Series C, Series D and Series F Convertible Preferred Stock are convertible into shares of Common Stock at a 1-for-0.1504 conversion rate.
Consists of shares beneficially owned by Kleiner Perkins Caufield & Byers XII, LLC ("KPCB XII"), KPCB XII Founders Fund, LLC ("KPCB XII FF"), and individuals and entities associated with Kleiner Perkins Caufield & Byers. All shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee" for the accounts of such individuals and entities. The managing member of KPCB XII and KPCB XII FF is KPCB XII Associates, LLC ("KPCB XII Associates"). Brook Byers, L. John Doerr, Raymond Lane and Theodore Schlein, the managers of KPCB XII Associates, exercise shared voting and dispositive control over the shares held by KPCB XII and KPCB XII FF. KPCB XII and each of its managers disclaim beneficial ownership of such shares except to the extent of any pecuniary interest therein.
Shares of Series B Convertible Preferred Stock are convertible into shares of Common Stock at a 1-for-0.1855 conversion rate.
Shares of Series E Convertible Preferred Stock are convertible into shares of Common Stock at a 1-for-0.1728 conversion rate.
/s/ Susan Biglieri, Chief Financial Officer
2018-05-09
/s/ Susan Biglieri, Chief Financial Officer
2018-05-09
/s/ Susan Biglieri, Chief Financial Officer
2018-05-09