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