0001209191-20-031476.txt : 20200521
0001209191-20-031476.hdr.sgml : 20200521
20200521184626
ACCESSION NUMBER: 0001209191-20-031476
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20200521
FILED AS OF DATE: 20200521
DATE AS OF CHANGE: 20200521
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilde Healthcare Holding B.V.
CENTRAL INDEX KEY: 0001420106
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39293
FILM NUMBER: 20903281
BUSINESS ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
BUSINESS PHONE: 31(0)30-2192549
MAIL ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilde Healthcare IV Management B.V.
CENTRAL INDEX KEY: 0001757508
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39293
FILM NUMBER: 20903282
BUSINESS ADDRESS:
STREET 1: NEWTONLAAN 91
CITY: UTRECHT
STATE: P7
ZIP: 3584 BP
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: NEWTONLAAN 91
CITY: UTRECHT
STATE: P7
ZIP: 3584 BP
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cooperatieve Gilde Healthcare IV U.A.
CENTRAL INDEX KEY: 0001756335
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39293
FILM NUMBER: 20903283
BUSINESS ADDRESS:
STREET 1: NEWTONLANN 51
CITY: UTRECHT
STATE: P7
ZIP: 3508AB
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: NEWTONLANN 51
CITY: UTRECHT
STATE: P7
ZIP: 3508AB
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Inari Medical, Inc.
CENTRAL INDEX KEY: 0001531048
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 452902923
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 9 PARKER, SUITE 100
CITY: IRVINE
STATE: CA
ZIP: 92618
BUSINESS PHONE: 949-923-4747
MAIL ADDRESS:
STREET 1: 9 PARKER, SUITE 100
CITY: IRVINE
STATE: CA
ZIP: 92618
FORMER COMPANY:
FORMER CONFORMED NAME: Inceptus Newco1 Inc.
DATE OF NAME CHANGE: 20110923
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2020-05-21
0
0001531048
Inari Medical, Inc.
NARI
0001756335
Cooperatieve Gilde Healthcare IV U.A.
NEWTONLAAN 91 3584 BP
UTRECHT
P7
NETHERLANDS
0
0
1
0
0001757508
Gilde Healthcare IV Management B.V.
NEWTONLAAN 91
3584 BP
UTRECHT
P7
NETHERLANDS
0
0
1
0
0001420106
Gilde Healthcare Holding B.V.
NEWTONLAAN 91
3584 BP
UTRECHT
P7
NETHERLANDS
0
0
1
0
Series C Preferred Stock
Common Stock
7599350
I
See footnote
Each share of the Issuer's preferred stock is convertible on a one-to-one basis into shares of the Issuer's common stock at the holder's election and has no expiration date. The preferred stock will automatically convert into common stock upon the closing of the Issuer's initial public offering.
All securities reported are held of record by Cooperatieve Gilde Healthcare IV U.A. ("Gilde"). Gilde is managed by Gilde Healthcare IV Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of Management and Holding may be deemed to have voting, investment and dispositive power with respect to the securities held by Gilde. Each of Management and Holding disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities, except to the extent of their respective pecuniary interests therein.
Exhibit 24 - Power of Attorney.
Cooperatieve Gilde Healthcare IV U.A., By: /s/ Mitchell Hill, Attorney-in-Fact
2020-05-21
Gilde Healthcare IV Management B.V., By: /s/ Mitchell, Attorney-in-Fact
2020-05-21
Gilde Healthcare HOlding B.V., By: /s/ Mitchell Hill, Attorney-in-Fact
2020-05-21
EX-24.3_917061
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
With respect to holdings of and transactions in securities issued by Inari
Medical, Inc. (the "Company"), the undersigned hereby constitutes and appoints
the individual or individuals named on Schedule A attached hereto and as may be
amended from time to time, or any of them signing singly, with full power of
substitution and resubstitution, to act as the undersigned's true and lawful
attorney-in-fact to:
1. prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the United States Securities and Exchange Commission (the
"SEC") a Form ID, including amendments thereto, and any other documents
necessary or appropriate to obtain and/or regenerate codes and passwords
enabling the undersigned to make electronic filings with the SEC of reports
required by Section 16(a) of the Securities Exchange Act of 1934, as amended, or
any rule or regulation of the SEC;
2. execute for and on behalf of the undersigned, Forms 3, 4, and 5 in accordance
with Section 16 of the Securities Exchange Act of 1934, as amended, and the
rules thereunder;
3. do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4, or 5,
complete and execute any amendment or amendments thereto, and timely file such
form with the SEC and any stock exchange or similar authority; and
4. take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution and
resubstitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorneys-in-fact substitute or substitutes, shall
lawfully do or cause to be done by virtue of this Power of Attorney and the
rights and powers herein granted.
The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934, as amended.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 7th day of May, 2020.
Cooperatieve Gilde Healthcare IV U.A.
By: /s/ Marc Perret
Name: Marc Perret
Title: Managing Director
Gilde Healthcare IV Management B.V.
By: /s/ Marc Perret
Name: Marc Perret
Title: Managing Director
Gilde Healthcare Holding B.V.
By: /s/ Marc Perret
Name: Marc Perret
Title: Managing Director
Schedule A
Individual Appointed as Attorney-in-Fact with Full Power of Substitution and
Resubstitution
1. William Hoffman
2. Mitchell Hill