0001104659-18-031863.txt : 20180509
0001104659-18-031863.hdr.sgml : 20180509
20180509211904
ACCESSION NUMBER: 0001104659-18-031863
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180502
FILED AS OF DATE: 20180509
DATE AS OF CHANGE: 20180509
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tansey Casey M
CENTRAL INDEX KEY: 0001474322
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38468
FILM NUMBER: 18820222
MAIL ADDRESS:
STREET 1: 2735 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
a4.xml
4
X0306
4
2018-05-02
0
0001609550
Inspire Medical Systems, Inc.
INSP
0001474322
Tansey Casey M
C/O INSPIRE MEDICAL SYSTEMS, INC.
9700 63RD AVENUE NORTH, SUITE 200
MAPLE GROVE
MN
55369
1
0
1
0
Common Stock
2018-05-07
4
C
0
360902
A
360902
I
See Footnote
Common Stock
2018-05-07
4
C
0
389893
A
750795
I
See Footnote
Common Stock
2018-05-07
4
C
0
472581
A
1223376
I
See Footnote
Common Stock
2018-05-07
4
C
0
210147
A
1433523
I
See Footnote
Common Stock
2018-05-07
4
C
0
163962
A
1597485
I
See Footnote
Common Stock
2018-05-07
4
C
0
570769
A
2168254
I
See Footnote
Common Stock
2018-05-07
4
P
0
187500
16.00
A
187500
D
Series A Convertible Preferred Stock
2018-05-07
4
C
0
2400000
0
D
Common Stock
360902
0
I
See Footnote
Series B Convertible Preferred Stock
2018-05-07
4
C
0
2102315
0
D
Common Stock
389893
0
I
See Footnote
Series C Convertible Preferred Stock
2018-05-07
4
C
0
3142670
0
D
Common Stock
472581
0
I
See Footnote
Series D Convertible Preferred Stock
2018-05-07
4
C
0
1397478
0
D
Common Stock
210147
0
I
See Footnote
Series E Convertible Preferred Stock
2018-05-07
4
C
0
948855
0
D
Common Stock
163962
0
I
See Footnote
Series F Convertible Preferred Stock
2018-05-07
4
C
0
3795620
0
D
Common Stock
570769
0
I
See Footnote
Employee Stock Option (right to buy)
16.00
2018-05-02
4
A
0
17296
0
A
2028-05-02
Common Stock
17296
17296
D
Shares of Series A, Series C, Series D and Series F Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1504 conversion rate immediately prior to the closing of the Issuer's initial public offering ("IPO") for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Sixth Amended and Restated Certificate of Incorporation (as amended, the "Certificate of Incorporation")). These shares had no expiration date.
Shares of Series B Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1855 conversion rate immediately prior to the closing of the Issuer's IPO for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Certificate of Incorporation). These shares had no expiration date.
Shares of Series E Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1728 conversion rate immediately prior to the closing of the Issuer's IPO for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Certificate of Incorporation). These shares had no expiration date.
The shares are held of record by U.S. Venture Partners IX, L.P. ("USVP IX"). Presidio Management Group IX, LLC ("PMG IX") is the general partner of USVP IX and may be deemed to have sole voting and dispositive power over the shares held by USVP IX. Casey Tansey, a director of the Issuer, and each of Irwin Federman, Steven M. Krausz, David E. Liddle, Paul A. Matteucci, Jonathan D. Root, and Philip M. Young, are managing members of PMG IX, and may be deemed to share voting and dispositive power over the shares held by USVP IX. Such persons and entities disclaim beneficial ownership of shares held by USVP IX, except to the extent of any proportionate pecuniary interest therein.
The option vests and becomes exercisable on May 2, 2019, subject to the Reporting Person's continuous service to the Issuer through such date. The option was erroneously included on the Reporting Person's Form 3 filed on May 2, 2018.
/s/ Richard Buchholz, as Attorney-in-Fact for Casey Tansey
2018-05-09