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