0001628280-21-018955.txt : 20210921 0001628280-21-018955.hdr.sgml : 20210921 20210921183505 ACCESSION NUMBER: 0001628280-21-018955 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210917 FILED AS OF DATE: 20210921 DATE AS OF CHANGE: 20210921 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Krummel Thomas M CENTRAL INDEX KEY: 0001495768 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40797 FILM NUMBER: 211267492 MAIL ADDRESS: STREET 1: C/O CALIFORNIA WATER SERVICE GROUP STREET 2: 1720 N. FIRST STREET CITY: SAN JOSE STATE: CA ZIP: 95118 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PROCEPT BioRobotics Corp CENTRAL INDEX KEY: 0001588978 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 260199180 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 900 ISLAND DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94065 BUSINESS PHONE: 650-232-7200 MAIL ADDRESS: STREET 1: 900 ISLAND DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94065 4 1 wf-form4_163226369378321.xml FORM 4 X0306 4 2021-09-17 0 0001588978 PROCEPT BioRobotics Corp PRCT 0001495768 Krummel Thomas M C/O PROCEPT BIOROBOTICS CORPORATION 900 ISLAND DRIVE REDWOOD CITY CA 94065 1 0 0 0 Common Stock 2021-09-17 4 C 0 5963 A 75919 D Common Stock 2021-09-17 4 P 0 5000 25 A 80919 D Series C Convertible Preferred Stock 2021-09-17 4 C 0 5963 D Common Stock 5963.0 0 D Each share of Series A Preferred Stock , Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock, Series E Preferred Stock, Series F Preferred Stock and Series G Preferred Stock (collectively, the "Preferred Stock") will convert automatically into one share of Common Stock upon the closing of the Issuer's initial public offering. These shares had no expiration date. Represents a purchase in the Issuer's public offering. /s/ Alaleh Nouri, Attorney-in-Fact for Thomas M. Krummell 2021-09-21