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