0000899243-21-000738.txt : 20210106
0000899243-21-000738.hdr.sgml : 20210106
20210106181425
ACCESSION NUMBER: 0000899243-21-000738
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210104
FILED AS OF DATE: 20210106
DATE AS OF CHANGE: 20210106
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Nielsen Kirk G.
CENTRAL INDEX KEY: 0001523522
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39293
FILM NUMBER: 21512110
BUSINESS ADDRESS:
BUSINESS PHONE: 650-233-7877
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-01-04
0
0001531048
Inari Medical, Inc.
NARI
0001523522
Nielsen Kirk G.
C/O INARI MEDICAL, INC.
9 PARKER, SUITE 100
IRVINE
CA
92618
1
0
0
0
Common Stock
2021-01-04
4
J
0
856437
0.00
D
1427394
I
See footnote
Common Stock
2021-01-04
4
J
0
220530
0.00
A
220530
I
See footnote
Common Stock
2021-01-04
4
J
0
220530
0.00
D
0
I
See footnote
Common Stock
2021-01-04
4
J
0
11932
0.00
A
26638
D
Common Stock
2021-01-04
4
J
0
5395
0.00
D
8991
I
See footnote
Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Venture Capital IV, L.P. ("Versant IV"), to its partners, pursuant to a Rule 10b5-1 distribution plan.
Shares held by Versant IV. Versant Ventures IV, LLC ("Versant Ventures IV GP") is the general partner of Versant IV. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant IV; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
Represents a change in the form of ownership of Versant Ventures IV GP by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant IV.
Shares held by Versant Ventures IV GP. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Ventures IV GP; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Ventures IV GP to its members.
Represents a change in the form of ownership of the Reporting Person by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant Ventures IV GP.
Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Side Fund IV, L.P. ("Versant Side Fund"), to its partners, pursuant to a Rule 10b5-1 distribution plan.
Shares held by Versant Side Fund. Versant Ventures IV GP is the general partner of Versant Side Fund. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Side Fund; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
/s/ Robin L. Praeger, Attorney-in-Fact for Kirk Nielsen
2021-01-06