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