0001209191-20-032411.txt : 20200527 0001209191-20-032411.hdr.sgml : 20200527 20200527183525 ACCESSION NUMBER: 0001209191-20-032411 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200527 FILED AS OF DATE: 20200527 DATE AS OF CHANGE: 20200527 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: 20916537 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 2020-05-27 0 0001531048 Inari Medical, Inc. NARI 0001523522 Nielsen Kirk G. C/O INARI MEDICAL, INC. 9 PARKER, SUITE 100 IRVINE CA 92618 1 0 1 0 Common Stock 2020-05-27 4 C 0 5745542 A 5745542 I See footnote Restricted Stock Unit 2020-05-27 4 A 0 8947 19.00 A Common Stock 8947 8947 D Series A Preferred Stock 2020-05-27 4 C 0 3571426 D Common Stock 3571426 0 I See footnote Series B Preferred Stock 2020-05-27 4 C 0 1197058 D Common Stock 1197058 0 I See footnote Series C Preferred Stock 2020-05-27 4 C 0 977058 D Common Stoc 977058 0 I See footnote Upon the closing of the Issuer's initial public offering, each share of preferred stock automatically converted into shares of the Issuer's common stock on a one-for-one basis. Includes (i) 3,549,070 shares held of record by Versant Venture Capital IV, L.P. ("Versant Capital") and (ii) 22,356 shares held of record by Versant Side Fund IV, L.P. ("Versant Side"). Includes (i) 1,189,565 shares held of record by Versant Capital and (ii) 7,493 shares held of record by Versant Side. Includes (i) 970,942 shares held of record by Versant Capital and (ii) 6,116 shares held of record by Versant Side The Reporting Person may be deemed to beneficially own the shares indirectly by reason of the Reporting Person is a managing member of Versant Ventures IV, LLC, the sole general partner of Versant Capital and Versant Side. The Reporting Person disclaims beneficial ownership of the securities reported herein except to the extent of his pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Person, as applicable, is the beneficial owner of, or has any pecuniary interest in, such securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. The restricted stock unit vests in three equal annual installments beginning on May 27, 2020. /s/ Mitchell Hill, Attorney-in-Fact for Kirk Nielsen 2020-05-27