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