0001209191-21-028325.txt : 20210426
0001209191-21-028325.hdr.sgml : 20210426
20210426171716
ACCESSION NUMBER: 0001209191-21-028325
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210426
FILED AS OF DATE: 20210426
DATE AS OF CHANGE: 20210426
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Garfield Greg Shaw
CENTRAL INDEX KEY: 0001594406
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40337
FILM NUMBER: 21854969
MAIL ADDRESS:
STREET 1: C/O SEMLER SCIENTIFIC, INC.
STREET 2: 2330 NW EVERETT ST.
CITY: PORTLAND
STATE: OR
ZIP: 97210
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: NeuroPace Inc
CENTRAL INDEX KEY: 0001528287
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 223550230
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 455 N. BERNARDO AVENUE
CITY: MOUNTAIN VIEW
STATE: CA
ZIP: 94043
BUSINESS PHONE: 6502372700
MAIL ADDRESS:
STREET 1: 455 N. BERNARDO AVENUE
CITY: MOUNTAIN VIEW
STATE: CA
ZIP: 94043
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-04-26
0
0001528287
NeuroPace Inc
NPCE
0001594406
Garfield Greg Shaw
368 EAST CAMPBELL AVENUE
SUITE 200
CAMPBELL
CA
95008
1
0
0
0
Common Stock
2021-04-26
4
C
0
18891
0.00
A
18891
I
See Footnote
Common Stock
2021-04-26
4
C
0
5595493
0.00
A
5614384
I
See Footnote
Series A' Preferred Stock
0.00
2021-04-26
4
C
0
859
0.00
D
Common Stock
859
0
I
See Footnote
Series B' Preferred Stock
0.00
2021-04-26
4
C
0
18032
0.00
D
Common Stock
18032
0
I
See Footnote
Series A' Preferred Stock
0.00
2021-04-26
4
C
0
323591
0.00
D
Common Stock
324450
0
I
See Footnote
Series B' Preferred Stock
0.00
2021-04-26
4
C
0
5271902
0.00
D
Common Stock
5271902
0
I
See Footnote
Shares are held by the Greg and Dori Garfield Living Revocable Trust.
KCK Ltd. has sole voting and investment power with respect to the shares. The board of directors of KCK Ltd., consisting of Antoine Sacy, Kamal Kassar, and Nael Karim Kassar, has delegated its authority to vote or invest the shares to Nael Karim Kassar. As such, Nael Karim Kassar may also be deemed to have sole voting and investment with respect to the shares. Mr. Kassar and Greg Garfield, who serves as Senior Managing Director with KCK-US, Inc., an affiliate of KCK Ltd., are also members of our board of directors.
Each share of Preferred Stock automatically converted on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering, for no additional consideration. The Preferred Stock has no expiration date.
/s/ Mark B. Weeks, Attorney-in-Fact
2021-04-26