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