0001127602-24-017110.txt : 20240531 0001127602-24-017110.hdr.sgml : 20240531 20240531161038 ACCESSION NUMBER: 0001127602-24-017110 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240529 FILED AS OF DATE: 20240531 DATE AS OF CHANGE: 20240531 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sarafan Lily CENTRAL INDEX KEY: 0001736341 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41805 FILM NUMBER: 241009767 MAIL ADDRESS: STREET 1: C/O COUNSYL, INC. STREET 2: 180 KIMBALL WAY CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Maplebear Inc. CENTRAL INDEX KEY: 0001579091 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] ORGANIZATION NAME: 07 Trade & Services IRS NUMBER: 460723335 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 50 BEALE STREET, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: (888) 246-7822 MAIL ADDRESS: STREET 1: 50 BEALE STREET, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 4 1 form4.xml PRIMARY DOCUMENT X0508 4 2024-05-29 0001579091 Maplebear Inc. CART 0001736341 Sarafan Lily C/O MAPLEBEAR INC. 50 BEALE STREET, SUITE 600 SAN FRANCISCO CA 94105 1 0 Common Stock 2024-05-29 4 A 0 6841 0 A 18874 D The shares represent restricted stock units, which vest in full on the earlier of (i) the date of the Issuer's next annual meeting of stockholders (or the date immediately prior to such meeting if the Reporting Person's service as a director ends at such meeting due to the Reporting Person's failure to be re-elected or the Reporting Person not standing for re-election) or (ii) the one-year anniversary of the grant date, in each case subject to the Reporting Person's continued service through such date. /s/ Bradley Libuit, Attorney-in-Fact 2024-05-31