0001104659-18-061739.txt : 20181012 0001104659-18-061739.hdr.sgml : 20181012 20181012114746 ACCESSION NUMBER: 0001104659-18-061739 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181010 FILED AS OF DATE: 20181012 DATE AS OF CHANGE: 20181012 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jain Mudit K. CENTRAL INDEX KEY: 0001584404 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38468 FILM NUMBER: 181119669 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Inspire Medical Systems, Inc. CENTRAL INDEX KEY: 0001609550 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 261377674 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 9700 63RD AVENUE N STREET 2: SUITE 200 CITY: MAPLE GROVE STATE: X1 ZIP: 55369 BUSINESS PHONE: 763-205-7970 MAIL ADDRESS: STREET 1: 9700 63RD AVENUE N STREET 2: SUITE 200 CITY: MAPLE GROVE STATE: X1 ZIP: 55369 4 1 a4.xml 4 X0306 4 2018-10-10 0 0001609550 Inspire Medical Systems, Inc. INSP 0001584404 Jain Mudit K. C/O INSPIRE MEDICAL SYSTEMS, INC. 9700 63RD AVENUE NORTH, SUITE 200 MAPLE GROVE MN 55369 1 0 0 0 Common Stock 2018-10-10 4 A 0 307 40.60 A 495 D Common Stock 2095507 I See Footnote Represents shares of vested, restricted common stock received in lieu of cash fees pursuant to the Issuer's Non-Employee Director Compensation Policy, which shares are subject to the Reporting Person's lock-up agreement entered into in connection with the Registrant's initial public offering. These shares are held of record by Synergy Life Science Partners, LP ("Synergy"). Synergy Venture Partners, LLC ("SVP LLC") serves as the sole General Partner of Synergy. As such, SVP LLC possesses sole voting and investment control over the securities owned by Synergy, and may be deemed to have indirect beneficial ownership of the securities held by Synergy. SVP LLC, however, owns no securities of the Issuer directly. Mr. Jain, a director of the Issuer, is a Manager of SVP LLC and shares voting and dispositive power over the shares held by Synergy. Mr. Jain disclaims beneficial ownership of the shares held by Synergy except to the extent of his proportionate pecuniary interest therein. /s/ Richard Buchholz, Attorney-in-Fact 2018-10-12