SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
KLEINER PERKINS CAUFIELD & BYERS VIII LP

(Last) (First) (Middle)
2750 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/12/2004
3. Issuer Name and Ticker or Trading Symbol
NUVASIVE INC [ NUVA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Series A Preferred Stock(1) 2,020,361 D
Series B Preferred Stock(1) 1,031,127 D
Series C Preferred Stock(1) 356,268 D
Series D Preferred Stock(1) 933,993 D
Series D-1 Preferred Stock(1) 627,780 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant (Right to Purchase Common Stock)(2) 07/11/2002 07/11/2009 Common Stock 47,820 $0.63 D
Warrant (Right to Purchase Common Stock)(2) 07/29/2002 07/11/2009 Common Stock 3,944 $0.63 D
Warrant (Right to Purchase Common Stock)(2) 07/19/2003 07/11/2009 Common Stock 52,624 $0.63 D
Warrant (Right to Purchase Series B Preferred Stock)(2) 10/13/1999 10/13/2004 Series B Preferred Stock 41,467 $2.75 D
Warrant (Right to Purchase Series D Preferred Stock)(2) 02/14/2001 02/14/2006 Series D Preferred Stock 62,006 $2.53 D
Warrant (Right to Purchase Series D Preferred Stock)(2) 04/12/2001 04/12/2006 Series D Preferred Stock 11,584 $2.53 D
Explanation of Responses:
1. Immediately following the closing of the initial public offering of the Issuer's Common Stock, all outstanding shares of Preferred Stock will be automatically converted into shares of the Issuer's Common Stock.
2. This warrant will be automatically exercised for shares of common stock upon the closing of the initial public offering of the Issuer's Common Stock pursuant to the cashless exercise provisions contained therein, based on the price to the public in such offering.
/s/ Joseph S. Lacob, general partner of KPCB VIII Associates, L.P., its general partner 05/12/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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