0001628280-21-018954.txt : 20210921
0001628280-21-018954.hdr.sgml : 20210921
20210921183449
ACCESSION NUMBER: 0001628280-21-018954
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210917
FILED AS OF DATE: 20210921
DATE AS OF CHANGE: 20210921
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MOLL FREDERIC H
CENTRAL INDEX KEY: 0001260157
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40797
FILM NUMBER: 211267490
MAIL ADDRESS:
STREET 1: C/O INTUITIVE SURGICAL INC
STREET 2: 950 KIFER ROAD
CITY: SUNNYVALE
STATE: CA
ZIP: 94086
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PROCEPT BioRobotics Corp
CENTRAL INDEX KEY: 0001588978
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 260199180
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 900 ISLAND DRIVE
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: 650-232-7200
MAIL ADDRESS:
STREET 1: 900 ISLAND DRIVE
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
4
1
wf-form4_163226367108643.xml
FORM 4
X0306
4
2021-09-17
0
0001588978
PROCEPT BioRobotics Corp
PRCT
0001260157
MOLL FREDERIC H
C/O PROCEPT BIOROBOTICS CORPORATION
900 ISLAND DRIVE
REDWOOD CITY
CA
94065
1
0
0
0
Common Stock
2021-09-17
4
C
0
329890
A
482521
D
Common Stock
2021-09-17
4
P
0
400000
25
A
882521
D
Series B Convertible Preferred Stock
0.0
2021-09-17
4
C
0
45586
D
Common Stock
45586.0
0
D
Series C Convertible Preferred Stock
0.0
2021-09-17
4
C
0
89840
D
Common Stock
89840.0
0
D
Series D Convertible Preferred Stock
0.0
2021-09-17
4
C
0
108214
D
Common Stock
108214.0
0
D
Series E Convertible Preferred Stock
0.0
2021-09-17
4
C
0
9104
D
Common Stock
9104.0
0
D
Series F Convertible Preferred Stock
0.0
2021-09-17
4
C
0
16974
D
Common Stock
16974.0
0
D
Series G Convertible Preferred Stock
0.0
2021-09-17
4
C
0
60172
D
Common Stock
60172.0
0
D
Each share of Series A Preferred Stock, Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock, Series E Preferred Stock, Series F Preferred Stock and Series G Preferred Stock converted automatically into one share of Common Stock upon the closing of the Issuer's initial public offering. These shares have no expiration date.
Represents a purchase in the Issuer's public offering.
/s/ Alaleh Nouri, Attorney-in-Fact for Frederic Moll
2021-09-21