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