0001246360-16-006355.txt : 20160720
0001246360-16-006355.hdr.sgml : 20160720
20160720211417
ACCESSION NUMBER: 0001246360-16-006355
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160720
FILED AS OF DATE: 20160720
DATE AS OF CHANGE: 20160720
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: IMPINJ INC
CENTRAL INDEX KEY: 0001114995
STANDARD INDUSTRIAL CLASSIFICATION: ELECTRONIC COMPONENTS, NEC [3679]
IRS NUMBER: 912041398
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 400 FAIRVIEW AVENUE NORTH
STREET 2: SUITE 1200
CITY: SEATTLE
STATE: WA
ZIP: 98109
BUSINESS PHONE: 206-517-5300
MAIL ADDRESS:
STREET 1: 400 FAIRVIEW AVENUE NORTH
STREET 2: SUITE 1200
CITY: SEATTLE
STATE: WA
ZIP: 98109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ALBERG TOM A
CENTRAL INDEX KEY: 0001184752
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37824
FILM NUMBER: 161776400
MAIL ADDRESS:
STREET 1: PO BOX 81226
CITY: SEATTLE
STATE: WA
ZIP: 98108-1226
3
1
form.xml
PRIMARY DOCUMENT
X0206
3
2016-07-20
0
0001114995
IMPINJ INC
PI
0001184752
ALBERG TOM A
400 FAIRVIEW AVE N. SUITE 1200
SEATTLE
WA
98109
true
false
false
false
SERIES 1 PREFERRED STOCK
0
COMMON STOCK
672895
I
See footnote
SERIES 2 PREFERRED STOCK
0
COMMON STOCK
412203
I
See footnote
SERIES 2 WARRANT (RTB)
9.32
2017-06-30
COMMON STOCK
29623
I
See footnote
Reflects a 1-for-12 reverse stock split of the Issuer's outstanding shares effected July 8, 2016.
The Series 1 Preferred Stock will automatically convert to shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering on a 1-for-1 basis.
Each share has no expiration date.
72,531 of these shares are held of record by Madrona Managing Director Fund, LLC; 541,350 of these shares are held of record by Madrona Venture Fund I-A, L.P.; and 59,014 of these shares are held of record by Madrona Venture Fund I-B, L.P.
Madrona Investment Partners, LLC, as the sole general partner of Madrona Venture Fund I-A, L.P. and Madrona Venture Fund I-B, L.P., may be deemed to beneficially own certain of the shares held of record by Madrona Venture Fund I-A, L.P. and Madrona Venture Fund I-B, L.P. but disclaims beneficial ownership of such shares in which it does not have an actual pecuniary interest. Tom A. Alberg, a member of the board of directors, disclaims beneficial ownership of all shares held of record by Madrona Managing Director Fund, LLC, Madrona Venture Fund I-A, L.P. and Madrona Venture Fund I-B, L.P., in which he does not have an actual pecuniary interest. By virtue of their relationship as affiliated entities who have overlapping general partners and managing directors, Madrona Managing Director Fund, LLC, Madrona Venture Fund I-A, L.P., Madrona Venture Fund I-B, L.P., Madrona Investment Partners, LLC and Mr. Alberg may be deemed to share voting and investment control of the record shares.
The Series 2 Preferred Stock will automatically convert to shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering on a 1.24996780424983-for-1 basis.
44,409 shares are held of record by Madrona Managing Director Fund, LLC; 331,695 shares are held of record by Madrona Venture Fund I-A, L.P.; and 36,099 shares are held of record by Madrona Venture Fund I-B, L.P.
3,191 shares are held of record by Madrona Managing Director Fund, LLC; 23,838 shares are held of record by Madrona Venture Fund I-A, L.P.; and 2,594 shares are held of record by Madrona Venture Fund I-B, L.P.
Power of Attorney
Yukio Morikubo as Attorney in fact for Tom Alberg
2016-07-20
EX-24
2
ex24alberg.txt
POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of
NanoString Technologies, Inc. (the "Company"), hereby
constitutes and appoints Wilson Sonsini Goodrich &
Rosati, Professional Corporation, and each of Evan Fein,
Ryan Schafer and Yukio Morikubo the undersigned's true
and lawful attorney-in-fact to:
1. complete and execute Forms ID, 3,4 and 5 and other
forms and all amendments thereto as such attorney-in-
fact shall in his or her discretion determine to be
required or advisable pursuant to Section 16 of the
Securities Exchange Act of 1934 (as amended) and the
rules and regulations promulgated thereunder, or any
successor laws and regulations, as a consequence of the
undersigned's ownership, acquisition or disposition of
securities of the Company; and
2. do all acts necessary in order to file such forms
with the Securities and Exchange Commission, any
securities exchange or national association, the Company
and such other person or agency as the attorney-in-fact
shall deem appropriate.
The undersigned hereby ratifies and confirms all that
said attorneys-in-fact and agents shall do or cause to
be done by virtue hereof. The undersigned acknowledges
that the foregoing attorneys-in-fact, in serving in such
capacity at the request of the undersigned, are not
assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16
of the Securities Exchange Act of 1934 (as amended).
This Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to
file Forms ID, 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities
issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to the Company
and the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 20th day of
July, 2016. /s/ Tom Alberg
Tom Alberg
the
undersigned in a signed writing delivere