0001246360-19-001285.txt : 20190501 0001246360-19-001285.hdr.sgml : 20190501 20190501174911 ACCESSION NUMBER: 0001246360-19-001285 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171115 FILED AS OF DATE: 20190501 DATE AS OF CHANGE: 20190501 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ALBERG TOM A CENTRAL INDEX KEY: 0001184752 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37824 FILM NUMBER: 19788962 MAIL ADDRESS: STREET 1: PO BOX 81226 CITY: SEATTLE STATE: WA ZIP: 98108-1226 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 4 1 form.xml PRIMARY DOCUMENT X0306 4 2017-11-15 false 0001114995 IMPINJ INC PI 0001184752 ALBERG TOM A 400 FAIRVIEW AVE N. SUITE 1200 SEATTLE WA 98109 true false false false COMMON STOCK 112792 D COMMON STOCK 31219 I By Raven Trust Fund COMMON STOCK 2017-11-15 4 J false 4817 0 D 0 I By Alberg Family Investments LLC Shares held of record by Raven Trust Fund. Mr. Alberg shares voting and dispositive control over such shares but disclaims beneficial ownership over such shares. Alberg Family Investments LLC holds shares of record in the Issuer. Mr. Alberg shared voting and dispositive control over such shares but disclaimed beneficial ownership over such shares. On November 15, 2017, Mr. Alberg sold his interests in Alberg Family Investments LLC on a pro rata basis to certain family members of Mr. Alberg, none of whom reside in Mr. Alberg's household. As a result, Mr. Alberg ceased to have reportable beneficial ownership of the shares of the Issuer held by Alberg Family Investments LLC that were included in Mr. Alberg's prior ownership reports. Yukio Morikubo as Attorney in fact for Tom Alberg 2019-05-01