0001246360-19-002037.txt : 20190830 0001246360-19-002037.hdr.sgml : 20190830 20190830170711 ACCESSION NUMBER: 0001246360-19-002037 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190828 FILED AS OF DATE: 20190830 DATE AS OF CHANGE: 20190830 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: 191070193 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 2019-08-28 false 0001114995 IMPINJ INC PI 0001184752 ALBERG TOM A 400 FAIRVIEW AVE N. SUITE 1200 SEATTLE WA 98109 true false false false COMMON STOCK 31219 I By Raven Trust Fund COMMON STOCK 2019-08-28 4 J false 1887 0 A 87269 D 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. Distribution of Common Stock held by ARCH Venture Fund V, L.P. to its partners for no consideration. Yukio Morikubo as Attorney in fact for Tom Alberg 2019-08-30