0001193125-21-032362.txt : 20210208 0001193125-21-032362.hdr.sgml : 20210208 20210208161551 ACCESSION NUMBER: 0001193125-21-032362 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20210208 DATE AS OF CHANGE: 20210208 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Inari Medical, Inc. CENTRAL INDEX KEY: 0001531048 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 452902923 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-91521 FILM NUMBER: 21601595 BUSINESS ADDRESS: STREET 1: 9 PARKER, SUITE 100 CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 949-923-4747 MAIL ADDRESS: STREET 1: 9 PARKER, SUITE 100 CITY: IRVINE STATE: CA ZIP: 92618 FORMER COMPANY: FORMER CONFORMED NAME: Inceptus Newco1 Inc. DATE OF NAME CHANGE: 20110923 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MILDER DONALD B CENTRAL INDEX KEY: 0001279660 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 SC 13G 1 d87152dsc13g.htm SC 13G SC 13G

 

 

United States

Securities and Exchange Commission

Washington, D.C. 20549

 

 

Schedule 13G

(Rule 13d-102)

Information to be Included in Statements Filed Pursuant

to § 240.13d-1(b), (c) and (d) and Amendments Thereto Filed

Pursuant to § 240.13d-2

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No.     )*

 

 

Inari Medical, Inc.

(Name of Issuer)

Common Stock, par value $0.001

(Title of Class of Securities)

45332Y109

(CUSIP Number)

December 31, 2020

(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

 

☐

Rule 13d-1(b)

 

☐

Rule 13d-1(c)

 

☒

Rule 13d-1(d)

 

*

The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 

 

 

CUSIP No. 45332Y109    Schedule 13G    Page 1 of 4

 

  1    

Names of Reporting Persons

 

Donald B. Milder

  2  

Check the Appropriate Box if a Member of a Group

(a)  ☐        (b)  ☐

 

  3  

SEC Use Only

 

  4  

Citizenship or Place of Organization

 

United States

Number of

Shares

Beneficially

Owned by

Each

Reporting

Person

With

    5     

Sole Voting Power

 

5,266,455

   6   

Shared Voting Power

 

0

   7   

Sole Dispositive Power

 

5,266,455

   8   

Shared Dispositive Power

 

0

  9    

Aggregate Amount Beneficially Owned by Each Reporting Person

 

5,266,455

10  

Check if the Aggregate Amount in Row (9) Excludes Certain Shares

 

Not Applicable

11  

Percent of Class Represented by Amount in Row 9

 

10.8%

12  

Type of Reporting Person

 

IN

CUSIP No. 45332Y109    Schedule 13G    Page 2 of 4

 

ITEM 1. (a)

Name of Issuer:

Inari Medical, Inc. (the “Issuer”).

 

  (b)

Address of Issuer’s Principal Executive Offices:

9 Parker, Suite 100, Irvine, CA 92618.

 

ITEM 2. (a)

Name of Person Filing:

This statement is filed on behalf of Donald B. Milder (the “Reporting Person”).

 

  (b)

Address or Principal Business Office:

The business address of the Reporting Person is c/o Inari Medical, Inc., 9 Parker, Suite 100, Irvine, CA 92618.

 

  (c)

Citizenship:

The Reporting Person is a citizen of the United States.

 

  (d)

Title of Class of Securities:

Common stock, par value $0.001 per share (“Common Stock”).

 

  (e)

CUSIP Number:

45332Y109

 

ITEM 3.

Not applicable.

 

ITEM 4.

Ownership.

The ownership information below represents beneficial ownership of shares of Common Stock as of December 31, 2020, based upon 48,710,821 shares of Common Stock outstanding as of November 6, 2020 based on the Issuer’s quarterly report on Form 10-Q filed with the Securities and Exchange Commission on November 12, 2020.

(a) Amount beneficially owned:

Consists of (i) 239,841 shares of Common Stock held directly by the Reporting Person and (ii) 5,026,614 shares of Common Stock held directly by Milder Community Property Trust, whereby the Reporting Person is the trustee.

CUSIP No. 45332Y109    Schedule 13G    Page 3 of 4

 

(b) Percent of class: 10.8%

(c) Number of shares as to which the person has:

 

  (i)

Sole power to vote or to direct the vote: 5,266,455

 

  (ii)

Shared power to vote or direct the vote: 0

 

  (iii)

Sole power to dispose or to direct the disposition of: 5,266,455

 

  (iv)

Shared power to dispose or to direct the disposition of: 0

 

ITEM 5.

Ownership of Five Percent or Less of a Class.

Not applicable.

 

ITEM 6.

Ownership of More than Five Percent on Behalf of Another Person.

Not applicable.

 

ITEM 7.

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company.

Not applicable.

 

ITEM 8.

Identification and Classification of Members of the Group.

Not applicable.

 

ITEM 9.

Notice of Dissolution of Group.

Not applicable.

 

ITEM 10.

Certification.

Not applicable.

CUSIP No. 45332Y109    Schedule 13G    Page 4 of 4

 

SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Date: February 8, 2021

 

Donald B. Milder
/s/ Donald B. Milder