0001209191-20-032409.txt : 20200527
0001209191-20-032409.hdr.sgml : 20200527
20200527183339
ACCESSION NUMBER: 0001209191-20-032409
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200527
FILED AS OF DATE: 20200527
DATE AS OF CHANGE: 20200527
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MILDER DONALD B
CENTRAL INDEX KEY: 0001279660
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39293
FILM NUMBER: 20916535
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
ISSUER:
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
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2020-05-27
0
0001531048
Inari Medical, Inc.
NARI
0001279660
MILDER DONALD B
C/O INARI MEDICAL, INC.
9 PARKER, SUITE 100
IRVINE
CA
92618
1
0
1
0
Common Stock
2020-05-27
4
P
0
239841
19.00
A
239841
D
Common Stock
2020-05-27
4
C
0
5033614
A
5033614
I
Milder Community Property Trust
Restricted Stock Unit
2020-05-27
4
A
0
8947
19.00
A
Common Stock
8947
8947
D
Series B Preferred Stock
2020-05-27
4
C
0
3591179
D
Common Stock
3591179
0
I
Milder Community Property Trust
Series C Preferred Stock
2020-05-27
4
C
0
1442435
D
Common Stock
1442435
0
I
Milder Community Property Trust
Upon the closing of the Issuer's initial public offering, each share of preferred stock automatically converted into shares of the Issuer's common stock on a one-for-one
basis.
The reporting person is a trustee of the Milder Community Property Trust DTD 11/7/91, as amended.
The restricted stock unit vests in three equal annual installments beginning on May 27, 2020.
/s/ Mitchell Hill, Attorney-in-Fact for Donald Milder
2020-05-27