SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Amzak Health Investors, LLC

(Last) (First) (Middle)
980 FEDERAL HIGHWAY, SUITE 315

(Street)
BOCA RATON FL 33432

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Inspire Medical Systems, Inc. [ INSP ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/07/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/07/2018 C 1,372,043 A (1) 1,372,043 D(2)
Common Stock 05/07/2018 P 125,000 A $16 1,497,043 D(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series F Convertible Preferred Stock (1) 05/07/2018 C 9,124,088 (1) (1) Common Stock 1,372,043 $0 0 D(2)
1. Name and Address of Reporting Person*
Amzak Health Investors, LLC

(Last) (First) (Middle)
980 FEDERAL HIGHWAY, SUITE 315

(Street)
BOCA RATON FL 33432

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Kazma Michael D

(Last) (First) (Middle)
980 FEDERAL HIGHWAY, SUITE 315

(Street)
BOCA RATON FL 33432

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Hove Anders D

(Last) (First) (Middle)
980 FEDERAL HIGHWAY, SUITE 315

(Street)
BOCA RATON FL 33432

(City) (State) (Zip)
Explanation of Responses:
1. Shares of Series F Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1504 conversion rate immediately prior to the closing of the Issuer's initial public offering for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Sixth Amended and Restated Certificate of Incorporation, as amended). These shares had no expiration date.
2. These shares are held of record by Amzak Health Investors, LLC ("Amzak Health"). Joyce Erony, a director of the Issuer, Michael D. Kazma, and Anders Hove are managers of Amzak Health and, as a result, have shared voting and dispositive power over the shares held by Amzak Health. Each of Ms. Erony and Mr. Hove disclaims beneficial ownership of the shares held by Amzak Health except to the extent of his or her proportionate pecuniary interest therein.
/s/ Richard Buchholz, as Attorney-in-Fact for Amzak Health Investors, LLC 05/09/2018
/s/ Richard Buchholz, as Attorney-in-Fact for Michael D. Kazma 05/09/2018
/s/ Richard Buchholz, as Attorney-in-Fact for Anders Hove 05/09/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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