0001209191-20-032399.txt : 20200527 0001209191-20-032399.hdr.sgml : 20200527 20200527182137 ACCESSION NUMBER: 0001209191-20-032399 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: Cooperatieve Gilde Healthcare IV U.A. CENTRAL INDEX KEY: 0001756335 STATE OF INCORPORATION: P7 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39293 FILM NUMBER: 20916510 BUSINESS ADDRESS: STREET 1: NEWTONLANN 51 CITY: UTRECHT STATE: P7 ZIP: 3508AB BUSINESS PHONE: 949-396-6322 MAIL ADDRESS: STREET 1: NEWTONLANN 51 CITY: UTRECHT STATE: P7 ZIP: 3508AB REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gilde Healthcare IV Management B.V. CENTRAL INDEX KEY: 0001757508 STATE OF INCORPORATION: P7 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39293 FILM NUMBER: 20916511 BUSINESS ADDRESS: STREET 1: NEWTONLAAN 91 CITY: UTRECHT STATE: P7 ZIP: 3584 BP BUSINESS PHONE: 949-396-6322 MAIL ADDRESS: STREET 1: NEWTONLAAN 91 CITY: UTRECHT STATE: P7 ZIP: 3584 BP REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gilde Healthcare Holding B.V. CENTRAL INDEX KEY: 0001420106 STATE OF INCORPORATION: P7 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39293 FILM NUMBER: 20916512 BUSINESS ADDRESS: STREET 1: NEWTONLAAN 91 STREET 2: PO BOX 85067 CITY: 3508 UTRECHT STATE: P7 ZIP: AB BUSINESS PHONE: 31(0)30-2192549 MAIL ADDRESS: STREET 1: NEWTONLAAN 91 STREET 2: PO BOX 85067 CITY: 3508 UTRECHT STATE: P7 ZIP: AB 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 0001756335 Cooperatieve Gilde Healthcare IV U.A. NEWTONLAAN 91 3584 BP UTRECHT P7 NETHERLANDS 0 0 1 0 0001757508 Gilde Healthcare IV Management B.V. NEWTONLAAN 91 3584 BP UTRECHT P7 NETHERLANDS 0 0 1 0 0001420106 Gilde Healthcare Holding B.V. NEWTONLAAN 91 3584 BP UTRECHT P7 NETHERLANDS 0 0 1 0 Common Stock 2020-05-27 4 P 0 342329 19.00 A 342329 I See footnote Common Stock 2020-05-27 4 C 0 7599350 A 7941679 I See footnote Series C Preferred Stock 2020-05-27 4 C 0 7599350 D Common Stock 7599350 0 I See footnote All securities reported are held of record by Cooperatieve Gilde Healthcare IV U.A. ("Gilde"). Gilde is managed by Gilde Healthcare IV Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of Management and Holding may be deemed to have voting, investment and dispositive power with respect to the securities held by Gilde. Each of Management and Holding disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities, except to the extent of their respective pecuniary interests therein. 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. Cooperatieve Gilde Healthcare IV U.A., By: /s/ Mitchell Hill, Name: Mitchell Hill, Title: Attorney-in-Fact 2020-05-27 Gilde Healthcare IV Management B.V., By: /s/ Mitchell Hill, Name: Mitchell Hill, Title: Attorney-in-Fact 2020-05-27 Gilde Healthcare Holding B.V., By: /s/ Mitchell Hill, Name: Mitchell Hill, Title: Attorney-in-Fact 2020-05-27