0001628280-21-018794.txt : 20210916 0001628280-21-018794.hdr.sgml : 20210916 20210916183903 ACCESSION NUMBER: 0001628280-21-018794 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210914 FILED AS OF DATE: 20210916 DATE AS OF CHANGE: 20210916 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Krummel Thomas M CENTRAL INDEX KEY: 0001495768 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40797 FILM NUMBER: 211258873 MAIL ADDRESS: STREET 1: C/O CALIFORNIA WATER SERVICE GROUP STREET 2: 1720 N. FIRST STREET CITY: SAN JOSE STATE: CA ZIP: 95118 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PROCEPT BioRobotics Corp CENTRAL INDEX KEY: 0001588978 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 260199180 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 900 ISLAND DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94065 BUSINESS PHONE: 650-232-7200 MAIL ADDRESS: STREET 1: 900 ISLAND DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94065 4 1 wf-form4_163183193044457.xml FORM 4 X0306 4 2021-09-14 0 0001588978 PROCEPT BioRobotics Corp PRCT 0001495768 Krummel Thomas M C/O PROCEPT BIOROBOTICS CORPORATION 900 ISLAND DRIVE REDWOOD CITY CA 94065 1 0 0 0 Stock Option (Right to Buy) 25.0 2021-09-14 4 A 0 10308 0 A 2031-09-14 Common Stock 10308.0 10308 D Option will vest and become exercisable in full on earlier of September 14, 2022 or the day prior to the date of the 2022 annual meeting of the stockholders, subject to the director's continued service. /s/ Alaleh Nouri, Attorney-in-Fact for Thomas M. Krummell 2021-09-16 EX-24 2 ex-24.htm THOMAS KRUMMELL POA
POWER OF ATTORNEY


With respect to holdings of and transactions in securities issued by Procept Biorobotircs Corporation (the "Company"), the undersigned hereby constitutes and appoints the individuals named on Schedule A attached hereto and as may be amended from time to time, or any of them signing singly, with full power of substitution and resubstitution, to act as the undersigned's true and lawful attorney-in-fact to:

1.    prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the United States Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain and/or regenerate codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended, or any rule or regulation of the SEC;

2.    execute for and on behalf of the undersigned, Forms 3, 4, and 5 in accordance with Section 16 of the Securities Exchange Act of 1934, as amended, and the rules thereunder;

3.    do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and

4.    take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-facts discretion.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution and resubstitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorneys-in-fact substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted.

The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is any Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 1st day of June, 2021.

By:  /s/ Thomas M. Krummell

Name:      Thomas M. Krummell


Schedule A

Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and Resubstitution

1.    Kevin Waters
2.    Alaleh Nouri
3.    Jonathan Stone