0000899243-21-011699.txt : 20210315 0000899243-21-011699.hdr.sgml : 20210315 20210315190626 ACCESSION NUMBER: 0000899243-21-011699 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210311 FILED AS OF DATE: 20210315 DATE AS OF CHANGE: 20210315 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Nielsen Kirk G. CENTRAL INDEX KEY: 0001523522 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39293 FILM NUMBER: 21743042 BUSINESS ADDRESS: BUSINESS PHONE: 650-233-7877 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 2021-03-11 0 0001531048 Inari Medical, Inc. NARI 0001523522 Nielsen Kirk G. C/O INARI MEDICAL, INC. 9 PARKER, SUITE 100 IRVINE CA 92618 1 0 0 0 Common Stock 2021-03-11 4 J 0 570957 0.00 D 0 I See footnote Common Stock 2021-03-11 4 J 0 147021 0.00 A 147021 I See footnote Common Stock 2021-03-11 4 J 0 147021 0.00 D 0 I See footnote Common Stock 2021-03-11 4 J 0 7955 0.00 A 46526 D Common Stock 2021-03-11 4 J 0 3596 0.00 D 0 I See footnote Common Stock 2021-03-12 4 S 0 206 120.00 D 46320 D Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Venture Capital IV, L.P. ("Versant IV") to its partners. Shares held by Versant IV. Versant Ventures IV, LLC ("Versant Ventures IV GP") is the general partner of Versant IV. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant IV; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein. Represents a change in the form of ownership of Versant Ventures IV GP by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant IV. Shares held by Versant Ventures IV GP. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Ventures IV GP; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein. Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Ventures IV GP to its members. Represents a change in the form of ownership of the Reporting Person by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant Ventures IV GP. Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Side Fund IV, L.P. ("Versant Side Fund") to its partners. Shares held by Versant Side Fund. Versant Ventures IV GP is the general partner of Versant Side Fund. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Side Fund; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein. /s/ Robin L. Praeger, Attorney-in-Fact for Kirk Nielsen 2021-03-15