0001209191-20-031433.txt : 20200521 0001209191-20-031433.hdr.sgml : 20200521 20200521182108 ACCESSION NUMBER: 0001209191-20-031433 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200521 FILED AS OF DATE: 20200521 DATE AS OF CHANGE: 20200521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hykes Andrew CENTRAL INDEX KEY: 0001806431 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39293 FILM NUMBER: 20903221 MAIL ADDRESS: STREET 1: C/O INARI MEDICAL, INC. STREET 2: 9 PARKER AVENUE, SUITE 100 CITY: IRVINE STATE: CA ZIP: 92618 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-05-21 0 0001531048 Inari Medical, Inc. NARI 0001806431 Hykes Andrew C/O INARI MEDICAL, INC. 9 PARKER, SUITE 100 IRVINE CA 92618 0 1 0 0 Chief Commercial Officer Common Stock 301371 D Series C Preferred Stock Common Stock 13570 D Stock Option 0.4284 2028-05-03 Common Stock 221100 D Stock Option 0.457 2029-03-12 Common Stock 16719 D Stock Option 6.4546 2030-01-17 Common Stock 16719 D Restricted Stock Unit 0.00 Common Stock 430517 D Each share of the Issuer's preferred stock is convertible on a one-to-one basis into shares of the Issuer's common stock at the holder's election and has no expiration date. The preferred stock will automatically convert into common stock upon the closing of the Issuer's initial public offering. The option is vested and exercisable as to 115,156 shares, and the remaining shares will vest and become exercisable in equal monthly installments until May 3, 2022. The option is vested and exercisable as to 5,573 shares, and the remaining shares will vest and become exercisable in equal monthly installments until March 12, 2023. The option is vested and exercisable as to 1,393 shares, and the remaining shares will vest and become exercisable in equal monthly installments until January 17, 2024. The restricted stock unit vests on March 12, 2023. Exhibit 24 - Power of Attorney. /s/ Mitchell Hill, Attorney-in-Fact for Andrew Hykes 2020-05-21 EX-24.3_917017 2 poa.txt POA DOCUMENT POWER OF ATTORNEY With respect to holdings of and transactions in securities issued by Inari Medical, Inc. (the "Company"), the undersigned hereby constitutes and appoints the individual or 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-fact's 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 the 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 20th day of April, 2020. Signature: /s/ Andrew Hykes Print Name: Andrew Hykes Schedule A Individual Appointed as Attorney-in-Fact with Full Power of Substitution and Resubstitution 1. William Hoffman 2. Mitchell Hill