0001209191-23-050227.txt : 20230920 0001209191-23-050227.hdr.sgml : 20230920 20230920201125 ACCESSION NUMBER: 0001209191-23-050227 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230918 FILED AS OF DATE: 20230920 DATE AS OF CHANGE: 20230920 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mehta Apoorva CENTRAL INDEX KEY: 0001991547 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41805 FILM NUMBER: 231267585 MAIL ADDRESS: STREET 1: C/O MAPLEBEAR INC. STREET 2: 50 BEALE STREET, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Maplebear Inc. CENTRAL INDEX KEY: 0001579091 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 460723335 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 50 BEALE STREET, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: (888) 246-7822 MAIL ADDRESS: STREET 1: 50 BEALE STREET, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 4 1 doc4.xml FORM 4 SUBMISSION X0508 4 2023-09-18 0 0001579091 Maplebear Inc. CART 0001991547 Mehta Apoorva C/O MAPLEBEAR INC. 50 BEALE STREET, SUITE 600 SAN FRANCISCO CA 94105 0 0 1 0 0 Non-Voting Common Stock 2023-09-18 4 A 0 4141 0.00 A 4141 D Common Stock 24109751 I See footnote All outstanding shares of non-voting common stock and shares of non-voting common stock underlying outstanding equity securities will convert into an equivalent number of shares of the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering. Consists of previously granted restricted stock units ("RSUs") for which the service-based vesting condition has been previously satisfied and the liquidity event-based vesting condition was satisfied upon the effectiveness of the registration statement on Form S-1 filed by the Issuer in connection with the Issuer's initial public offering. The shares are held by The Apoorva Mehta Revocable Trust, dated June 20, 2018, of which the reporting person is trustee and has sole voting and dispositive power. /s/ Bradley Libuit, Attorney-in-fact 2023-09-20