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