0001209191-23-050230.txt : 20230920 0001209191-23-050230.hdr.sgml : 20230920 20230920202524 ACCESSION NUMBER: 0001209191-23-050230 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: Sarafan Lily CENTRAL INDEX KEY: 0001736341 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41805 FILM NUMBER: 231267594 MAIL ADDRESS: STREET 1: C/O COUNSYL, INC. STREET 2: 180 KIMBALL WAY CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 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 0001736341 Sarafan Lily C/O MAPLEBEAR INC. 50 BEALE STREET, SUITE 600 SAN FRANCISCO CA 94105 1 0 0 0 0 Non-Voting Common Stock 2023-09-18 4 A 0 12033 0.00 A 12033 D 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 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. Certain of the RSUs remain subject to service-based vesting conditions. /s/ Bradley Libuit, Attorney-in-fact 2023-09-20