0001209191-23-050508.txt : 20230925 0001209191-23-050508.hdr.sgml : 20230925 20230925185211 ACCESSION NUMBER: 0001209191-23-050508 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230921 FILED AS OF DATE: 20230925 DATE AS OF CHANGE: 20230925 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simo Fidji CENTRAL INDEX KEY: 0001962727 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41805 FILM NUMBER: 231276893 MAIL ADDRESS: STREET 1: C/O SHOPIFY, INC. STREET 2: 151 O'CONNOR STREET, GROUND FLOOR CITY: OTTAWA STATE: Z4 ZIP: K2P 2L8 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 2023-09-21 0 0001579091 Maplebear Inc. CART 0001962727 Simo Fidji C/O MAPLEBEAR INC. 50 BEALE STREET, SUITE 600 SAN FRANCISCO CA 94105 1 1 0 0 President and CEO 0 Non-Voting Common Stock 2023-09-21 4 J 0 939163 D 0 D Common Stock 2023-09-21 4 J 0 939163 A 939163 D Non-Voting Common Stock 2023-09-21 4 J 0 33333 D 0 I See footnote Common Stock 2023-09-21 4 J 0 33333 A 33333 I See footnote Performance Stock Units 2023-09-21 4 J 0 1200000 0.00 D 2027-12-07 Non-Voting Common Stock 1200000 0 D Performance Stock Units 2023-09-21 4 J 0 1200000 0.00 A 2027-12-07 Common Stock 1200000 1200000 D Each share of Non-Voting Common Stock was automatically converted into one share of Common Stock in connection with the closing of the Issuer's initial public offering of common stock. The shares are held by the Djanga Trust. Each performance right represents a contingent right to receive one share of the Issuer's Common Stock. The initial performance condition was met, and 300,000 shares vested, upon the effectiveness of the Issuer's initial public offering and the remaining rights will vest upon the achievement of specified market valuations. /s/ Bradley Libuit, Attorney-in-fact 2023-09-25