0001104659-23-109451.txt : 20231016 0001104659-23-109451.hdr.sgml : 20231016 20231016195336 ACCESSION NUMBER: 0001104659-23-109451 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231012 FILED AS OF DATE: 20231016 DATE AS OF CHANGE: 20231016 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Herbert Timothy P. CENTRAL INDEX KEY: 0001737136 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38468 FILM NUMBER: 231328260 MAIL ADDRESS: STREET 1: C/O INSPIRE MEDICAL SYSTEMS, INC. STREET 2: 9700 63RD AVENUE NORTH, SUITE 200 CITY: MAPLE GROVE STATE: MN ZIP: 55369 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Inspire Medical Systems, Inc. CENTRAL INDEX KEY: 0001609550 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 261377674 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5500 WAYZATA BLVD STREET 2: SUITE 1600 CITY: GOLDEN VALLEY STATE: MN ZIP: 55416 BUSINESS PHONE: 763-957-5037 MAIL ADDRESS: STREET 1: 5500 WAYZATA BLVD STREET 2: SUITE 1600 CITY: GOLDEN VALLEY STATE: MN ZIP: 55416 4 1 tm2328548-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2023-10-12 0 0001609550 Inspire Medical Systems, Inc. INSP 0001737136 Herbert Timothy P. C/O INSPIRE MEDICAL SYSTEMS, INC. 5500 WAYZATA BLVD., SUITE 1600 GOLDEN VALLEY MN 55416 1 1 0 0 CEO and President 0 Common Stock 2023-10-12 4 M 0 21762 10.38 A 128413 I By LLC Common Stock 2023-10-12 4 M 0 63490 10.38 A 80907 I By Family Trust Common Stock 2023-10-12 4 M 0 113698 2.07 A 194605 I By Family Trust Common Stock 2023-10-12 4 M 0 9086 0.94 A 203691 I By Family Trust Common Stock 2023-10-12 4 F 0 10758 147.88 D 117655 I By LLC Common Stock 2023-10-12 4 F 0 31376 147.88 D 172315 I By Family Trust Common Stock 2023-10-12 4 F 0 52411 148.02 D 119804 I By Family Trust Common Stock 2023-10-12 4 F 0 4175 147.78 D 115629 I By Family Trust Common Stock 1133 D Common Stock 103658 I By Trust Stock Option (Right to Buy) 10.38 2023-10-12 4 M 0 21762 0 D 2028-04-08 Common Stock 21762 0 I By LLC Stock Option (Right to Buy) 10.38 2023-10-12 4 M 0 63490 0 D 2028-04-08 Common Stock 63490 0 I By Family Trust Stock Option (Right to Buy) 2.07 2023-10-12 4 M 0 113698 0 D 2024-03-30 Common Stock 113698 0 I By Family Trust Stock Option (Right to Buy) 0.94 2023-10-12 4 M 0 9086 0 D 2027-03-31 Common Stock 9086 0 I By Family Trust Securities held by the TPH 2022 LLC. Securities held by the Timothy P. Herbert 2013 Family Irrevocable GST Trust U/A/D November 27, 2013. Reflects the payment of the relevant exercise price and tax liability incident to the exercise of options by the withholding of common stock. Securities held by the Timothy P. Herbert 2018 Family Continuation Trust c/u the Timothy P. Herbert 2018 Grantor Retained Annuity Trust. The option is fully vested and exercisable. /s/ Bryan Phillips, Attorney-in-Fact for Timothy P. Herbert 2023-10-16