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