SEC Form 4 · accession 0001140361-17-038916

Restoration Robotics, Inc. · HAIR

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Oct 16, 2017

Accepted (ET)

Oct 17, 2017 · 6:38 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001409269

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Oct 16, 2017	C	1,538,461	—	A	1,538,461	I	See Footnote
Common Stock^F1,F2	Oct 16, 2017	C	1,647,297	—	A	3,185,758	I	See Footnote
Common Stock^F2	Oct 16, 2017	C	170,028	$7.00	A	3,355,786	I	See Footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series B Preferred Stock^F1,F2,F3	—	Oct 16, 2017	C	1,538,461	D	—	—	Common Stock	1,538,461	I
Series C Preferred Stock^F1,F2,F3	—	Oct 16, 2017	C	1,647,297	D	—	—	Common Stock	1,647,297	I
Convertible Promissory Note^F4,F2	$7.00	Oct 16, 2017	C	—	D	—	—	Common Stock	170,028	I

F1The shares of the Issuer's Preferred Stock automatically converted into shares of the Issuer's Common Stock, for no additional consideration, on a 1:1 basis immediately prior to the consummation of the Issuer's Initial Public Offering (the "IPO").
F2The shares are directly held by InterWest Partners IX, LP ("IWP IX"). InterWest Management Partners IX, LLC ("IWM LLC"), as the general partner of IWP IX, may be deemed to beneficially own the shares held by IWP IX. The Reporting Person is a managing director of IWM LLC, and as such may be deemed to beneficially own the shares held by IWP IX. The Reporting Person disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein.
F3The expiration date is not relevant to the conversion of these securities.
F4The amount reported in column 5 is the principal amount of Reporting Person's Convertible Promissory Note (the "Note"). The outstanding principal and accrued interest of the Note automatically converted into shares of the Issuer's Common Stock at the price per share available to the public as set forth in the final prospectus related to the Issuer's IPO upon the closing of the IPO.