SEC Form 4 · accession 0001104659-18-031861
Inspire Medical Systems, Inc. · INSP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jerry C Griffin
Director
Period of report
May 2, 2018
Accepted (ET)
May 9, 2018 · 9:16 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001609550
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | May 7, 2018 | C | 7,026 | — | A | 47,551 | D | |
| Common StockF2 | May 7, 2018 | C | 811 | — | A | 48,362 | D | |
| Common StockF1 | May 7, 2018 | C | 8,050 | — | A | 56,412 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series D Convertible Preferred StockF1 | — | May 7, 2018 | C | 46,729 | D | — | — | Common Stock | 7,026 | 0 | D |
| Series E Convertible Preferred StockF2 | — | May 7, 2018 | C | 4,695 | D | — | — | Common Stock | 811 | 0 | D |
| Series F Convertible Preferred StockF1 | — | May 7, 2018 | C | 53,535 | D | — | — | Common Stock | 8,050 | 0 | D |
| Employee Stock Option (right to buy)F3 | $16.00 | May 2, 2018 | A | 17,296 | A | — | May 2, 2028 | Common Stock | 17,296 | 17,296 | D |
Explanation of responses
- F1Shares of Series D and Series F Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1504 conversion rate immediately prior to the closing of the Issuer's initial public offering ("IPO") for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Sixth Amended and Restated Certificate of Incorporation (as amended, the "Certificate of Incorporation")). These shares had no expiration date.
- F2Shares of Series E Convertible Preferred Stock automatically converted into shares of the Issuer's Common Stock at a 1-for-0.1728 conversion rate immediately prior to the closing of the Issuer's IPO for no additional consideration (subject to the payment of cash in lieu of any fractional shares in accordance with the Issuer's Certificate of Incorporation). These shares had no expiration date.
- F3The option vests and becomes exercisable on May 2, 2019, subject to the Reporting Person's continuous service to the Issuer through such date. The option was erroneously included on the Reporting Person's Form 3 filed on May 2, 2018.