SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
ROOT JONATHAN D

(Last) (First) (Middle)
1460 EL CAMINO REAL
SUITE 100

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Inari Medical, Inc. [ NARI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/13/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/13/2021 J(1) 2,619,872 D (1) 0 I Directly owned by USVP X(2)
Common Stock 05/13/2021 J(1) 83,813 D (1) 0 I Directly owned by AFF X(2)
Common Stock 05/13/2021 J(1) 685,826 A (1) 685,826 I Directly owned by PMG X(3)
Common Stock 05/13/2021 J(1) 685,826 D (1) 0 I Directly owned by PMG X(4)
Common Stock 05/13/2021 J(1) 93,972 A (1) 521,864 D(5)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Represents a pro-rata in-kind distribution of the Issuer's common stock, and not a purchase or sale, without additional consideration to their respective partners, members and assignees, as applicable.
2. Represents a pro-rata in-kind distribution of the Issuer's common stock held directly by each of U.S. Venture Partners X, L.P. ("USVP X") and USVP X Affiliates Fund L.P. ("AFF X" and, together with USVP X, the "USVP X Funds"), without additional consideration, to its partners. Presidio Management Group X, L.L.C. ("PMG X") is the general partner of each of the USVP X Funds and may be deemed to have sole voting and dispositive power over the securities held by the USVP X Funds. The Reporting Person, a director of the Issuer, is a managing member of PMG X with additional rights with respect to such shares, and deemed to have sole voting and dispositive power over the reported securities held by the USVP X Funds, and disclaims beneficial ownership of such securities, except to the extent of any pecuniary interest therein.
3. Represents a pro-rata in-kind distribution of the Issuer's common stock to PMG X from each of the USVP X Funds, without additional consideration. The Reporting Person, a director of the Issuer, is a managing member of PMG X with additional rights with respect to the shares, and deemed to have sole voting and dispositive power over the reported securities held by PMG X, and disclaims beneficial ownership of such securities, except to the extent of any pecuniary interest therein.
4. Represents a pro-rata in-kind distribution of the Issuer's common stock held directly by PMG X, without additional consideration to its members (the "PMG Distribution"). The Reporting Person, a director of the Issuer, is a managing member of PMG X with additional rights with respect to the shares, and may be deemed to have sole voting and dispositive power over the reported securities held by PMG X, and disclaims beneficial ownership of such securities held by PMG X, except to the extent of any pecuniary interest therein.
5. Represents a change in the form of ownership from indirect to direct by virtue of the receipt of shares in the PMG X Distribution. Shares are held directly by the Reporting Person.
Dale Holladay, Attorney in Fact for the Reporting Person 05/17/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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