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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Inspire Medical Systems, Inc. [ INSP ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 08/23/2023 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | 08/23/2023 | M | 938 | A | $71 | 107,769(1) | D | |||
Common Stock | 08/23/2023 | M | 15 | A | $42.15 | 107,784 | D | |||
Common Stock | 103,658 | I | By Trust(2) | |||||||
Common Stock | 20,641 | I | By Family Trust(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 | ||||||||
Stock Option (Right to Buy) | $71 | 08/23/2023 | M | 938 | (4) | 12/16/2029 | Common Stock | 938 | $0 | 64,062 | D | ||||
Stock Option (Right to Buy) | $42.15 | 08/23/2023 | M | 15 | (5) | 12/18/2028 | Common Stock | 15 | $0 | 51,913(6) | D | ||||
Stock Option (Right to Buy) | $42.15 | (5) | 12/17/2028 | Common Stock | 33,030 | 33,030 | I | See Footnote(7) | |||||||
Stock Option (Right to Buy) | $2.07 | (5) | 03/30/2024 | Common Stock | 113,698 | 113,698 | I | See Footnote(7) | |||||||
Stock Option (Right to Buy) | $0.94 | (5) | 03/31/2027 | Common Stock | 9,086 | 9,086 | I | See Footnote(7) | |||||||
Stock Option (Right to Buy) | $10.38 | (5) | 04/08/2028 | Common Stock | 63,490 | 63,490 | I | See Footnote(7) | |||||||
Stock Option (Right to Buy) | $10.38 | (5) | 04/08/2028 | Common Stock | 21,762 | 21,762 | D | ||||||||
Stock Option (Right to Buy) | $194.82 | (8) | 12/14/2030 | Common Stock | 43,200 | 43,200 | D | ||||||||
Stock Option (Right to Buy) | $227.53 | (9) | 02/11/2032 | Common Stock | 17,773 | 17,773 | D | ||||||||
Stock Option (Right to Buy) | $263.16 | (10) | 02/10/2033 | Common Stock | 20,439 | 20,439 | D |
Explanation of Responses: |
1. Includes 58 additional shares acquired under the Inspire Medical Systems, Inc. 2018 Employee Stock Purchase Plan. |
2. Securities held by the Timothy P. Herbert 2018 Family Continuation Trust c/u the Timothy P. Herbert 2018 Grantor Retained Annuity Trust. |
3. Securities held by the Timothy P. Herbert 2013 Family Irrevocable GST Trust U/A/D November 27, 2013. |
4. The original grant of options to purchase 65,000 shares of common stock vested and became exercisable as to 25% of the underlying shares on the first anniversary of December 16, 2019 and the remaining 75% of the underlying shares have vested or will vest in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. |
5. The option is fully vested and exercisable. |
6. A portion of this award is now held by the Timothy P. Herbert 2013 Family Irrevocable GST Trust U/A/D November 27, 2013 and the total held directly by the Reporting Person has been updated accordingly. |
7. The Reporting Person previously reported this option grant as being directly owned, which is being updated herein to reflect that the current beneficial owner of all or a portion of the award is the Timothy P. Herbert 2013 Family Irrevocable GST Trust U/A/D November 27, 2013, over which the Reporting Person's spouse has investment control and the Reporting Person and his immediate family members have a pecuniary interest. |
8. The grant of options to purchase 43,200 shares of common stock vested and became exercisable as to 25% of the underlying shares on the first anniversary of December 14, 2020 and the remaining 75% of the underlying shares have vested or will vest in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. |
9. The grant of options to purchase 17,773 shares of common stock vested and became exercisable as to 25% of the underlying shares on the first anniversary of February 11, 2022 and the remaining 75% of the underlying shares have vested or will vest in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. |
10. The grant of options to purchase 20,439 shares of common stock vests and becomes exercisable as to 25% of the underlying shares on the first anniversary of February 10, 2023 and the remaining 75% of the underlying shares in 36 equal monthly installments thereafter, subject to the Reporting Person's continuous employment with the Issuer through the relevant vesting dates. |
Remarks: |
This Form 4 no longer reports securities held by the Margaret C. Herbert 2018 Family Irrevocable GST Trust because, subsequent to the Reporting Person's last Form 4, the Reporting Person is no longer considered the beneficial owner of securities held by such trust. The securities previously reported as being held by the Reporting Person's daughter are no longer reported in this Form 4 because the Reporting Person is no longer considered the beneficial owner of securities held. |
/s/ Bryan Phillips, Attorney-in-Fact for Timothy P. Herbert | 08/28/2023 | |
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |