Filing Details

Accession Number:
0001104659-12-011315
Form Type:
4
Zero Holdings:
No
Publication Time:
2012-02-21 15:20:33
Reporting Period:
2012-02-16
Filing Date:
2012-02-21
Accepted Time:
2012-02-21 15:20:33
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1145197 Insulet Corp "PODD" Surgical & Medical Instruments & Apparatus (3841) 043523891
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1181338 Md A Ross Jaffe C/O Versant Ventures
3000 Sand Hill Road, #4-210
Menlo Park CA 94025
Yes No No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Disposition 2012-02-16 598,380 $0.00 1,214,893 No 4 S Indirect Versant Venture Capital I, L.P.
Common Stock Disposition 2012-02-16 11,707 $0.00 23,768 No 4 S Indirect Versant Side Fund I, L.P.
Common Stock Acquisiton 2012-02-16 18,520 $0.00 18,520 No 4 J Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 S Indirect Versant Venture Capital I, L.P.
No 4 S Indirect Versant Side Fund I, L.P.
No 4 J Direct
Footnotes
  1. The Reporting Person is a managing member of Versant Ventures I, LLC ("VVI-LLC"), which is the general partner of each of Versant Side Fund I, L.P., Versant Venture Capital I, L.P., Versant Affiliates Fund I-A, L.P., and Versant Affiliates Fund I-B, L.P. (collectively, the "Versant Funds"). As such, the Reporting Person shares voting and investment power over the shares held by the Versant Funds and may be deemed to have indirect beneficial ownership of such shares. The Reporting Person disclaims beneficial ownership of such shares held by the Versant Funds, except to the extent of his proportionate pecuniary interest therein, if any.
  2. The shares are held by the Jaffe Family Trust dtd. 7/9/91 ("Jaffe Trust"). The shares were received in in-kind distributions of 17,349 shares from Versant Venture Capital I, L.P. and 1,171 shares by Versant Side Fund I, L.P. on February 16, 2012. The Reporting Person is a trustee and beneficiary of the Jaffe Trust.