Sec Form 4 Filing - GROSSMAN D KEITH @ Outset Medical, Inc. - 2020-09-17

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
GROSSMAN D KEITH
2. Issuer Name and Ticker or Trading Symbol
Outset Medical, Inc. [ OM]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
3052 ORCHARD DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
09/17/2020
(Street)
SAN JOSE, CA95134
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 09/17/2020 C 10,257 A 11,604 I ( 1 ) Held by The D. Keith and Hallie H. Grossman Family Living Trust ( 1 )
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Series C Redeemable Convertible Preferred Stock ( 2 ) 09/17/2020 C 38,588 ( 2 ) ( 2 ) Common Stock 4,885 $ 0 0 I ( 1 ) Held by The D. Keith and Hallie H. Grossman Family Living Trust ( 1 )
Series D Redeemable Convertible Preferred Stock ( 3 ) 09/17/2020 C 32,155 ( 3 ) ( 3 ) Common Stock 5,372 $ 0 0 I ( 1 ) Held by The D. Keith and Hallie H. Grossman Family Living Trust ( 1 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
GROSSMAN D KEITH
3052 ORCHARD DRIVE
SAN JOSE, CA95134
X
Signatures
/s/ LeeAnn Linck, attorney-in-fact for Donald Keith Grossman 09/17/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )These shares of common stock of the Issuer ("Shares") are held directly by The D. Keith and Hallie H. Grossman Family Living Trust, for which the reporting person and his spouse serve as trustees.
( 2 )The Series C redeemable convertible preferred stock automatically converted into Common Stock upon the closing of the IPO. Each share of Series C redeemable convertible preferred stock converted into approximately 0.1266 Shares. These shares had no expiration date.
( 3 )The Series D redeemable convertible preferred stock automatically converted into Common Stock upon the closing of the IPO. Each share of Series D redeemable convertible preferred stock converted into approximately 0.1671 Shares. These shares had no expiration 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).

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