# EDGAR Filing Document

**Accession Number:** 0001474322
**File Stem:** 0001415889-25-020276
**Filing Date:** 2025-7
**Character Count:** 12716
**Document Hash:** 5d20a40780d17f45bf58a949b45e0033
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001415889-25-020276.hdr.sgml**: 20250724

**ACCESSION NUMBER**: 0001415889-25-020276

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250724

**FILED AS OF DATE**: 20250724

**DATE AS OF CHANGE**: 20250724

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Tansey Casey M
- **CENTRAL INDEX KEY:** 0001474322

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42756
- **FILM NUMBER:** 251148283

**MAIL ADDRESS:**
- **STREET 1:** 1460 EL CAMINO REAL STE 100
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** U.S. Venture Partners XII, L.P.
- **CENTRAL INDEX KEY:** 0001734819

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42756
- **FILM NUMBER:** 251148284

**BUSINESS ADDRESS:**
- **STREET 1:** 1460 EL CAMINO REAL, SUITE 100
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
- **BUSINESS PHONE:** (650) 854-9080

**MAIL ADDRESS:**
- **STREET 1:** 1460 EL CAMINO REAL, SUITE 100
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Presidio Management Group XII, L.L.C.
- **CENTRAL INDEX KEY:** 0001734820

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42756
- **FILM NUMBER:** 251148285

**BUSINESS ADDRESS:**
- **STREET 1:** 1460 EL CAMINO REAL, SUITE 100
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
- **BUSINESS PHONE:** (650) 854-9080

**MAIL ADDRESS:**
- **STREET 1:** 1460 EL CAMINO REAL, SUITE 100
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** CARLSMED, INC.
- **CENTRAL INDEX KEY:** 0001794546
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **ORGANIZATION NAME:** 08 Industrial Applications and Services
- **EIN:** 831081863
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 1800 ASTON AVENUE
- **STREET 2:** SUITE 100
- **CITY:** CARLSBAD
- **STATE:** CA
- **ZIP:** 92008
- **BUSINESS PHONE:** 858-295-9290

**MAIL ADDRESS:**
- **STREET 1:** 1800 ASTON AVENUE
- **STREET 2:** SUITE 100
- **CITY:** CARLSBAD
- **STATE:** CA
- **ZIP:** 92008

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Presidio Management Group XII, L.L.C.<br><sub>(Last) (First) (Middle)</sub><br>C/O U.S. VENTURE PARTNERS<br>1460 EL CAMINO REAL, SUITE 100<br><sub>(Street)</sub><br>MENLO PARK, CA 94025<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-07-24 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>CARLSMED, INC. [ CARL ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>U.S. Venture Partners XII, L.P.<br><sub>(Last) (First) (Middle)</sub><br>1460 EL CAMINO REAL, SUITE 100<br><sub>(Street)</sub><br>MENLO PARK, CA 94025<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-07-24 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>CARLSMED, INC. [ CARL ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Tansey Casey M<br><sub>(Last) (First) (Middle)</sub><br>1460 EL CAMINO REAL, SUITE 100<br><sub>(Street)</sub><br>MENLO PARK, CA 94025<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-07-24 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>CARLSMED, INC. [ CARL ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2025-07-24 |  | C |  | 2948794 | A | <sup>(1)</sup> | 2948794 | I | See footnote<sup>(2)(3)(4)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 825135 | A | <sup>(1)</sup> | 3773929 | I | See footnote<sup>(2)(3)(4)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 531877 | A | <sup>(1)</sup> | 4305806 | I | See footnote<sup>(2)(3)(4)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 149655 | A | <sup>(1)</sup> | 149655 | I | See footnote<sup>(3)(4)(5)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 41876 | A | <sup>(1)</sup> | 191531 | I | See footnote<sup>(3)(4)(5)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 26993 | A | <sup>(1)</sup> | 218524 | I | See footnote<sup>(3)(4)(5)</sup> |
| Common Stock | 2025-07-24 |  | C |  | 1117743 | A | <sup>(1)</sup> | 1117743 | I | See footnote<sup>(3)(4)(6)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Preferred Series A Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 2948794 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 2948794 | $0 | 0 | I | See footnotes<sup>(2)(3)(4)</sup> |
| Preferred Series B Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 825135 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 825135 | $0 | 0 | I | See footnotes<sup>(2)(3)(4)</sup> |
| Preferred Series C Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 531877 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 531877 | $0 | 0 | I | See footnotes<sup>(2)(3)(4)</sup> |
| Preferred Series A Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 149655 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 149655 | $0 | 0 | I | See footnotes<sup>(3)(4)(5)</sup> |
| Preferred Stock Series B | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 41876 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 41876 | $0 | 0 | I | See footnotes<sup>(3)(4)(5)</sup> |
| Preferred Series C Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 26993 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 26993 | $0 | 0 | I | See footnotes<sup>(3)(4)(5)</sup> |
| Preferred Series C Stock | <sup>(1)</sup> | 2025-07-24 |  | C |  |  | 1117743 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 1117743 | $0 | 0 | I | See footnotes<sup>(3)(4)(6)</sup> |

---

### Footnotes:

(1) These shares of preferred stock are reported after giving effect to the 1-for-5.58 reverse split of the Issuer's common and preferred stock effected on July 10, 2025 (the "Reverse Split"). Each share of Series A Preferred Stock, Series B Preferred Stock, and Series C Preferred Stock is convertible into one share of the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering. These shares are reported in Table II above on an as-converted 1-to-1 basis with no additional consideration and have no expiration date.

(2) Stock held by U.S. Venture Partners XII, L.P. ("USVP XII").

(3) Presidio Management Group XII, L.L.C ("PMG XII") is the general partner of USVP XII and U.S. Venture Partners XII-A, L.P. ("USVP XII-A", and together with USVP XII, the "USVP XII Funds"). Presidio Management Group Select Fund I, L.L.C ("PMG SFI", and, together with USVP XII, USVP XII-A, U.S. Venture Partners Select Fund I, L.P. ("USVP SFI"), U.S. Venture Partners Select Fund I-A, L.P. ("USVP SFI-A"), and PMG XII, "USVP") is the general partner of USVP SFI and USVP SFI-A. PMG XII and PMG SFI may be deemed to share voting and dispositive power over the stock held by USVP.

(4) Each of Jonathan D. Root, Richard W. Lewis, Dafina Toncheva and Steven M. Krausz, are managing members of PMG XII, who may be deemed to share voting and dispositive power over the reported securities held by the USVP XII Funds. In addition, Casey M. Tansey is the managing partner of PMG XII and may be deemed to share voting and dispositive power over the reported securities held by the USVP XII Funds.  Each such persons and entities disclaim beneficial ownership of the reported securities held by the USVP XII Funds, except to the extent of any pecuniary interest therein.

(5) Stock Held by USVP XII-A.

(6) Stock held by USVP SFI, on its own behalf and as nominee for USVP SFI-A.

**Signature:** /s/ Dale Holladay, Authorized Signatory on behalf of Presidio Management Group  
**Date:** 2025-07-24

**Signature:** /s/ Dale Holladay, Authorized Signatory on behalf of U.S. Venture Partners XII, L.P.  
**Date:** 2025-07-24

**Signature:** /s/ Dale Holladay, Attorney-in-Fact for Casey M. Tansey  
**Date:** 2025-07-24

### Remarks:

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.**