# EDGAR Filing Document

**Accession Number:** 0001699350
**File Stem:** 0001641172-25-021629
**Filing Date:** 2025-7
**Character Count:** 10391
**Document Hash:** 43d05501909f4cf71531da9adeac6349
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001641172-25-021629.hdr.sgml**: 20250730

**ACCESSION NUMBER**: 0001641172-25-021629

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20250730

**FILED AS OF DATE**: 20250730

**DATE AS OF CHANGE**: 20250730

**REPORTING-OWNER**: 

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

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42771
- **FILM NUMBER:** 251169040

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

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** SHOULDER INNOVATIONS, INC.
- **CENTRAL INDEX KEY:** 0001699350
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **ORGANIZATION NAME:** 08 Industrial Applications and Services
- **EIN:** 270538764
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 13827 PORT SHELDON STREET
- **CITY:** HOLLAND
- **STATE:** MI
- **ZIP:** 49424
- **BUSINESS PHONE:** 616-566-0286

**MAIL ADDRESS:**
- **STREET 1:** 13827 PORT SHELDON STREET
- **CITY:** HOLLAND
- **STATE:** MI
- **ZIP:** 49424

## Exhibit 24.1

**Exhibit 24.1**

**Power of Attorney**

With respect to holdings of and transactions in securities issued by Shoulder Innovations, Inc. (the "Company"), the undersigned hereby constitutes and appoints the individuals named on <u>Schedule A</u> attached hereto and as may be amended from time to time, or any of them signing singly, with full power of substitution and resubstitution, to act as the undersigned's true and lawful attorney-in-fact to:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;1. prepare,
 execute in the undersigned's name and on the undersigned's behalf, and submit
 to the United States Securities and Exchange Commission (the "SEC") a Form ID,
 including amendments thereto, and any other documents necessary or appropriate to obtain
 and/or regenerate codes and passwords enabling the undersigned to make electronic filings
 with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934,
 as amended, or any rule or regulation of the SEC;

2. execute
 for and on behalf of the undersigned, Forms 3, 4, and 5 in accordance with Section 16 of
 the Securities Exchange Act of 1934, as amended, and the rules thereunder;

3. do
 and perform any and all acts for and on behalf of the undersigned which may be necessary
 or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment
 or amendments thereto, and timely file such form with the SEC and any stock exchange or similar
 authority; and

4. take
 any other action of any type whatsoever in connection with the foregoing which, in the opinion
 of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required
 by, the undersigned, it being understood that the documents executed by such attorney-in-fact
 on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and
 shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-facts
 discretion.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution and resubstitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorneys-in-fact substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted.

The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is any Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended.

This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 19th day of March, 2025.

---

| | |
|:---|:---|
| By: | /s/ Casey Tansey |
| Name: | Casey M. Tansey |

---

<u>Schedule A</u>

Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and Resubstitution

1. Robert
 Ball

2. Jeff
 Points

3. Matt
 Ahearn

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

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] 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**<sup>*</sup><br>Tansey Casey M<br><sub>(Last) (First) (Middle)</sub><br>C/O SHOULDER INNOVATIONS, INC.<br>1535 STEELE AVENUE SW, SUITE B<br><sub>(Street)</sub><br>GRAND RAPIDS, MI 49507<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>SHOULDER INNOVATIONS, INC. [ SI ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2025-07-30 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director   [X] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<br>_ _ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Series C Convertible Preferred Stock | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 1096971 | <sup>(1)</sup> | I | See Footnotes<sup>(2)(3)</sup> |
| Series D Convertible Preferred Stock | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 521498 | <sup>(1)</sup> | I | See Footnotes<sup>(2)(3)</sup> |
| Series E Convertible Preferred Stock | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 1074652 | <sup>(1)</sup> | I | See Footnotes<sup>(2)(3)</sup> |

---

### Footnotes:

(1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer will automatically convert into shares of Common Stock on a one-for-0.052410901 basis. The shares of preferred stock have no expiration date.

(2) Consists of (i) 1,043,988 shares of Common Stock underlying Series C Preferred Stock, 496,309 shares of Common Stock underlying Series D Preferred Stock and 146,106 shares of Common Stock underlying Series E Preferred Stock held by U.S. Venture Partners XII, L.P. ("USVP XII"); (ii) 52,983 shares of Common Stock underlying Series C Preferred Stock, 25,189 shares of Common Stock underlying Series D Preferred Stock, and 7,415 shares of Common Stock underlying Series E Preferred Stock held by U.S. Venture Partners XII-A, L.P ("USVP XII-A"); and (iii) 921,131 shares of Common Stock underlying Series E Preferred Stock held by U.S. Venture Partners Select Fund I, L.P. on its own behalf and as a nominee for U.S. Venture Partners Select Fund I-A, L.P. ("USVP Select").

(3) Presidio Management Group XII, L.L.C. ("PMG XII") is the general partner of USVP XII and USVP XII-A and has sole voting and dispositive power with respect to the shares held by USVP XII and USVP XII-A. The Reporting Person, Steven M. Krausz, Richard W. Lewis, Jonathan D. Root and Dafina Toncheva are the managing members of PMG XII, and share voting and dispositive power with respect to the shares held by USVP XII and USVP XII-A. Presidio Management Group Select Fund I, L.L.C. ("PMG Select") is the general partner of USVP Select and has sole voting and dispositive power with respect to the shares held by USVP Select. The Reporting Person, Richard W. Lewis, Jonathan D. Root and Dafina Toncheva are the managing members of PMG Select and share voting and dispositive power with respect to the shares held by USVP Select. Each of the managing members of PMG XII and PMG Select disclaims beneficial ownership of such holdings, except to the extent of their pecuniary interest in the shares.

**Remarks:**
Exhibit 24.1 - Power of Attorney

**Signature:** /s/ Jeffrey S. Points, as Attorney-in-Fact  
**Date:** 2025-07-30

### 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.**