UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 8-A
FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES
PURSUANT TO SECTION 12(b) OR 12(g) OF THE
SECURITIES EXCHANGE ACT OF 1934
INSULET CORPORATION
(Exact name of registrant as specified in its charter)
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Delaware
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04-3523891
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(State of incorporation or organization)
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(I.R.S. Employer Identification No.)
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9 Oak Park Drive
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Bedford, Massachusetts
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01730
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(Address of principal executive offices)
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(Zip Code)
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Securities to be registered pursuant to Section 12(b) of the Act:
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Title of each class
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Name of each exchange on which
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to be so registered
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each class is to be registered
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Common Stock, $0.001 par value per share
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The NASDAQ Stock Market LLC
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If this form relates to the registration of a class of securities pursuant
to Section 12(b) of the Exchange Act and is effective pursuant to General
Instruction A.(c), please check the following box.
þ
If this form relates to the registration of a class of securities pursuant
to Section 12(g) of the Exchange Act and is effective pursuant to General
Instruction A.(d), please check the following box.
o
Securities Act registration statement file number to which this form relates:
333-140694
(If
applicable)
Securities to be registered pursuant to Section 12(g) of the Act:
(Title of class)
INFORMATION REQUIRED IN REGISTRATION STATEMENT
Item 1. Description of Registrant’s Securities to be Registered.
For a description of the Registrant’s common stock to be registered hereunder, reference is
made to the information set forth under the heading “Description of Capital Stock” in the
Registrant’s Registration Statement on Form S-1, as amended (File No. 333-140694) (the
“Registration Statement”), filed under the Securities Act of 1933, as amended (the “Securities
Act”), which information is hereby incorporated by reference.
Item 2. Exhibits.
Under the Instructions as to exhibits with respect to Form 8-A, no exhibits are
required to be filed, because no other securities of the Registrant are registered on The NASDAQ
Stock Market LLC and the securities registered hereby are not being registered pursuant to Section
12(g) of the Exchange Act.
SIGNATURES
Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the
registrant has duly caused this registration statement to be signed on its behalf by the
undersigned, thereto duly authorized.
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Insulet Corporation
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Date: May 11, 2007
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By:
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/s/ Duane DeSisto
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President, Chief Executive Officer and Director
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