0001209191-15-009483.txt : 20150204 0001209191-15-009483.hdr.sgml : 20150204 20150204165842 ACCESSION NUMBER: 0001209191-15-009483 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150203 FILED AS OF DATE: 20150204 DATE AS OF CHANGE: 20150204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SV LIFE SCIENCES FUND IV, L.P. CENTRAL INDEX KEY: 0001367381 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576246 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: SV LIFE SCIENCES FUND IV LP DATE OF NAME CHANGE: 20060623 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III STRATEGIC PARTNERS, L.P. CENTRAL INDEX KEY: 0001233226 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576249 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III STRATEGIC PARTNERS L P DATE OF NAME CHANGE: 20030515 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III CO-INVESTMENT, L.P. CENTRAL INDEX KEY: 0001233315 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576250 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III CO INVESTMENT L P DATE OF NAME CHANGE: 20030515 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III (GP), L.P. CENTRAL INDEX KEY: 0001630790 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576252 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: (617) 367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ILSF III, LLC CENTRAL INDEX KEY: 0001630791 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576253 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: (617) 367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ENTELLUS MEDICAL INC CENTRAL INDEX KEY: 0001374128 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 204627978 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3600 HOLLY LANE NORTH STREET 2: SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 BUSINESS PHONE: 763-463-1595 MAIL ADDRESS: STREET 1: 3600 HOLLY LANE NORTH STREET 2: SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SV LIFE SCIENCES FUND IV STRATEGIC PARTNERS, L. P. CENTRAL INDEX KEY: 0001392309 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576247 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: SV LIFE SCIENCES FUND IV STRATEGIC PARTNERS L P DATE OF NAME CHANGE: 20070307 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III (LP1), L.P. CENTRAL INDEX KEY: 0001172861 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576251 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 6173671590 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE, SUITE 3900 STREET 2: 201 WASHINGTON STREET CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: INTERNATIONAL LIFE SCIENCES FUND III LP1 LP DATE OF NAME CHANGE: 20020508 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SV Life Sciences Fund IV (GP), L.P. CENTRAL INDEX KEY: 0001422340 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576248 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SVLSF IV, LLC CENTRAL INDEX KEY: 0001422339 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 15576254 BUSINESS ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 BUSINESS PHONE: 617-367-8100 MAIL ADDRESS: STREET 1: ONE BOSTON PLACE STREET 2: 201 WASHINGTON STREET, SUITE 3900 CITY: BOSTON STATE: MA ZIP: 02108 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-02-03 0 0001374128 ENTELLUS MEDICAL INC ENTL 0001422339 SVLSF IV, LLC ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001630791 ILSF III, LLC ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001630790 INTERNATIONAL LIFE SCIENCES FUND III (GP), L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001172861 INTERNATIONAL LIFE SCIENCES FUND III (LP1), L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001233315 INTERNATIONAL LIFE SCIENCES FUND III CO-INVESTMENT, L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001233226 INTERNATIONAL LIFE SCIENCES FUND III STRATEGIC PARTNERS, L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001422340 SV Life Sciences Fund IV (GP), L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001392309 SV LIFE SCIENCES FUND IV STRATEGIC PARTNERS, L. P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 0001367381 SV LIFE SCIENCES FUND IV, L.P. ONE BOSTON PLACE, SUITE 3900 201 WASHINGTON STREET BOSTON MA 02108 0 0 1 0 Common Stock 2015-02-03 4 C 0 1311597 A 1311597 I By ILSF LP1 Common Stock 2015-02-03 4 C 0 15562 A 15562 I By ILSF Co-Invest Common Stock 2015-02-03 4 C 0 12529 A 12529 I By ILSF Strategic Common Stock 2015-02-03 4 C 0 1781615 A 1781615 I By Fund IV Common Stock 2015-02-03 4 P 0 308878 17.00 A 2090493 I By Fund IV Common Stock 2015-02-03 4 C 0 50581 A 50581 I By Fund IV Strategic Common Stock 2015-02-03 4 P 0 8769 17.00 A 59350 I By Fund IV Strategic Series A Convertible Preferred Stock 2015-02-03 4 C 0 1174836 D Common Stock 293709 0 I By ILSF LP1 Series A Convertible Preferred Stock 2015-02-03 4 C 0 13940 D Common Stock 3485 0 I By ILSF Co-Invest Series A Convertible Preferred Stock 2015-02-03 4 C 0 11224 D Common Stock 2806 0 I By ILSF Strategic Series B Convertible Preferred Stock 2015-02-03 4 C 0 2434052 D Common Stock 608513 0 I By ILSF LP1 Series B Convertible Preferred Stock 2015-02-03 4 C 0 28882 D Common Stock 7220 0 I By ILSF Co-Invest Series B Convertible Preferred Stock 2015-02-03 4 C 0 23254 D Common Stock 5813 0 I By ILSF Strategic Series C Convertible Preferred Stock 2015-02-03 4 C 0 1213172 D Common Stock 409375 0 I By ILSF LP1 Series C Convertible Preferred Stock 2015-02-03 4 C 0 14395 D Common Stock 4857 0 I By ILSF Co-Invest Series C Convertible Preferred Stock 2015-02-03 4 C 0 11590 D Common Stock 3910 0 I By ILSF Strategic Series D Convertible Preferred Stock 2015-02-03 4 C 0 2977679 D Common Stock 744419 0 I By Fund IV Series D Convertible Preferred Stock 2015-02-03 4 C 0 84539 D Common Stock 21134 0 I By Fund IV Strategic Series E Convertible Preferred Stock 2015-02-03 4 C 0 4148785 D Common Stock 1037196 0 I By Fund IV Series E Convertible Preferred Stock 2015-02-03 4 C 0 117788 D Common Stock 29447 0 I By Fund IV Strategic Series A, B, C, D and E Convertible Preferred Stock (collectively, the "Preferred Stock") has no expiration date. The Preferred Stock converted into shares (the "Shares") of Issuer common stock upon the closing of the Issuer's initial public offering, giving effect to the 1-for-4 reverse stock split effected by the Issuer on January 12, 2015, which changed the conversion rate for the Series A, B, D and E Convertible Preferred Stock from 1-for-1 to 0.25-for-1 and, for the Series C Convertible Preferred Stock, from 1.3498-for-1 to an approximate 0.3374-for-1 basis (subject to the payment of cash, or the rounding up by a maximum of one share, for any fractional shares, in accordance with the Issuer's certificate of incorporation). International Life Sciences Fund III (GP), L.P. ("Fund III GP") is the general partner of each of: (i) International Life Sciences Fund III (LP1), L.P. ("ILSF LP1"), (ii) International Life Sciences Fund III Co-Investment, L.P. ("ILSF Co-Invest") and (iii) International Life Sciences Fund III Strategic Partners, L.P. ("ILSF Strategic" and collectively, the "Fund III Entities"). ILSF III, LLC (the "ILSF General Partner") is the general partner of Fund III GP and, through an investment committee comprised of James Garvey, Kate Bingham, Eugene D. Hill, III and Michael Ross controls voting and investment decisions over the Issuer's shares held by the Fund III Entities by majority vote. Each member of the investment committee of ILSF General Partner disclaims beneficial ownership over the Shares held by the Fund III Entities except to the extent of any pecuniary interest therein. Each of ILSF General Partner and Fund III GP disclaim beneficial ownership over the Shares held by the Fund III Entities except to the extent of their respective pecuniary interest therein. SV Life Sciences Fund IV (GP), L.P. ("Fund IV GP") is the general partner of each of SV Life Sciences Fund IV, L.P. ("Fund IV") and SV Life Sciences Fund IV Strategic Partners, L.P. ("Fund IV Strategic" and together with Fund IV, the "Fund IV Entities"). SVLSF IV, LLC (the "SVLS General Partner") is the general partner of Fund IV GP and, through an investment committee comprised of David Milne (also a member of the Issuer's board of directors), James Garvey, Kate Bingham, Eugene D. Hill, III and Michael Ross controls voting and investment decisions over the Issuer's shares held by the Fund IV Entities by a majority vote. Each member of the investment committee of SVLS General Partner disclaims beneficial ownership over the Shares held by the Fund IV Entities except to the extent of any pecuniary interest therein. Each of SVLS General Partner and Fund IV GP disclaim beneficial ownership over the Shares held by the Fund IV Entities except to the extent of their respective pecuniary interest therein. SVLSF IV, LLC By: /s/ Denise Marks, Member 2015-02-04 ILSF III, LLC; By: /s/ Denise Marks, Member 2015-02-04 International Life Sciences Fund III (GP), L.P.; By: ILSF III, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 International Life Sciences Fund III (LP1), L.P.; By: International Life Sciences Fund III (GP), L.P., its General Partner; By: ILSF III, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 International Life Sciences Fund III Co-Investment, L.P.; By: International Life Sciences Fund III (GP), L.P., its General Partner; By: ILSF III, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 International Life Sciences Fund III Strategic Partners, L.P.; By: International Life Sciences Fund III (GP), L.P., its General Partner; By: ILSF III, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 SV Life Sciences Fund IV (GP), L.P.; By: SVLSF IV LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 SV Life Sciences Fund IV Strategic Partners, L.P.; By: SV Life Sciences Fund IV (GP), L.P., its General Partner; By: SVLSF IV, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04 SV Life Sciences Fund IV, L.P.; By: SV Life Sciences Fund IV (GP), L.P., its General Partner; By: SVLSF IV, LLC, its General Partner; By: /s/ Denise Marks, Member 2015-02-04