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