0001209191-14-007836.txt : 20140206 0001209191-14-007836.hdr.sgml : 20140206 20140206085531 ACCESSION NUMBER: 0001209191-14-007836 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140205 FILED AS OF DATE: 20140206 DATE AS OF CHANGE: 20140206 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Eleven Biotherapeutics, Inc. CENTRAL INDEX KEY: 0001485003 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 252025616 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 215 FIRST STREET STREET 2: SUITE 400 CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617-871-9911 MAIL ADDRESS: STREET 1: 215 FIRST STREET STREET 2: SUITE 400 CITY: CAMBRIDGE STATE: MA ZIP: 02142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEVIN MARK J CENTRAL INDEX KEY: 0001180428 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36296 FILM NUMBER: 14578157 MAIL ADDRESS: STREET 1: 40 LANDSDOWNE STREET CITY: CAMBRIDGE STATE: MA ZIP: 02139 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-02-05 0 0001485003 Eleven Biotherapeutics, Inc. EBIO 0001180428 LEVIN MARK J 215 FIRST STREET, SUITE 400 CAMBRIDGE MA 02142 1 0 0 0 Common Stock 330708 I See footnote. Series A Preferred Stock Common Stock 3267716 I See footnote. Series B Preferred Stock Common Stock 481619 I See footnote. Common Stock Warrant (right to purchase) 0.0635 Common Stock 127077 I See footnote. Common Stock Warrant (right to purchase) 0.0635 Common Stock 82989 I See footnote. The securities are directly held by Third Rock Ventures, L.P. ("TRV LP"). The general partner of TRV LP is Third Rock Ventures GP, LP ("TRV GP"). The general partner of TRV GP is Third Rock Ventures GP, LLC ("TRV LLC"). The Reporting Person is a manager of TRV LLC and disclaims beneficial ownership of all shares except to the extent of his pecuniary interest, if any, therein. The Series A Preferred Stock is convertible into Common Stock on an 6.35-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The Series B Preferred Stock is convertible into Common Stock on an 6.35-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The Warrant to purchase Common Stock as shown in column 3 is exercisable at any time at the holder's election prior to June 28, 2018, and automatically upon the closing of the Issuer's initial public offering. The Warrant to purchase Common Stock as shown in column 3 is exercisable at any time at the holder's election prior to December 4, 2018, and automatically upon the closing of the Issuer's initial public offering. /s/ Mark J. Levin 2014-02-06