0000899243-17-026997.txt : 20171120
0000899243-17-026997.hdr.sgml : 20171120
20171120172827
ACCESSION NUMBER: 0000899243-17-026997
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171120
FILED AS OF DATE: 20171120
DATE AS OF CHANGE: 20171120
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ross Michael Jay
CENTRAL INDEX KEY: 0001254452
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38295
FILM NUMBER: 171214822
MAIL ADDRESS:
STREET 1: C/O SV HEALTH INVESTORS, LLC
STREET 2: ONE BOSTON PLC, 201 WASHINGTON ST. #3900
CITY: BOSTON
STATE: MA
ZIP: 02108
FORMER NAME:
FORMER CONFORMED NAME: ROSS MICHAEL JAY
DATE OF NAME CHANGE: 20030715
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Arsanis, Inc.
CENTRAL INDEX KEY: 0001501697
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 273181608
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 890 WINTER STREET, SUITE 230
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: 781-819-5704
MAIL ADDRESS:
STREET 1: 890 WINTER STREET, SUITE 230
CITY: WALTHAM
STATE: MA
ZIP: 02451
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-11-20
0
0001501697
Arsanis, Inc.
ASNS
0001254452
Ross Michael Jay
C/O SV HEALTH INVESTORS ONE BOSTON PLACE
SUITE 3900, 201 WASHINGTON STREET
BOSTON
MA
02108
1
0
1
0
Common Stock
2017-11-20
4
C
0
19128
A
19128
I
See Footnote
Common Stock
2017-11-20
4
C
0
404
A
19532
I
See Footnote
Common Stock
2017-11-20
4
C
0
247010
A
266542
I
See Footnote
Common Stock
2017-11-20
4
C
0
5219
A
271761
I
See Footnote
Common Stock
2017-11-20
4
C
0
322102
A
593863
I
See Footnote
Common Stock
2017-11-20
4
C
0
6806
A
600669
I
See Footnote
Common Stock
2017-11-20
4
C
0
111955
A
712624
I
See Footnote
Common Stock
2017-11-20
4
C
0
2365
A
714989
I
See Footnote
Common Stock
2017-11-20
4
C
0
202915
A
917904
I
See Footnote
Common Stock
2017-11-20
4
C
0
4288
A
922192
I
See Footnote
Common Stock
2017-11-20
4
C
0
431980
A
1354172
I
See Footnote
Common Stock
2017-11-20
4
C
0
14789
A
1368961
I
See Footnote
Common Stock
2017-11-20
4
P
0
483448
10.00
A
1852409
I
See Footnote
Common Stock
2017-11-20
4
P
0
16552
10.00
A
1868961
I
See Footnote
Series A-1 Convertible Preferred Stock
2017-11-20
4
C
0
65287
0.00
D
Common Stock
19128
0
I
See Footnote
Series A-1 Convertible Preferred Stock
2017-11-20
4
C
0
1380
0.00
D
Common Stock
404
0
I
See Footnote
Series A-2 Convertible Preferred Stock
2017-11-20
4
C
0
690259
0.00
D
Common Stock
247010
0
I
See Footnote
Series A-2 Convertible Preferred Stock
2017-11-20
4
C
0
14587
0.00
D
Common Stock
5219
0
I
See Footnote
Series B Convertible Preferred Stock
2017-11-20
4
C
0
721402
0.00
D
Common Stock
322102
0
I
See Footnote
Series B Convertible Preferred Stock
2017-11-20
4
C
0
15246
0.00
D
Common Stock
6806
0
I
See Footnote
Series C Convertible Preferred Stock
2017-11-20
4
C
0
224665
0.00
D
Common Stock
111955
0
I
See Footnote
Series C Convertible Preferred Stock
2017-11-20
4
C
0
4747
0.00
D
Common Stock
2365
0
I
See Footnote
Series D Convertible Preferred Stock
2017-11-20
4
C
0
692552
0.00
D
Common Stock
202915
0
I
See Footnote
Series D Convertible Preferred Stock
2017-11-20
4
C
0
14635
0.00
D
Common Stock
4288
0
I
See Footnote
Series D Convertible Preferred Stock
2017-11-20
4
C
0
1474348
0.00
D
Common Stock
431980
0
I
See Footnote
Series D Convertible Preferred Stock
2017-11-20
4
C
0
50477
0.00
D
Common Stock
14789
0
I
See Footnote
The Series A-1 Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series A-1 Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
The Series A-2 Convertible Preferred Stock converted into Common Stock on a 0.35785-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series A-2 Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
The Series B Convertible Preferred Stock converted into Common Stock on a 0.44650-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series B Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
The Series C Convertible Preferred Stock converted into Common Stock on a 0.49832-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series C Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
The Series D Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series D Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
These shares are owned directly by SV Life Sciences Fund V, L.P. ("SVLS V LP"). SV Life Sciences Fund V (GP), LP ("SVLS V GP") is the general partner of SVLS V LP. The general partner of SVLS V GP is SVLSF V, LLC. The reporting person, a member of the investment committee of SVLSF V, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
These shares are owned directly by SV Life Sciences Fund V Strategic Partners, L.P. ("SVLS V SPP"). SVLS V GP is the general partner of SVLS V SPP. The general partner of SVLS V GP is SVLSF V, LLC. The reporting person, a member of the investment committee of SVLSF V, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
These shares are owned directly by SV Life Sciences Fund VI, L.P. ("SVLS VI LP"). SV Life Sciences Fund VI (GP), LP ("SVLS VI GP") is the general partner of SVLS VI LP. The general partner of SVLS VI GP is SVLSF VI, LLC. The reporting person, a member of the investment committee of SVLSF VI, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
These shares are owned directly by SV Life Sciences Fund VI Strategic Partners, L.P. ("SVLS VI SPP"). SVLS VI GP is the general partner of SVLS VI SPP. The general partner of SVLS VI GP is SVLSF VI, LLC. The reporting person, a member of the investment committee of SVLSF VI, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
/s/ Mike Gray, attorney-in-fact
2017-11-20